Acculturation: Implications for Individuals, Families and Societies

SOCIAL JUSTICE, EQUALITY AND EMPOWERMENT

ACCULTURATION: IMPLICATIONS FOR INDIVIDUALS, FAMILIES AND SOCIETIES

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SOCIAL JUSTICE, EQUALITY AND EMPOWERMENT

ACCULTURATION: IMPLICATIONS FOR INDIVIDUALS, FAMILIES AND SOCIETIES

TARA M. JOHNSON EDITOR

Nova Science Publishers, Inc. New York

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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Acculturation : implications for individuals, families and societies / editor, Tara M. Johnson. p. cm. Includes index. ISBN 978-1-61209-170-9 (eBook) 1. Acculturation. 2. Assimilation (Sociology) 3. Social mobility. I. Johnson, Tara M. HM841.A334 2010 305.5'62--dc22 2010041338

Published by Nova Science Publishers, Inc. † New York

CONTENTS Preface Chapter 1

vii The Relationship between Acculturation and Violence in Minority Adolescents Paul R. Smokowski, Corinne David-Ferdon and Nancy Stroupe

1

Acculturation Success in Employment among Chinese Migrants from the Mainland to Hong Kong Chau-kiu Cheung

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Chapter 3

The Implicit Cognitive Perspective in Acculturation Daisung Jang and Do-Yeong Kim

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Chapter 4

Acculturation and Mental Health Status, Help-Seeking, Service Use, and Outcomes for Latino and Asian/Pacific Islander Youth Judy Ho and Shantel Daniels

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Chapter 2

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Worlds Apart: Bicultural Identity Development in Latino Adolescents Martica Bacallao and Paul R. Smokowski

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Acculturation, Sociocultural Adaptation and Self-Esteem of Immigrant Youth In Portugal Félix Neto and Joana Neto

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Does Acculturation Equal A+? Correlates of College-Going Expectations Amongst Hispanic and Asian Immigrant Youth Elizabeth Trejos-Castillo and Jobi Martinez

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Impact of Acculturation on Physical Activity and Dietary Behaviors in Latinos Cody J. Robinson, Joseph Martinez, Andrea Cherrington, Brooke Barbara, Brad Boye and Dorothy W. Pekmezi

185

vi Chapter 9

Index

Contents Acculturation and Psychological Characteristics of Bosnian Internally Displaced and Refugee Adolescents from Srebrenica Region after the War 1992-1995 in Bosnia and Herzegovina Mevludin Hasanović, Osman Sinanović and Slobodan Pavlović

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PREFACE Acculturation is the exchange of cultural features that results when groups of individuals having different cultures come into continuous first hand contact; the original cultural patterns of either or both groups may be altered, but the groups remain distinct. This book gathers the most current research in the study of acculturation from across the globe. Some topics discussed in this compilation are acculturation and its influence on adolescent interpersonal and self-directed violence; acculturation success in employment among Chinese migrants from the Mainland to Hong Kong; and the dynamics of second-culture acquisition for Latino immigrant adolescents. Chapter 1 - Although seminal reviews have been published on acculturation and mental health in adults and adolescents, far less is known about how acculturation influences adolescent interpersonal and self-directed violence. This article aims to fill this gap by providing a comprehensive review of research linking acculturation and violence behavior for adolescents of three minority populations: Latino, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN). The preponderance of evidence from studies on Latino and A/PI youth indicate that higher levels of adolescent assimilation (i.e., measured by time in the United States, English language use, U.S. cultural involvement, or individualism scales) were a risk factor for youth violence. Ethnic group identity or culture of origin involvement appear to be cultural assets against youth violence with supporting evidence from studies on A/PI youth; however, more studies are needed on Latino and AI/AN youth. Although some evidence shows low acculturation or cultural marginality to be a risk factor for higher levels of fear, victimization, and being bullied, low acculturation also serves as a protective factor against dating violence victimization for Latino youth. An important emerging trend in both the Latino and, to a lesser extent, A/PI youth literature shows that the impact of acculturation processes on youth aggression and violence can be mediated by family dynamics. The literature on acculturation and self-directed violence is extremely limited and has conflicting results across the examined groups, with high acculturation being a risk factor for Latinos, low acculturation being a risk factor of A/PI youth, and acculturation-related variables being unrelated to suicidal behavior among AI/AN youth. Bicultural skills training as a youth violence and suicide prevention practice is discussed. Chapter 2 - Migrants‘ successful acculturation occurs when they acquire class or occupational positions higher in the host place than in the origin. This is upward class mobility. Conversely, descending in the class hierarchy or downward mobility is an indication of acculturation failure. A longstanding but untested claim is the possibility of

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acculturation success in Hong Kong due to the openness and abundance of opportunity in the city. Moreover, gender differentials in acculturation success are still uncertain. For the clarification of the issues, a study of 622 adult migrants from the mainland of China to Hong Kong reveals the different forms of acculturation success or failure by log-linear modeling. Results demonstrate gender differences in patterns of class mobility. Essentially, male migrants were equally likely to experience upward and downward mobility. In contrast, female migrants were likely to fall out of employment and are unlikely to have upward mobility. Female migrants, furthermore, experienced less upward or downward mobility than did their male counterparts. To conclude, whereas male migrants are highly and equally likely to face acculturation success and failure in Hong Kong, female migrants are unlikely to exhibit acculturation success there. Chapter 3 - In this chapter, the conceptual basis for the use of the implicit cognition paradigm in the acculturation domain is discussed. In particular, it is argued that the process of acculturation occurs in conscious (explicit) modes, but also in non-conscious (implicit) modes. In addition, implicit cognitions derived from such non-conscious processes may play an important role in determining the acculturation and well-being outcomes. First, the authors note that most research in the acculturation domain has been conducted using survey-type measures, which may only reflect explicit processes in acculturation. they also note a developing trend in applying the implicit cognitive perspective in the study of acculturation, by specifically defining implicit psychological acculturation by showing how it may complement existing conceptual frameworks of acculturation, and demonstrating how it may provide data about the fundamental processes of acculturation which are not available to introspection. Furthermore, the authors speculate about changes in the pattern of explicit and implicit cognitions in reaction to contact with another culture by providing a working model of explicit and implicit culture acquisition. Second, examine the burgeoning literature on acculturation using implicit measures on three key topics, namely, identity, parental relations, and intergroup relations. Through a brief review of extant research, the authors show support for their arguments, highlighting the necessity for the implicit cognitive perspective in acculturation research. In addition, they provide evidence that implicit measures have implications for both psychological and social acculturation, namely implicit psychological acculturation. Finally, the potential for future research in acculturation issues using the implicit cognition paradigm, and implications for organizations are discussed. Chapter 4 - Acculturation is the psychosocial adaptation of persons from their culture of origin to a new or host cultural environment, and can include relearning language, incorporating new values, expectations, and beliefs. Research has demonstrated that acculturation can relate to a variety of mental health issues for youth and their families, including mental health status and well-being, knowledge and attitudes towards professional mental health services, the mental health help seeking pathway, and mental health treatment engagement and outcomes for ethnic minority children with emotional/behavioral problems. This chapter will review the literature on acculturation, traditional values and beliefs, and mental health status in Latino and Asian/Pacific Islander youth, and examine attitudes of immigrant families towards mental health illness and treatment. Literature on how acculturation relates to mental health help service use, and treatment engagement and outcomes for Latino and Asian/Pacific Islander youth will also be explored. The authors will examine barriers likely to be encountered in the mental health service pathway for ethnic minority families, and conclude with recommendations for acculturation research and future

Preface

ix

research directions in minority mental health, and provide recommendations for culturally sensitive practice. Chapter 5 - Specific Aims: This paper focuses on the dynamics of second-cultureacquisition for Latino immigrant adolescents. In-depth qualitative interviews were conducted to examine: (a) adaptation to life in the United States, (b) bicultural identity development, and (c) environmental influences that affected both cultural adaptation and bicultural identity development. Methods: Standardized, open-ended interviews were conducted with four adolescents and three parents who represented two different Latino subgroups (Mexicans, and Columbians). All of the participants immigrated to the United States within the last five years. Interview transcriptions were analyzed using Atlas.ti. The text was coded, categorized, and an extensive process of network mapping was performed. A network map was drawn to display a model for describing adolescent bicultural identity development processes. Results: Latino adolescents thought that they had three worlds to balance. (1) Their Latino world was primarily driven by dynamics within the home. This world was particularly invested in maintaining the adolescent‘s sense of familism and pride in her or his culture of origin. (2) School and American friends dominated the American world. These American influences were Assimilationist, pushing the adolescent to become increasingly integrated into American culture. The third world (3) was characterized by an emerging sense of self for the adolescent. This represented the internal process for integrating these disparate influences and making personal identity decisions. Each of these worlds has specific dynamics that help or inhibit bicultural development. Implications: This model can help social work researchers and practitioners understand the systemic dynamics behind adolescent acculturation. Practitioners can help Latino adolescents adjust by lowering assimilation pressures in the school environment and by targeting acculturation issues in Latino family systems. Chapter 6 - The main research questions of the study were: (1) Do immigrant adolescents‘ self-esteem differ from national youth‘s self-esteem? (2) In what way and to what extent are immigrant youth‘s acculturation orientations and perceived discrimination related to their self-esteem? Answering these questions is seen as important to the exploration of needs and possibilities for improving immigrant youth‘s acculturation experiences and their adaptation. The study sample consisted of 299 immigrant adolescents from three ethnocultural groups (Guineans, Mozambicans, and Sao Tomese) and 320 native Portuguese adolescents. The majority of adolescents with immigrant background was born in Portugal or had immigrated before the age of 7 years (69%). The mean duration of residence in Portugal for both the foreign born and host born participants was 11.5 years (SD = 4.98). Adolescents from immigrant families reported similar levels of self-esteem to that of their native Portuguese counterparts. Predictive factors - socio-demographic, acculturation, and sociocultural variables - were significantly linked to youths‘ self-esteem. Major predictors of self-esteem were integration, behavioral problems, ethnic orientation, and school adaptation. Chapter 7 - One of the most important foundations of a country‘s economic growth and future rests on education. The American society is not an exception to that reality. In fact, given the rapid demographical and societal changes it is paramount to further understand the educational trajectories of the immigrant groups representing the fastest growing minorities: Hispanics and Asians—approx. 56% of all immigrants are Hispanic or Asian descendent children under 18 years old—. Despite an increased awareness about the impact of the

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immigration process on today‘s societies, acculturation effects on college-going expectations among immigrant youth remains an underdeveloped area of research. On one hand, this is due to the complexity of the assimilation patterns to the host culture plus variations occurring across immigrant groups (Portes & Zhou; 1993). On the other hand, current scholarship on the effects of acculturation on educational expectations among immigrant youth is not only inconclusive but has failed to examine additional correlates such as individual, family, and social factors (Kao & Tienda, 1995; Feliciano & Rumbaut, 2005). The current study examines multiple correlates of college-going expectations among N= 4,566 immigrant youth drawn from the National Longitudinal Study of Adolescent Health (Add Health, Wave I & II). The study subsamples include: n=779 foreign-born and n=2,394 American-born Hispanic and n=524 foreign-born and n=869 American-born Asian immigrant youth. Parental support (e.g., felt supported by parents), social support (e.g., felt supported by teachers, other adults), depression (e.g. felt cannot do things right), school connectedness (e.g., felt close to people at school), school problems (e.g., experienced problems getting along with other students) and acculturation (e.g., English vs. other language use) were examined as predictors of college-going expectations across groups. Consistent with previous scholarship, results provided evidence that depression, social support, school connectedness, and school problems were significantly associated with college-going expectations across samples; however, parental support was not found to be significant in the current study. Though acculturation was significantly associated with college-going expectations across samples, moderation by acculturation in the association of college-going expectations and individual and contextual factors was not significant. Theoretical and practical implications of the study results are further discussed. Chapter 8 - The United States population is growing, and its racial and ethnic composition is changing. According to the U.S. Census Bureau, the Latino population is projected to increase rapidly from 1995 to 2025, accounting for 44 percent of the growth in the nation's population. Latinos already accounted for almost half (1.4 million) of the national population growth (2.9 million) between July 1, 2005 and July 1, 2006. While much of this growth can be attributed to high birth rates among Latinos in the U.S., immigration constitutes a significant proportion. For Latinos, introduction to U.S. culture occurs with varying degrees of acculturation, defined as ―the bidirectional process in which individuals adopt new values, beliefs, and norms as an adaption into a new, mainstream culture while still retaining some aspects of their traditional culture.‖. The influence of acculturation on specific behaviors has been a subject of investigation for decades. Chapter 9 – Aim: To estimate the frequency, type and severity of psychological trauma among Bosnian refugee and internally displaced adolescents after the 1992-1995 war in Bosnia and Herzegovina. Methods: The sample of 225 pupils (112 females and 113 males) aged of 15.1±2.1 years were evaluated for assessment of war traumatic events, acculturation, neuroticism, school behavioral problems; and presence of post-traumatic stress disorder (PTSD). The sample was divided into group of participants from eastern Bosnian region (Srebrenica and Podrinje) (n=143) who had been exposed to the war catastrophes in their original region, and survived Srebrenica catastrophe 1995 and a group of participants from north-east Bosnian region (Semberija and Posavina), who were exposed to the war catastrophes in the first beginning of war, in April 1992 and became refugees during the whole war and after it (n=82).

Preface

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Results: In both groups, refugee and internally displaced adolescents had been exposed to severe war trauma and had reported high level of trauma more than three years after the war. Among participants from Srebrenica region the authors found 52 of 143 (36.4%) participants lost father what is significantly more than participants from Semberija region 7 of 82 (8.5%) (Chi-square=20.860, df=1, P<0.001), significantly more children from Srebrenica 94 of 143 (65.7%), stayed in homeland and survived additional trauma exposure to war catastrophes as refugees in so called ―free territory‖, after survived war experiences in 1992, while from Semberija region only 22 of 82 (26.8%) experienced whole war period out of original places (Chi-square=31.583, df=1, P<0.001). The level of trauma severity (mean±standard deviation = 4.3±0.9 on a scale from 0-5), and stress level 2.0±1.2 were higher among adolescents and internally displaced from Srebrenica than among those from Semberija (4.1±1.1 and 1.7±1.1, respectively) but not significantly (p=0.150; P=0.072, respectively, t-test). The level severity of re-experience cluster symptoms, (mean±standard deviation = 2.5±1.4 on a scale from 0-5) were significantly higher among adolescents from Srebrenica than among those from Semberija region (1.9±1.2, t-test=3.255, P=0.001). The prevalence of PTSD statistically significantly differed between Srebrenica group (67.8%) and Semberija group of respondents (52.4%) (Chi-square=5.253, df=1, P=0.022). Participants from Srebrenica had significantly more acculturation problems for: Missed friends during exile/displacement, Wanted to return to native place/homeland, Listened to news from native place/homeland and Had alimentary problems after being exiled/displaced (p<0.05), and there were no statistically significant differences for the rest of listed acculturation problems between groups. According the Tscore of Achenbach check list, (mean±standard deviation on the scale from 0-100), from Srebrenica reported significantly more severe anxious depressed behavior (58.8±10.7) than their peers from Semberija (54.9±8.9) (t-test=7.782, P=0.006); they reported significantly more severe withdrawn depressed behavior too (57.6±11.2; 53.4±9.5 respectively) (ttest=8.226, P=0.005), also they reported significantly more severe internalizing problems (57.3±9.0; 54.1±7.5 respectively) (t-test=7.309, P=0.007). Participants from Srebrenica had more severe thought problems (54.5±8.0; 51.6±6.0 respectively) (t-test=8.082, P=0.005), as well as significantly more expressed attention problems (53.0±4.5; 51.8±3.5 respectively) (ttest=4.583, P=0.033). The prevalence of anxious-depressed behavior in clinical range among Srebrenica participants 24 of 143 (16.8%) were significantly higher than among their peers from Semberija 8 of 82 (9.8%) (Chi square=9.611, P=0.008), also the prevalence of thought problems were significantly more expressed among Srebrenica adolescents 13 of 143 (9.1%) related to 5 of 82 (6.1%) (Chi-square=7.143, P=0.028). Adolescents from Srebrenica reported significantly lower activeness, 66 of 143 (46.2%) which is under average activeness, related to 21 of 82 (25.6%) among children from Semberija (Chi-square=10.408, P=0.005). Sociability among children from Srebrenica with over average sociability 80 of 143 (55.4%) were significantly less than among children from Semberija 59 of 82 (72.0%) (Chisquare=6.836, P=0.033). Adolescents from Srebrenica were significantly more introverted 31 of 143 (21.7%) than their peers 11 of 82 (13.4%), but less extroverted 25 of 243 (17.5%) related to 29 of 82 (35.4%) (Chi-square=9.692, P=0.008). The severity of trauma experiences and stress level highly correlated with severity of neuroticism (Pearson r=0.394, P<0.001; r=0.551, P<0.001 respectively), but negatively highly

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correlated with sociability (r=-0.170, P=0.011; r=-0.3, P<0.001). Stress level severity highly correlated with level of activeness (r=0.145, P=0.030). Conclusions: Bosnia-Herzegovina refugee and internally displaced adolescents, 3.5 years after war, suffer from PTSD very frequently. Adolescents from Srebrenica region suffered significantly more from PTSD, acculturation problems, anxious/depressed behavior problems, and thought problems. Also they were significantly less active, less sociable, and less extroverted, in other words they were significantly more introverted. Professionals and institutions involved in education and mental health care of adolescents should develop programs to address this after war outcomes among young population.

In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 1

THE RELATIONSHIP BETWEEN ACCULTURATION AND VIOLENCE IN MINORITY ADOLESCENTS

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Paul R. Smokowski,1 Corinne David-Ferdon2 and Nancy Stroupe2 University of North Carolina at Chapel Hill, School of Social Work, NC, USA 2 National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA

ABSTRACT Although seminal reviews have been published on acculturation and mental health in adults and adolescents, far less is known about how acculturation influences adolescent interpersonal and self-directed violence. This article aims to fill this gap by providing a comprehensive review of research linking acculturation and violence behavior for adolescents of three minority populations: Latino, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN). The preponderance of evidence from studies on Latino and A/PI youth indicate that higher levels of adolescent assimilation (i.e., measured by time in the United States, English language use, U.S. cultural involvement, or individualism scales) were a risk factor for youth violence. Ethnic group identity or culture of origin involvement appear to be cultural assets against youth violence with supporting evidence from studies on A/PI youth; however, more studies are needed on Latino and AI/AN youth. Although some evidence shows low acculturation or cultural marginality to be a risk factor for higher levels of fear, victimization, and being bullied, low acculturation also serves as a protective factor against dating violence victimization for Latino youth. An important emerging trend in both the Latino and, to a lesser extent, A/PI youth literature shows that the impact of acculturation processes on youth aggression and violence can be mediated by family dynamics. The literature on acculturation and self-directed violence is extremely limited and has conflicting results 

Please direct correspondence to Paul Smokowski, Ph.D., Professor, University of North Carolina at Chapel Hill, School of Social Work, CB # 3550, 325 Pittsboro St., Chapel Hill, NC 27599-3550, phone 919-843-8281, or e-mail [email protected].

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Paul R. Smokowski, Corinne David-Ferdon and Nancy Stroupe across the examined groups, with high acculturation being a risk factor for Latinos, low acculturation being a risk factor of A/PI youth, and acculturation-related variables being unrelated to suicidal behavior among AI/AN youth. Bicultural skills training as a youth violence and suicide prevention practice is discussed.

ACCULTURATION AND VIOLENCE IN MINORITY ADOLESCENTS: A REVIEW OF THE EMPIRICAL LITERATURE Reviews of the association between acculturation and mental health in adults (LaFromboise et al., 1993; Rogler et al., 1991) and in adolescents (Gonzales et al., 2002) have been conducted, but far less is known about how acculturation influences adolescent interpersonal and self-directed violence. Recent overviews have examined possible risk and protective factors linking immigration, acculturation, youth violence, and suicide (Boutakidis et al., 2006; Hovey and King, 1997; Soriano et al., 2004); however, no review has critically assessed the scientific rigor and specific results of empirical studies in these areas, except for Le‘s (2002) review of research on delinquency among Asian/Pacific Islanders. This article fills this gap by providing a comprehensive review of research linking acculturation and violence for Latino, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN) adolescents. Although African American youth are disproportionately impacted by interpersonal violence (Centers for Disease Control and Prevention [CDC], 2007b, 2007c) and African Americans are the second largest minority group in the United States (U.S. Census Bureau, 2007a), this important group is not examined in this review. Extremely few studies have examined the role of acculturation when examining the predictors of behavior of recently immigrated Black youth from Caribbean or African countries (Bui and Thongniramol, 2005). In addition, acculturation typically is not a factor considered when examining predictors of violence among African American youth who have resided in the United States for multiple generations. However, the role of cultural identity development and the value of collectivism have been argued to be important factors to consider when examining violence among U.S.born African American youth (see Whaley, 2003, for a review). Future research on the predictors and prevention of violence among these important subgroups of youth should consider the important influence of culture. In the sections below, we establish the importance of minority and immigrant youth as a burgeoning sociodemographic group that is grappling with interpersonal and self-directed violence as serious public health concerns. Then, we introduce acculturation as a dynamic phenomenon that affects many minority youths. We critically analyze empirical studies testing the relationship between acculturation dynamics and a range of violence outcomes. In the concluding sections, we discuss implications for prevention and intervention programming.

The Relationship between Acculturation and Violence in Minority Adolescents

3

DEFINITIONS: ACCULTURATION, INTERPERSONAL VIOLENCE, AND SELF-DIRECTED VIOLENCE Acculturation Acculturation was first defined as ―phenomena which results when groups of individuals having different cultures come into continuous first hand contact with subsequent changes in the original culture patterns of either or both groups‖ (Redfield et al., 1936, p. 149). This original definition stressed continuous, long-term change and allowed for the process to be bidirectional, wherein both of the interacting cultures could make accommodations. During the decades since acculturation was first defined, a number of alternative definitions have been offered that often stress unidirectional, rather than bidirectional, change. For example, Smith and Guerra (2006) refer to acculturation as ―the differences and changes in values and behaviors that individuals make as they gradually adopt the cultural values of the dominant society‖ (p. 283). These unidirectional trends suggest that cultural change results from interactions between dominant and nondominant groups, and such change is commonly characterized by nondominant groups taking on the language, laws, religions, norms, and behaviors of the dominant group (Berry, 1998; Castro et al., 1996). Many factors, such as differences in attitudes between generations and sociopolitical trends, have influenced the conceptualization of acculturation, leaving no universally accepted definition of the term. Adding further complexity, many other constructs in cultural research, such as assimilation, enculturation, acculturation stress, segmented assimilation, and biculturalism, have been invoked under the umbrella of acculturation research. The term acculturation, which denotes the bidirectional process of cultural change, is often erroneously used interchangeably with the term assimilation, which captures unidirectional adaptations made by minority individuals to fit into the host society. Consequently, the original Redfield (1936) definition captures the bidirectional notion of acculturation whereas the description offered by Smith and Guerra (2006) denotes the unidirectional assimilation approach. These competing unidirectional and bidirectional approaches dominate acculturation research, influencing conceptualization, measurement, analytic strategies, and results of empirical studies in this area (Cabassa, 2003). Two criteria determine the end point for acculturation adaptations: whether the acculturating individual or group retains cultural identity and whether a positive relationship to the dominant society is established (Berry, 1998). The common notion of assimilation entails persons losing their culture-of-origin identity to identify with the dominant (host) cultural group. Integration, or biculturalism, would ensue from both retaining ethnic cultural identity and establishing a positive relationship with the dominant culture. Retaining cultureof-origin identity without establishing a positive relationship to the dominant culture would indicate rejection of the dominant culture, separation, and unwillingness to assimilate. Finally, losing cultural identity without establishing a positive relationship to the dominant culture would be the hallmark of de-culturation or cultural marginality (Berry, 1980; LaFromboise et al., 1993). Acculturation is the overall process of cultural involvement. Assimilation is generally associated with high levels of host culture involvement. A moderate to high level of involvement in both cultures marks integration or biculturalism. Separation or

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Paul R. Smokowski, Corinne David-Ferdon and Nancy Stroupe

maintaining ethnic identity alone (enculturation) is associated with high levels of involvement in the culture of origin. In contrast to the unidirectional assimilation approach, the bidirectional approach considers enculturation (i.e., adoption and maintenance of behaviors, norms, values, and customs from a person‘s culture of origin), ethnic identity (i.e., a person‘s self-definition based on membership in a distinct group derived from a perceived shared heritage), and biculturalism (i.e., ability to integrate attributes of two cultures and competently navigate between cultural systems (Gonzales et al., 2002; LaFromboise et al., 1993) as important aspects of the acculturation process. Enculturation or culture-of-origin involvement is a broad concept and usually encompasses ethnic identity. At times, these terms are used synonymously in the literature. In this review, we will use the terms as they are presented in the studies being discussed. In our integrative discussions, we will keep these concepts as separate as possible, with the understanding that ethnic identity is one critical component of enculturation. In light of having no universally accepted definition for acculturation, for the purposes of our review we examined studies that use both bidirectional and unidirectional approaches to assess acculturation. Accordingly, we included studies that measured acculturation in a variety of ways (e.g., language use, generation status, acculturation stress, ethnic identity). In our review and critique of extant studies, the discussion of the nature and measurement of acculturation is continued.

Violence: Inter-Personal and Self-Directed Violence is "the intentional use of physical force or power, threatened or actual, against oneself, against another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation" (Dahlberg and Krug, 2002, p. 5). For this review, we focus on the subcategories of interpersonal and self-directed violence and on these forms of violence experienced by persons between the ages of 10 and 24 years. Adolescent interpersonal violence includes violence between unrelated youth who have a romantic/intimate relationship (i.e., dating violence) as well as violence between unrelated youth who may or may not know each other in other contexts and environments (i.e., youth violence). Similar to acculturation, adolescent interpersonal violence has been assessed in multiple ways across studies. Dating violence has also been assessed in a variety of ways including verbal, emotional, and physical abuse and sexual assault. Youth violence researchers use measures including gang membership, bullying, physical fighting, weapon carrying, verbal threats, aggressive behavior, externalizing symptoms, and serious criminal activity such as homicide or assaults. For this review, we examined studies that measured the subcategories of dating violence and youth violence victimization and perpetration in a variety of ways. Self-directed violence is a subcategory of violence that includes when a person intentionally inflicts violence on himself or herself with the goal of causing harm that may or may not shorten or end their life. Measures of suicidal ideation, plans, and attempts and suicide related deaths are regularly used in this area. In this review, we examined studies that included any of these measures with samples of ethnic minority adolescents.

The Relationship between Acculturation and Violence in Minority Adolescents

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GROWTH OF RACIAL AND ETHNIC MINORITY YOUTH POPULATIONS The racial and ethnic makeup of the U.S. has changed more rapidly since 1965 than during any other period in history. The reform in immigration policy of 1965, the increase in self-identification by ethnic minorities, and the slowing of the country‘s birth rates, especially among non-Hispanic White Americans, have all led to an increasing, and increasingly diverse, racial and ethnic minority population in the United States. (U.S. Department of Health and Human Services, 2001, p. 56) As the Surgeon General‘s report on mental health, culture, race, and ethnicity cited above indicates, the United States is currently experiencing the largest growth of racial and ethnic minority populations in its history (see also, Suarez-Orozco and Suarez-Orozco, 2001). In July 2006, the U.S. minority population reached 100.7 million, which equates to one in three residents of the nation being a minority (U.S. Census Bureau, 2007a). According to the U.S. Census Bureau, of the U.S. population, 14.8% are Latino, 5% are A/PI, and 0.3% are AI/AN. Latinos and A/PIs are among the fastest growing sociodemographic groups in the nation. Although these minority groups display tremendous within group heterogeneity, reports of population growth, behavior, and risk or protective factors often are presented for the general group (e.g., Latino) rather than differentiated by specific subgroups (e.g., Cuban, Mexican, Puerto Rican). Throughout this article, we focus on the subgroups when possible and discuss the general group when information about subgroups was unavailable. In addition, the label given to a group varies (e.g., Hispanic versus Latino) because we chose to maintain the labels used in the source material. The rise in the U.S. Latino population is the result of immigration of youth and families born in other countries as well as high birth rates among Latino families. In 2004, approximately a quarter of the U.S. Latino population reported non-U.S. nativity with the largest percentage coming from Mexico followed by Puerto Rico and Central American countries (U.S. Census Bureau, 2007b). A majority of Latino immigrants have come to the United States since 1990, which demonstrates that a large segment of the Latino population is still adjusting to life in this country. Of the nearly three-quarters of the Latino population who are U.S. citizens, approximately 61% are U.S.-born and are associated with the significantly higher birth rate among Latino women relative to non-Hispanic, White women (U.S. Census Bureau, 2007c). The remarkable growth of the A/PI population is also fueled by both recent immigration of Asian individuals and above average birth rates of both Asian and Pacific Islander families (U.S. Census Bureau, 2007d). For instance, approximately 33% of the current Asian population came to the United States during the 1990s, and an additional 17% have immigrated since 2000. A majority of these immigrants have come from either China or Japan and reside in Hawaii. In contrast, 78% of Pacific Islanders are native. In addition, A/PI women are significantly more likely than non-Hispanic, White women to give birth (U.S. Census Bureau, 2007e). Although Latinos and Asians dominate the foreign-born U.S. population, these are not the only minority groups that cope with acculturation. Currently, there are more than 550 federally recognized American Indian tribes and Alaskan Native groups (U.S. Department of the Interior, 2007). In 2004, approximately 2.2 million persons identified themselves as AI/AN, and an additional 1.9 million identified themselves as being mixed heritage of AI/AN

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Paul R. Smokowski, Corinne David-Ferdon and Nancy Stroupe

and another race (U.S. Census Bureau, 2007f). The AI/AN population continues to grow, and experienced a 65% increase from 1990 to 2007 (Indian Health Service, 2007). Growth of this group is a result, in part, to AI/AN women having relatively higher birth rates than nonHispanic, White women. In addition, American Indian adolescent mothers aged 15 to 19 years have the second highest birthrate (67.8 per 1,000) compared with Black (63.1 per 1,000) and Hispanic (82.6 per 1,000) adolescent mothers (Martin et al., 2006). Children and adolescents represent significant proportions of the growing racial and ethnic minority populations (U.S. Census Bureau, 2007a). Currently, one-fourth of the total U.S. population is under the age of 18 years; however, youth represent a third of the Latino population, nearly a third of the A/PI population, and a slightly more than a quarter of the AI/AN population. These statistics underscore that a substantial group of adolescents is likely to wrestle with acculturation-related issues during formative stages in their development.

INTERPERSONAL AND SELF-DIRECTED VIOLENCE AMONG ADOLESCENTS Latino, A/PI, and AI/AN adolescents engage in high levels of aggression and violent behavior and have high rates of self-directed violence that cause serious problems for themselves, their families, and their communities (CDC, 2007a, 2007c, 2008; Grunbaum et al., 2000; Perry, 2004). Prevalence estimates for these behaviors by group are presented below. Given that this review included a broad definition of interpersonal violence victimization and perpetration, we present prevalence estimates for adolescent dating and sexual violence and other youth violence indicators. Latino youth are adequately sampled in national data sets, such as the 2007 Youth Risk Behavior Survey (YRBS; CDC, 2008), to provide stable estimates of behavior on an annual basis. However, A/PI and AI/AN youth are not sufficiently represented in the YRBS to allow for annual presentations of prevalence estimates, and data have to be combined across several years to yield stable estimates (Grunbaum et al., 2000). We present the most recent data available for all three groups, but the year(s) the data reflect vary. When data are available, we report what year(s) the data reflect, and we provide prevalence estimates for youth in general or for White and Black youth to illustrate the prevalence of these behaviors among Latino, A/PI, and AI/AN youth relative to other groups of adolescents.

Dating Violence and Sexual Violence Data focusing on dating violence prevalence among adolescents from specific racial and ethnic communities are limited, but some studies have suggested that adolescents from racial and ethnic minority groups experience higher rates of victimization compared to nonHispanic White adolescents. According to the 2007 YRBS data, 11.1% of Hispanic students reported being hit or slapped by a boyfriend or girlfriend, which was lower than the percentage reported by non-Hispanic Black students (14.2%) but significantly higher than non-Hispanic, White peers (8.4%; CDC, 2008). Halpern and her colleagues (2001) examined data from a longitudinal survey (1994 –1995) related to physical and psychological dating

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violence (e.g., psychological dating violence is defined as when a partner treated them disrespectfully in front of others, swore at them, or threatened them with violence). These researchers found that Hispanic, A/PI, White, and Black youth had a relatively equal likelihood of experiencing psychological abuse; however, the likelihood of A/PI males experiencing physical, or both physical and psychological dating abuse was two times greater than that of White male adolescents. Although limited, the data on dating violence among AI/AN youth suggested prevalence rates that were relatively consistent with other groups. Specifically, a report by the Bureau of Indian Affairs (2001) indicated 9.6% of AI/AN youth had reported being victims of physical dating violence. This percentage is relatively consistent with national YRBS estimates from 2001 that indicated 9.1 % of non-Hispanic, White students, 11.2% of non-Hispanic, Black students, and 9.9% of Hispanic students were victims of physical dating violence (CDC, 2007a). The prevalence of psychological dating abuse for AI/AN youth is unknown. The prevalence of sexual victimization that occurs in adolescent dating relationships is obscured by how data are collected. The YRBS does not specify a timeframe or perpetrator in its sexual violence question (i.e., student ever been physically forced to have sexual intercourse when he/she did not want to); therefore, adolescents positively endorsing this item include youth who were victimized by a dating partner as well as those who were victimized by adults during childhood. With this limitation in mind, 7.8% of 9th through 12th graders in 2007 reported they were sexual assault victims (CDC, 2008). Almost 9% of Hispanic students participating in the 2007 YRBS reported they had been sexually victimized, which was significantly higher than the percentage of non-Hispanic, White (7%) but not non-Hispanic, Black (10.5%) students. The national prevalence of sexual violence for A/PI youth is unknown. In 2002, AI/AN youth age 12 years and older were found to be 3.5 times more likely to have experienced a rape or sexual assault compared to all races (Perry, 2004). This estimate was higher than 2001 YRBS data available for AI/AN youth and youth from other race and ethnic groups. Specifically, in 2001, 9.2% of AI/AN reported sexual victimization (Bureau of Indian Affairs, 2001), which was consistent with national YRBS estimates from 2001 that indicated 6.9% of non-Hispanic, White students, 9.6% of non-Hispanic, Black students, and 8.9% of Hispanic students were victims of sexual violence (CDC, 2007a). Across racial and ethnic groups, females are significantly more likely to report being sexual violence victims than are males.

Youth Violence Disparities also exist in the prevalence of other forms of youth violence perpetration and victimization. In the 2007 YRBS (CDC, 2008), Hispanic high school students reported being in a physical fight (40.4%) and injured in a physical fight (6.3%) in the past year with relatively equal prevalence as non-Hispanic, Black students (44.7% and 5.3%, respectively) but with significantly higher prevalence than non-Hispanic, White students (33.7% and 3%, respectively). Furthermore, Hispanic students (8.7%) were significantly more likely to report that they had been threatened or injured with a weapon at school within the last year than were non-Hispanic, White students (6.9%), and Hispanic students were significantly more likely to skip school because of safety concerns than their non-Hispanic, White peers (9.6% vs. 4%). Moreover, these patterns remain stable when gender is considered. Such experiences

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of threats and safety concerns may be related to exposure to gangs; in 1995, one-half of the Latino students surveyed by the Departments of Education and Justice reported that street gangs were present at school during the previous 6 months (Kaufman et al., 2001). In 1999, 28% of Latino students reported gang exposure (Kaufman et al., 2001). National estimates of youth violence and victimization for A/PI youth are limited, and the available estimates suggest that A/PI youth are less likely than their peers to engage in physical fights (Grunbaum et al., 2000). YRBS data from 1991 through 1997 have demonstrated that significantly fewer A/PI students (31.3%) participated in a fight in the year preceding the survey relative to non-Hispanic, Black (46.4%) and Hispanic (43.1%) students. The prevalence estimates also differed from non-Hispanic, White peers with the level of difference varying by gender. A/PI female students (23.6%) demonstrated relatively similar prevalence estimates as non-Hispanic, White female students (27.6%), whereas A/PI male students (37.4%) were significantly less likely to report physical fighting relative to nonHispanic, White male peers (46.8%). AI/AN youth have reported higher rates of violence perpetration and victimization than their peers from other race and ethnic groups. For example, in 2001, 44% of AI/AN students reported they had been in a physical fight, and 8.6% reported they had been injured in a physical fight in the last year (Bureau of Indian Affairs, 2001). These estimates are relatively higher than those reported for non-Hispanic, White (32.2% and 3.4%, respectively), nonHispanic, Black (36.5% and 5.3%, respectively), and Hispanic (35.8% and 4.4%, respectively) students for the same year (CDC, 2007a). Furthermore, AI/AN students were relatively more likely to report that they had been threatened or injured with a weapon at school (10.1%), and felt too unsafe to attend school (12.8%) than non-Hispanic, White (8.5% and 5.0%, respectively), non-Hispanic, Black (9.3% and 9.8%, respectively), and Hispanic (8.9% and 10.2%, respectively) students in the same year (CDC, 2007a). Male AI/AN students (50%) were more likely to have reported being in a fight (50%), or being threatened or injured with a weapon (13%) than were female AI/AN students (38.8% and 7.2%, respectively); however, female AI/AN youth (14.1%) were more likely to have felt unsafe going to school than their male AI/AN peers (11.6%). In addition, other estimates, such as by the National Crime Victimization Survey (NCVS), from 1991 through 2002, have suggested that the average violent crime victimization rate among AI youth was higher than other groups, with AI youth having 2 times the victimization rate of Blacks, 2.5 times the rate of Whites, and 4.5 times the rate of A/PI youth (Perry, 2004).

Self-Directed Violence The prevalence of self-directed violence by youth, as measured by suicidal ideation and behavior, also differs across racial and ethnic groups. According to the 2007 YRBS, Hispanic (15.9%), non-Hispanic, White (14%), and non-Hispanic, Black (13.2%) students were equally likely to have seriously considered attempting suicide in the last year (CDC, 2008). However, significantly more Hispanic youth (12.8%) reported making a suicide plan in the past year than either non-Hispanic, White (10.8%) or non-Hispanic, Black (9.5%) students. In addition, Hispanic youth (10.2%) were significantly more likely to report having attempted suicide than either non-Hispanic, White (5.6%) or non-Hispanic, Black (7.7%) students. Female students have consistently demonstrated significantly higher prevalence of suicide-related

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behaviors, and the overall patterns of prevalence estimates generally remain stable when gender and race/ethnicity were simultaneously considered. However, in reports using combined data for males and females, the significant at-risk group of Hispanic females is hidden. Specifically, 21.1% of Hispanic females have seriously considered suicide, 15.2% have made a suicide plan, and 14% report having attempted suicide (CDC, 2008). A/PI youth also engage in suicide ideation and behavior at rates equal to and somewhat greater than some racial/ethnic groups. Results from the 1991 through 1997 YRBS demonstrated that 24.7% A/PI students had seriously considered suicide as compared with 24.3% of non-Hispanic, White students, 19.4% of non-Hispanic, Black students, and 25% of Hispanic students (Grunbaum et al., 2000). In addition, 21% of A/PI students reported they had developed a suicide plan in the year preceding the study whereas 19.2% of non-Hispanic, White students, 15.4% of non-Hispanic, Black students, and 20.7% of Hispanic students reported making a suicide plan. Furthermore, 8.9% of A/PI students had made at least one suicide attempt compared to 7.1% of non-Hispanic, White students, 7.8% of non-Hispanic, Black students, and 11.5% of Hispanic students. Suicide is a major issue also facing AI/AN communities, with suicide the second leading cause of death for AI/AN youth ages 10 to 24 years (CDC, 2007c). In 2001, 19% of AI/AN high school students reported they had seriously considered suicide, which was relatively consistent with other groups such as non-Hispanic, White (19.7%) and Hispanic (19.4%) students, but a higher rate than non-Hispanic, Black students (13.3%; Bureau of Indian Affairs, 2001; CDC, 2007a). AI/AN youth had relatively higher prevalence estimates for making a suicide plan (16.4%) and attempting suicide (16%) when compared to nonHispanic, White (15.3% and 7.9%, respectively), non-Hispanic, Black (10.3% and 8.8%, respectively), and Hispanic youth (14.1% and 12.1%, respectively; Bureau of Indian Affairs, 2001; CDC, 2007a). Furthermore, examination of suicidal ideation and behavior prevalence estimates for Navajo youth in 2003 demonstrated substantially higher estimates; 23% of Navaho students had seriously considered suicide in the last year (compared with 16.9% for all races), and 20% of Navajo youth had attempted suicide (compared with 8.5% for all races in the national 2003 YRBS; Navajo Nation, 2003). To summarize, available data have indicated that Latino, A/PI, and AI/AN adolescents are at high risk for engaging in a range of harmful interpersonal and self-directed violence behaviors. Although national data underscore the disparities among ethnic minority groups, these data do not explain why these differences exist. One critical difference between the subgroups of Latino, AI/AN, and A/PI adolescents and many of their peers from other minority and majority racial groups is that the adolescents in these subgroups have to cope with the complexities inherent in the acculturation process in addition to the stress of adolescence. The balance of this article explores specific studies that considered the links among acculturation, interpersonal violence, and self-directed violence.

STUDY INCLUSION AND EXCLUSION CRITERIA To review the extant literature on adolescent acculturation, interpersonal violence, and self-directed violence, we conducted an extensive search for empirical studies that used survey items or instruments to measure acculturation and violence. We established four

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inclusion/ exclusion criteria for our review. First, studies were included if the sample was a group of foreign-born or U.S.-born Latino, A/PI, or AI/AN adolescents between the ages of 10 and 24 years who were living in the U.S. We excluded studies that sampled participants from a broad age range if the majority of the participants were outside of the adolescent range (e.g., Austin, 2004; Brook et al., 2004; Lee and Ulmer, 2000). We excluded studies that examined acculturation issues as they relate to the adoption of cultural values of a country other than the United States (e.g., Wong, 2001) and that provided qualitative narratives of acculturation. Second, studies were accepted if they included a measure of adolescents‘ acculturation (e.g., language use, generational status, acculturation stress or strain, or multidimensional instruments). We excluded studies if they only assessed broad family constructs, such as general family pride (e.g., Taylor et al., 1997) or parental acculturationrelated stress (e.g., Spencer and Le, 2006). Further, we excluded studies if the acculturation assessment was not clearly operationalized (Lester, 1999). Third, studies were included if dating or youth violence perpetration or victimization as defined above was operationalized as the dependent, behavioral variable. We included studies with general measures of delinquency and crime if interpersonal violence was assessed in combination with other delinquency constructs (e.g., Brook et al. 1998; Samaniego and Gonzales, 1999; Willgerodt and Thompson, 2006). However, we excluded studies with measures of delinquency if interpersonal violence indicators (e.g., assault, fighting) were not included, and excluded studies that measured violence knowledge, pro-violence attitudes, and unspecified misconduct as the dependent variables (Arbona et al., 1999; Bankston and Zhou, 1997; Hishinuma et al., 2005; Lopez and Brummett, 2003; Ulloa et al., 2004). Fourth, we included studies that measured a broad range of self-directed violence behaviors (e.g., suicidal thoughts, attempts). We did not review studies that examined general depressive symptoms or internalizing problems (Smokowski and Bacallao, 2007). Using these inclusion criteria, we searched academic databases in psychology, sociology, criminology, social work, public health, and anthropology for published articles. We also examined the reference lists of all located studies, and contacted authors of published works to gain their assistance in identifying articles that are currently in press. All studies from peerreviewed journals or books that were published since 1970 and those currently in press were included. We did not include master‘s theses or doctoral dissertations because they often have not gone through a similar level of peer review.

RESULTS Tables 1, 2, and 3 show 41 studies that met the inclusion criteria. Two of these studies (Decker et al., 2007; Silverman et al., 2007) included Latino and A/PI youth. Our review located 26 studies that examined acculturation and dating violence, youth violence, or selfdirected behavior in Latino adolescents (see Table 1). As Table 2 illustrates, 13 studies examined the associations among acculturation and dating violence, youth violence, or selfdirected among A/PI youth. Although we were unable to locate any studies that investigated acculturation and dating violence or youth violence in AI/AN youth, we found four studies (see Table 3) that examined acculturation and self-directed violence in AI/AN youth.

Table 1. Studies Examining the Association between Acculturation and Interpersonal and Self-Directed Violence among Latino Youth Study

Sample

Sanderson, Coker, Roberts, Tortolero, and Reininger (2004)

4,525 9th graders (51% female); 100% Mexican American from Texas

Decker, Raj, and Silverman (2007); Silverman, Decker, and Raj (2007)

6,019 9th-12th graders (100% female); 76% White; 10% Hispanic; 7% African American; 3% Asian; 2% Other/mixed from Massachusetts (%‘s vary slightly across articles)

Acculturation Measures Language use, parent birthplace, salience of ethnicity, ethnic discrimination

Violence Measures YRBS dating violence victim

Language use, immigrant status

YRBS sexual assault victim and dating violence victim

Results ∙English-speaking only females were significantly more likely to experience dating violence than peers speaking both English and Spanish in home. ∙Spanish-speaking only females were significantly less likely to experience dating violence than peers speaking both English and Spanish in home. ∙For females, parent birthplace outside of US was significantly associated with a reduced likelihood of dating violence relative to peers whose parents were born in US. ∙For females, ethnic discrimination significantly positively associated with dating violence. ∙For females, high salience of ethnicity significantly associated with low dating violence victimization. ∙For males, language use, parent birthplace, salience of ethnicity, and ethnic discrimination not associated with dating violence. ∙Hispanic girls reported significantly lower prevalence of sexual assault prior to the past year and dating violence victimization relative to peers. ∙Sexually active, immigrant Hispanic girls reported significantly higher prevalence of sexual assault prior to the past year and sexual assault in past year relative to peers. ∙Sexually active, immigrant Hispanic girls were significantly less likely than peers to report dating violence victimization. ∙No significant association between language and sexual assault or dating violence for Hispanic youth.

Table 1. (Continued) Study Youth Violence Buriel, Calzada, and Vasquez (1982)

Sommers, Fagan, and Baskin (1993)

Vega, Gil, Warheit, Zimmerman, and Apospori (1993) Vega, Khoury, Zimmerman, Gil, and Warheit (1995)

Sample

Acculturation Measures

Violence Measures

Results

81 13-16-year-olds (100% male); 100% Mexican American from California; Generation status: 33% 1st, 33% 2nd, 33% 3rd 1,077 12-19-year-olds (mean age 15.7; 100% male); 100% Puerto Rican from New York

Generation status

Delinquency

Combined language familiarity and usage, ethnic interaction, identification, and background, and cultural lifestyle and traditions; familism; immigrant status

Interpersonal violence

1993: 1,843 6th-7th graders 100% Cuban from Miami

Language and acculturation conflict, perceived discrimination, birthplace, perception of closed society

Youth reported delinquency; parent reported CBCL; teacher reported TRF

∙3rd generation adolescents had significantly higher delinquency rates than 1st or 2nd generation adolescents. ∙1st and 2nd generation adolescents did not significantly differ on delinquency. ∙Highly acculturated adolescents and adolescents with low familism were significantly more likely to engage in violence. ∙No significant differences in violence between immigrant versus US born youth. ∙For immigrant youth, acculturation did not significantly predict interpersonal violence but lower levels of familism significantly predicted higher violence. ∙For US born youth, higher acculturation and lower familism were significantly predictive of higher interpersonal violence. ∙Among Cuban youth, language conflict, acculturation conflict, perceived discrimination, and perception of a closed society were significantly positively associated with delinquency. ∙Among Cuban youth, birth inside the US and higher perception of a closed society significantly predicted delinquency. ∙African American youth had significantly higher CBCL problem behavior than Cuban youth and significantly higher TRF relative to all groups except Puerto Rican. ∙No significant differences between Hispanic subgroups on CBCL or TRF. ∙Among foreign born Hispanic youth, those with higher language conflicts had significantly higher CBCL and TRF problem behaviors. ∙Among US born Hispanic youth, those with higher language conflicts, perceived discrimination, and perception of a closed society had significantly higher TRF problem behaviors.

1995: 2,360 6th-7th graders; 69% Hispanic; Non-Hispanic White; 13% African American from Miami; Of Hispanic youth: 71% US born, 43% Cuban, 12% Nicaraguan, 7% Columbian, 6% Puerto Rican, 32% other

Study

Sample

Brook, Whiteman, Balka, Win, and Gursen (1998)

882 16-25-year-olds (mean age 20; 56% male); 52% African American; 48% Puerto Rican from New York

Samaniego and Gonzales (1999)

Carvajal, Hanson, Romero, and Coyle (2002)

Dinh, Roosa, Tein, and Lopez (2002)

Acculturation Measures Family church attendance, country of origin, familism

Violence Measures Delinquency and physical violence

214 7th-8th graders (mean age 13.5; 57% female); 100% Mexican American; 44% born in Mexico; Generation status: 43% 1st, 30% 2nd, 26% 3rd

Combined language use and generation status

National Youth Survey delinquency scale

1,119 6th-7th graders (mean age 12; 53% female); 63% Latino, 37% non-Latino White from northern California; Of Latino youth: 62% Mexican American, Generation status of Latino youth: 13% 1st, 40% 2nd, 26% 3rd, 21% 4th or more 330 4th-8th graders (50% male); 100% Hispanic from southwest US; 33% born outside US; Home language: 44% Spanish, 35% English, 21% equal Spanish and English; Survey language: 76% English, 24% Spanish

Bidimensional Acculturation Scale Latino orientation and Other Group orientation subscales Latent factor of immigrant status, home language, language used to complete survey

Injury or threat victim, physical fight

Problem behavior proneness latent factor based Arizona Criminal Justice Survey (gang, substance use), Denver Youth Survey (peer delinquency), YSR (conduct problems)

Results ∙Family church attendance was significantly inversely associated with delinquency/violence at 5 year followup. ∙Having been born in the US significantly associated with higher levels of violence. ∙Familism was not significantly associated with delinquency/violence at 5 year follow-up. ∙Acculturation significantly positively correlated with delinquency. ∙Effect of acculturation on delinquency mediated by family conflict and inconsistent discipline. Acculturation positively related to family conflict and inconsistent discipline, which were positively related to delinquency. ∙Effect of acculturation on delinquency mediated by maternal monitoring. Acculturation negatively related to monitoring, which was negatively related to delinquency. ∙Latinos and non-Latino youth did not significantly differ on reports of being injured or threatened or fighting. ∙Acculturation was not significantly associated with any violence measures. ∙Level of acculturation of Hispanic youth significantly positively related to their problem behavior proneness one year later. ∙Relationship between acculturation and problem behavior mediated by parental involvement. Youth with higher levels of acculturation reported lower levels of parental involvement, which predicted higher problem behavior proneness.

Table 1. (Continued) Study

Sample

Yu, Huang, Schwalberg, Overpeck, and Kogan (2003)

15,220 6th-10th graders (53% female); 58.6% White; 19.3% Hispanic; 17.5% Black; 4.6% Asian from national sample; Of Hispanic youth: 24% foreign born, 27% English in home, 27% other home language, 46% mixed home language 230 9th-12th graders (52% male); 94% Hispanic; 4.4% White; 1.8% Other from Texas; 52% speak Spanish at home 48% speak English at home 18,097 12-21-year-olds (51% female); 62.6% White; 22.2% Black; 7.4% Asian; 7.8% Other races; 17.5% Hispanic from national sample; Generation of overall sample: 8% 1st, 15.2% 2nd, 76.8% 3rd 2,491 5-13-year olds (mean age 9.2; 52% male); 100% Puerto Rican from San Juan (54%) and South Bronx, New York (46%)

Brown and Benedict (2004)

Bui and Thongniramol (2005)

Bird, Canino, Davies, Duarte, Febo, Ramirez, Hoven, Wicks, Musa, and Loeber (2006); Bird, Davies, Duarte, Shen, Loeber, and Canino (2006) Gonzales, Deardorff, Formoso, Barr, and Barrera (2006)

175 11-15-year-olds (mean age 12.9; 51% female); 100% Mexican from southwest US; 38% born in Mexico; 62% born in US

Acculturation Measures Language use

Violence Measures Bullied victimization for race or religion

Results

Language use

Fear of weaponassociated victimization Violent delinquency

∙Spanish-speaking youth significantly more fearful of weaponassociated victimization than English-speaking peers.

Immigration generation

Child and Parent report of Cultural Life Style Inventory Bidirect-ional Scale (lang-uage preference, other ethnic characteristics) Adolescent, maternal, and family linguistic acculturation

DISC-IV disruptive behavior disorders subscale was given to children and adults

CBCL mother report conduct disorder subscale; YSR adolescent report conduct disorder subscale

∙Relative to English-only speaking Hispanic peers, Hispanic youth who spoke another language at home were significantly more likely to be bullied.

∙2nd and 3rd generation Hispanic youth were 60% and 88%, respectively, more likely to report violence than 1st generation Hispanic peers. ∙No significant differences were found between 2nd and 3rd generation Hispanic youth. ∙Child and parent acculturation and parent-child acculturation gap not associated with disruptive behavior disorders.

∙Latino youth acculturation positively related to adolescent reported conduct problems but unrelated to mother report. ∙Maternal acculturation positively related to adolescent and mother reported conduct problems. ∙Direct relationship between family acculturation and adolescent or mother reported conduct problems not significant. ∙Effect of family acculturation on mediated by family conflict. Pathway led from higher family acculturation to higher family conflict to increased adolescent reported conduct problems. ∙Effect of maternal acculturation mediated by interparental conflict. Pathway led from higher maternal acculturation to higher interparental conflict to higher mother reported problems.

Study

Sample

Smokowski, and Bacallao (2006)

481 11-19-year-olds (mean age 15; 54% female); 61% Mexican; 39% Other Central/South American countries from North Carolina (69%) and from Arizona (31%); 80% born outside of the US

Schwartz, Zamboanga, and Jarvis (2007)

347 6th-8th graders (approximately 50% male); 58% Mexican, 42% Puerto Rico, Honduras, Chile, Cuba or other Hispanic countries; 86% US born, from western Michigan

Self-Directed Violence Swanson, Linskey, Quintero-Salinas, Pumariega, and Holzer (1992) Vega, Gil, Warheit, Apospori, and Zimmerman (1993)

Acculturation Measures Adolescent and parent report of BIQ‘s Cultureof-Origin Involvement and US Culture Involvement subscales; Adolescent report of acculturation conflict with family Acculturation Rating Scale for Mexican Americans-II; MEIM; SAFE-C (acculturative stress)

Violence Measures YSR aggression scale

Results

Externalizing symptoms

∙Direct relationship between US orientation, Hispanic orientation, and ethnic identity and externalizing symptoms not significant. ∙Relationship between ethnic identity and externalizing mediated by self-esteem. Pathways led from higher ethnic identity to higher self-esteem and from higher self-esteem to lower externalizing. ∙Relationship between acculturative stress and externalizing mediated by self-esteem. Pathways led from higher stress to lower self-esteem and from lower self-esteem to more externalizing symptoms. ∙US orientation indirectly related to externalizing symptoms through acculturative stress and self-esteem.

4,157 11-19 year olds (50% female); 57% Mexican from Mexico; 43% Mexican American from Texas

US resident

Suicide thoughts

∙Mexican youth residing in US had significantly higher rates of suicidal ideation than peers living in Mexico. ∙Living in the US significantly predicted more suicidal thoughts.

5,303 6th-8th graders (100% male); 28% Cuban; 29% Other Hispanic; 14% African American; 14% White, nonHispanic; 9% Nicaraguan; 3% Haitian, 3% Caribbean black from in Miami, Florida

Acculturation stress (language conflict, acculturation conflict, perceived discrimination, perceived closed society)

Suicide attempts

∙Controlling for suicide ideation and attempts at Time 1, use of psychoactive drugs or cocaine interacted with higher acculturation stress (all four measures) to predict higher rates of suicide attempts among Cuban students and Other Hispanic students one year later. ∙Controlling for suicide ideation and attempts at Time 1, use of alcohol interacted with higher acculturation conflicts and use of cigarettes interacted with language conflicts to predict significantly higher rates of suicide attempts among Other Hispanic students one year later.

∙Latino youth with a stronger culture-of-origin involvement had significantly lower levels of aggression. ∙Direct relationship between adolescent US cultural involvement and acculturation conflicts and aggression not significant. ∙Effect of acculturation conflicts mediated by familism and parentadolescent conflict. Pathways led from more acculturation conflicts to lower familism to higher aggression and from more acculturation conflicts to more parent-child adolescent conflict to higher aggression. ∙Effect of parent US cultural involvement mediated by parentadolescent conflict. Pathway led higher US cultural involvement to lower conflict to lower aggression.

Table 1. (Continued) Study

Sample

Hovey and King (1996)

70 14-20-year-olds (mean age 16.8; 57% female); 77% Mexican; 4% Central American; 4% South American; 2% Spanish from southern California; generational status: 23% 1st early (<12), 66% late 1st immigrants (>12), 11% 2nd 61 adolescents (mean age 15.1; 66% female); 100% Mexican American from Texas; 85% US born; 15% Mexico born 242 8th graders (mean age 13.7; 57% female); 100% Mexican American from Texas

Ng (1996)

Rasmussen, Negy, Carlson, and Burns (1997)

Acculturation Measures Acculturation stress

Violence Measures SIQ-JR

Results

Time living in US

Pierce Suicide Intent Scale

∙Relative to a low suicide intent group, the high suicide intent group lived in the US for a significantly shorter period of time.

Acculturation Rating Scale for Mexican Americans

SIQ-JR

∙Acculturation not independently predictive of suicide ideation. ∙When examined in combination with depressive symptoms and low self-esteem, high acculturation was significantly and positively predicted of suicide ideation. ∙ Acculturating stress was significantly positively associated with suicidal ideation. ∙Time living in the US unrelated to suicidal ideation.

Hovey (1998)

54 students (mean age 16.8; 52% female); immigrant Mexican-American from a Southern California

Acculturation stress; time living in US

SIQ-JR

Olvera (2001)

158 6th-8th graders (mean age=12; 54% female); 56% Hispanic; 21% Anglo; 14% mixed; 1% African American from Texas

Spanish language preference; immigration/ generation status

DSD

∙Acculturation stress significantly positively associated with suicidal ideation among Latino youth. ∙More acculturation stress was a significant predictor of increased levels of suicidal ideation.

∙Hispanic youth had significantly higher suicidal ideation than Anglo youth. ∙Hispanic ancestry significantly predicted suicidal ideation. ∙Spanish language preference unrelated to suicidal ideation. ∙Having US born mother significantly decreased the risk for suicide.

Note: Unless noted, acculturation and violence measures completed only by participating youth. BIQ=Bicultural Involvement Questionnaire; CBCL=Child Behavior Checklist; DISC-IV=Diagnostic Interview Schedule for Children–IV; DSD=Diagnostic and Statistical Manual Scale for Depression; SAFE-C=Societal, Attitudinal, Familial, and Environmental Acculturative Stress Scale for Children; SIQ-JR=Suicidal Ideation Questionnaire-Junior; TRF=Teacher Report Form; US=United States YRBS=Youth Risk Behavior Survey; YSR=Youth Self-Report.

Table 2. Studies Examining the Association between Acculturation and Interpersonal and Self-Directed Violence among Asian American/Pacific Island Youth Study

Sample th

th

Acculturation Measures

Violence Measures

Results

Decker, Raj, and Silverman (2007); Silverman, Decker, and Raj (2007) Youth Violence Yu, Huang, Schwalberg, Overpeck, and Kogan (2003)

6,019 9 -12 graders (100% female); 76% White; 10% Hispanic; 7% African American; 3% Asian; 2% Other/mixed from Massachusetts (%‘s vary slightly across articles)

Language use, immigrant status

YRBS sexual assault victim and dating violence victim

∙No significant association between language use or immigrant status and sexual violence or dating violence among Asian youth.

15,220 6th-10th graders (53% female); 58.6% White; 19.3% Hispanic; 17.5% Black; 4.6% Asian; Of Asian youth: 58% foreign born, 27% English in home, 26% other home language, 46% mixed home language

Language use

Bullied victimization for race or religion

∙Relative to English-only speaking Asian peers, Asian youth who spoke another language at home were significantly more likely to be bullied. ∙Mixed language use at home was not a risk factor.

Shrake and Siyon, (2004)

217 13-18-year-olds (mean age 15.8; 57% female) 100% Korean American from Los Angeles; 52% Korean born, 46% US born

Ethnic Identity and Attitudes toward Other Groups subscales of MEIM; perceived discrimination

Externalizing scale of YSR

∙Ethnic identity and Attitudes toward Other Groups significantly negatively associated with externalizing for Korean youth. ∙Perceived discrimination significantly positively associated to externalizing. ∙High ethnic identity significantly predicted lower levels of externalizing. ∙High perceived discrimination significantly predicted higher levels of externalizing.

Bui and Thongniramol (2005)

18,097 12-21-year-olds (51% female); 62.6% White; 22.2% Black; 7.4% Asian; 7.8% Other races; 17.5% Hispanic from national sample; Generation of overall sample: 8% 1st, 15.2% 2nd, 76.8% 3rd

Immigration generation

Violent delinquency

∙No significant differences in violence by immigration generation for Asian youth.

Table 2. (Continued) Study Go and Le (2005); Le and Stockdale (2005); Le and Wallen (2007); Ngo and Le (2007); Le and Stockdale (2008)

Sample 329 10-18-year-olds; 34% Cambodian; 20% Chinese; 26% Vietnamese; 20% Laotian/Mien; 2nd generation: 81% Chinese, 88% Cambodian, 53% Vietnamese (%‘s vary slightly across articles)

Acculturation Measures MEIM factors of Ethnic Identity and Ethnic Belonging; Individualism and collectivism cultural orientation; intergenerational/intercultural conflict (acculturative dissonance); acculturated behavior

Violence Measures General measure of serious delinquency; Denver Youth Survey serious delinquency; serious violence; violence victimization

Results ∙Chinese youth were significantly less seriously delinquent relative to Cambodian, Laotian/Mien, and Vietnamese peers. ∙Individualism positively related to, and collectivism negatively related to, serious delinquency, with partial mediation through peer delinquency and with model invariant across Asian groups. ∙Acculturated behavior, collectivism, and intergenerational/intercultural conflict interacted with certain stressors (emotional hardship, physical abuse, emotional abuse) to predict Denver Youth Survey serious delinquency; significance of interactions varied by Asian ethnic group. ∙Acculturative dissonance was significantly predictive of serious violence, with full mediation through peer delinquency. ∙Ethnic identity not significantly associated with serious violence. ∙Ethnic identity was a positive predictor of delinquency for male Cambodian youth but not for female Cambodian youth. ∙Ethnic belonging unrelated to delinquency for Cambodian youth.

Willgerodt and Thompson (2006)

1,003 7th-12th graders (50% male); 40% White; 39% Filipino; 21% Chinese from national sample

Immigration generation based on youth and parent place of birth

Delinquency

∙Filipino youth had significantly higher delinquency than Chinese and White peers. ∙Among Filipino, 2nd generation had significantly higher delinquency than 1st generation. No difference relative to 3rd generation peers. ∙Among Chinese youth, no significant difference in delinquency by generation status.

Self-Directed Violence Study Sample Lau, 285 4-17-year-olds (mean age Jernewall, 12.9; 39% Chinese; 32% Zane, and Southeast Asian; 14% Korean; Meyers 13% Japanese; 2% Filipino (2002) from California; 13% suicidal, 87% nonsuicidal

Acculturation Measures Combined English proficiency, primary home language, age of immigration, proportion of life in US

Violence Measures Consensus of two raters‘ review of medical charts for a history of suicidal ideation and self-harm

Results ∙Suicidal group had a significantly fewer US born Asian youth and were significantly older when they immigrated to the US relative to the nonsuicidal group. ∙Suicidal and nonsuicidal groups did not differ on language. ∙Japanese and Korean youth more acculturated than Chinese and Southeast Asian youth. ∙Lower acculturation significantly predicted higher suicide risk. ∙Significant interaction between acculturation and parent-adolescent conflict. When conflict is high, less acculturated youths were at higher risk of suicide than the more acculturated group. When conflict was low, there was no significant difference in risk for the two acculturation groups. ∙No significant ethnic group differences in predicting suicide.

Note: Unless noted, acculturation and violence measures completed only by participating adolescent. MEIM=Multigroup Ethnic Identity Measure; US=United States; YRBS=Youth Risk Behavior Survey; YSR=Youth Self-Report

Table 3. Studies Examining the Association between Acculturation and Self-Directed Violence among American Indian/Alaskan Native Youth Self-Directed Violence Study

Sample

Acculturation Measures

Violence Measures

Results

Howard-Pitney, LaFromboise, Basil, September, and Johnson (1992) Novins, Beals, Roberts, and Manson (1999) Freedenthal and Stiffman (2004)

83 9th graders (mean age 15.6; 58% female); 100% Zuni from New Mexico

Traditionality (level of integration into pueblo religious life)

Ever suicide attempt; Suicide Probability Scale

∙Traditionality was unrelated to a history of a suicide attempt or suicide ideation.

1,378 9th-12th graders (mean age 15.9; 51% female); Southwest, Northern Plains, Pueblo tribes 314 13-20-year-olds (mean age 15.6; 56% female); 100% American Indian from southwest US; 46% urban reared; 54% reservation reared

Bicultural Ethnic Identity

SIQ-JR

∙Ethnic identity unrelated to suicide ideation for all three tribes.

Orthogonal Cultural Identity Scale

History of suicide attempt

Yoder, Whitbeck, Hoyt, and LaFromboise (2006)

201 5th-8th graders (mean age 12; 54% male); 100% American Indian from Midwest US

Enculturation (traditional activities, cultural identity, spirituality)

YSR suicidal ideation item

∙Urban and reservation-reared youth did not significantly differ in their history of suicide attempts. ∙For both urban and reservation-reared youth, cultural identity was not a significant predictor of suicide. ∙Enculturation not significant predictor of suicidal ideation. ∙When examined in combination with other risk and protective factors, high enculturation was significantly predictive of lower suicidal ideation.

Note: Unless noted, acculturation and violence measures completed only by participating adolescent. SIQ-JR=Suicidal Ideation Questionnaire-Junior; YSR=Youth SelfReport.

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Throughout the review, we use the terms for acculturation and violence provided in each of the articles. Specific operationalizations for each construct are provided in the tables.

Research on Latino Adolescents Research methods. Mirroring the heterogeneity in the Latino population, investigators studying Latino adolescents drew their study samples from several different locations. Multiethnic studies were conducted in Miami (Vega et al., 1993a; Vega et al., 1995), Michigan (Schwartz, Zamboanga, and Jarvis, 2007), and Massachusetts (Decker et al., 2007; Silverman et al., 2007). Puerto Rican samples came from New York City (Bird, Canino, et al., 2006; Bird, Davies, et al. 2006; Brook et al., 1993; Whiteman et al., 1998). Researchers in the Southwest, typically Arizona (Dinh et al., 2002; Gonzales et al., 2006; Samaniego and Gonzales, 1999) and California (Buriel et al., 1982; Carvajal et al., 2002; Hovey, 1998; Hovey and King, 1996), studied samples of Mexican or Mexican American participants. Samples with a large proportion of Cuban participants came from southern parts of Florida (Vega et al., 1993a; Vega et al., 1993b; Vega et al., 1995). Six studies were conducted in Texas (Brown and Benedict, 2004; Ng, 1996; Olvera, 2001; Rasmussen et al., 1997; Sanderson et al., 2004; Swanson et al., 1992) and one (Smokowski and Bacallao, 2006) used a sample of predominantly Mexican adolescents living in either North Carolina or Arizona. Only two studies (Bui and Thongniramol, 2005; Yu et al., 2003) examined nationally representative survey samples of youth. In general, sample sizes were adequate for youth violence research, ranging from 81 (Buriel et al., 1982) to 18,097 adolescents (Bui and Thongniromol, 2005). Only four of the studies on Latino interpersonal violence had samples with fewer than 300 participants, and 14 of the articles had samples with more than 500 participants. The research literature on Latino self-directed violence (seven studies) also had a range of sample sizes; three of the seven studies had samples with fewer than 75 participants (Hovey, 1998; Hovey and King, 1996; Ng, 1996) whereas the samples of the other four studies ranged from 156 (Olvera, 2001) to 5,303 youth (Vega et al., 1993a). Although this group of Latino studies deserves praise for taking into account the heterogeneity among Latino subgroups (e.g., Cubans in Miami, Puerto Ricans in New York City), samples of different Latino subgroups were largely considered in isolation. These different subgroup samples have not been brought together or systematically compared, which further complicates the generalization of results and the ability to draw conclusions for the larger, heterogeneous population of Latinos. Along with isolated samples of Latino subgroups, there were also broad differences in the unidirectional or bidirectional operationalization of acculturation. The most common measure of acculturation was language use or conflict, which was used either as a sole indicator or examined in combination with other acculturation measures in 54% of the studies. Six out of 26 Latino studies (23%) used a sole indicator of acculturation: language use (Brown and Benedict, 2004; Yu, et al., 2003), immigration generation (Buriel et al., 1982; Bui and Thongniramol, 2005), U.S. residency (Swanson et al., 1992), or time living in the United States (Ng, 1996). Although most studies used multiple indicators of acculturation, these indicators were frequently examined as independent predictors and not as a unified construct. For instance, some studies augmented language use with other simple measures, such as parental birthplace (Sanderson et al., 2004), immigrant status (Decker et al., 2007; Silverman

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et al., 2007), and immigrant/generation status (Olvera, 2001). A few studies used unique measures to assess acculturation stress, acculturation conflicts, discrimination conflicts (Hovey, 1998; Hovey and King, 1996; Sanderson et al., 2004; Schwartz et al., 2007; Vega et al., 1993a, Vega et al., 1995), and familism or family pride (Brook et al., 1998; Sommers et al., 1993). The most elaborate studies utilized multiple scales from different informants (e.g., parents and children) to measure different dimensions of acculturation with the assumption that acculturation is not unidirectional (Bird, Canino, et al., 2006; Bird, Davies, et al., 2006; Carvajal et al., 2002; Rasmussen et al., 1997; Smokowski and Bacallao, 2006). For example, Bird and his colleagues (Bird, Canino, et al., 2006) used the Cultural Life Style Inventory Bidirectional Scale to assess child and parent acculturation preferences in language use and other ethnic characteristics. In another study, two orthogonal, or independent, seven-item measures of cultural orientation (i.e., Latino orientation, other group orientation) based on the Bidimensional Acculturation Scale were used to measure acculturation (Carvajal et al., 2002). Similarly, Ramussen and her colleagues (1997) used a shortened version of the Acculturation Rating Scale for Mexican Americans to measure language use and ethnic identification of the youth and his or her parents. Smokowski and Bacallao (2006) used the Bicultural Involvement Questionnaire to measure four dimensions of family acculturation: adolescent culture-of-origin involvement, adolescent host culture involvement, parent culture-of-origin involvement, and parent host culture involvement. Considering that none of the studies included in this review directly compared unidirectional to bidirectional acculturation measures, we paid special attention to measurement differences during our analysis. Interpersonal violence indicators also varied across studies. The extant studies clustered into three groups looking at distinct aspects of interpersonal and self-directed violence involving youth: (a) dating and sexual violence and victimization; (b) youth physical violence, aggression, or conflict; and (c) suicidal behavior. All articles on dating or sexual violence used an item or items from the YRBS as their outcome measures. The youth physical violence, aggression, or conflict category included five studies that used the Child Behavior Checklist or Youth Self-Report (Dinh et al., 2002; Gonzales et al., 2006; Smokowski and Bacallao, 2006b; Vega et al., 1993b, 1995), two articles used the Diagnostic Interview Schedule for children – IV disruptive behavior disorders subscale (Bird, Canino et al., 2006; Bird, Davies et al., 2006), and nine used various self-report items or measures of delinquency, theft or vandalism, deviancy, victimization from being bullied, and fear of being assaulted with a weapon. Only two studies included multiple informants for youth violence (Gonzales et al., 2006; Vega et al., 1995). Self-directed violence was assessed by single items (Swanson et al., 1992; Vega et al., 1993a) as well as standardized measures such as the Suicidal Ideation Questionnaire-Junior (Hovey, 1998; Hovey and King, 1996; Ramussen et al., 1997), Pierce Suicide Intent Scale (Ng, 1996), and the Diagnostic and Statistical Manual Scale for Depression (Olvera, 2001). Dating and sexual violence victimization. There were three extant studies on acculturation and dating violence; however, two published articles derived from the same sample of participants (Decker et al., 2007; Silverman et al., 2007). All three studies indicated that being an immigrant or less acculturated was a protective factor against dating violence victimization (Decker et al., 2007; Sanderson et al., 2004; Silverman et al., 2007). For instance, after examining data from more than 4,500 Latinas in southern Texas, Sanderson and her colleagues (2004) concluded that greater acculturation may be associated with greater

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prevalence of dating violence victimization, but this association was moderated by gender. For females, parental birthplace outside of the United States and high salience of ethnicity was significantly associated with a reduced likelihood of dating violence victimization. Reporting ethnic discrimination was also strongly associated with increased dating violence victimization among females. However, for males, language use, parental birthplace, salience of ethnicity, and ethnic discrimination were not associated with dating violence. In a large, multiethnic sample from Massachusetts (Decker et al., 2007; Silverman et al., 2007), among all adolescent females identifying as Hispanic and among those Latinas who reported being sexually active, immigrant females were at reduced risk for dating violence but were at higher risk for sexual assault as compared to nonimmigrant Hispanic girls. However, language spoken at home was not a relevant factor for adolescents regarding their vulnerability to dating violence. This lack of a significant effect for language spoken at home is at odds with results from Sanderson and her colleagues (2004), who indicated that Spanishonly speaking females were significantly less likely to experience dating violence than peers who spoke both English and Spanish in the home. In addition, English-only speaking females were significantly more likely to experience dating violence than peers who spoke both English and Spanish in their homes. This initial evidence indicated that low to moderate acculturation levels might be a cultural asset against dating violence victimization, especially for females; however, more studies are needed to confirm these assertions. Youth violence. The association between acculturation and youth violence outcomes was examined in 16 studies; 13 of these investigations examined the perpetration of violence as the outcome, and three studies examined fear of being a victim of violence as the outcome. Of the reports that considered the perpetration of youth violence, the results were somewhat mixed but favored a significant positive association between acculturation and youth violence. Of the empirical investigations focused on adolescent acculturation and youth violence perpetration, 9 of the 13 studies reported that higher adolescent U.S. cultural involvement (defined in different ways and sometimes referred to as assimilation) was associated with increased youth violence (Brook et al., 1998; Bui and Thongniramol, 2005; Buriel et al., 1982; Dinh et al., 2002; Samaniego and Gonzales, 1999; Smokowski and Bacallao, 2006; Sommers et al., 1993; Vega et al., 1993b; Vega et al., 1995). For example, Bui and Thongniramol (2005) examined a nationally representative subsample of 18,097 students from the National Longitudinal Study of Adolescent Health. Using logistic regression models, odds ratio statistics indicated that youth who were second or third generation Hispanics were 60% and 88% (respectively) more likely to report violent delinquency compared to their first generation counterparts. Among a predominantly Cuban sample of 2,360 adolescents living in Miami, Vega and his colleagues (1995) reported that only language conflicts were associated with total behavior problems as reported by the parents and teachers of immigrant adolescents. However, among the U.S.-born Cuban youth, language conflicts, perceived discrimination, and perceptions of a closed society were associated with behavior problems reported by teachers but not by parents. Furthermore, Dinh and her colleagues (2002), whose assessment of 330 Hispanic youth represents one of the few longitudinal studies, found higher acculturation significantly predicted higher levels of youthreported problem behavior proneness (i.e., gang, peer delinquency, conduct problems) one year later. However, four studies failed to find significant associations between acculturation variables and youth violence perpetration. Bird and his colleagues (Bird, Canino, et al., 2006;

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Bird, Davies, et al., 2006) reported that the level of acculturation, parent-child acculturation gaps, and cultural stress were not associated with disruptive behavior disorders in their probability samples of 2,491 Puerto Rican youth ages 5 to 13 years old in San Juan and the South Bronx in New York City. In a Southwestern sample of 175 Mexican youth and their mothers, the direct relationship between family linguistic acculturation and adolescent conduct problems was not significant (Gonzales et al., 2006); however, an indirect relationship mediated through family conflict was found. Similarly, U.S. orientation, Hispanic orientation, and ethnic identity did not have a direct relationship with externalizing symptoms of Hispanic youth from western Michigan, but self-esteem was found to mediate the relationship between ethnic identity, U.S. orientation, and acculturative stress and externalizing symptoms (Schwartz et al., 2007). Finally, acculturation was not significantly associated with any violence measures in Carvajal and his colleagues‘ (2002) study of 1,119 sixth and seventh graders from northern California. Along with the positive direct effect of higher adolescent U.S. cultural involvement on engagement in youth violence, three studies examined acculturation as a risk factor of increasing fear and the chances of victimization. Brown and Benedict‘s (2004) survey of 230 high school students from Brownsville, Texas reported that immigrant youths with low acculturation (as gauged by language commonly spoken at home) were more fearful of weapon-associated victimization than nonimmigrant youths. Language spoken at home was the only demographic variable that proved to have a significant impact on fear of being shot and fear of being stabbed. Consistently, in a nationally representative sample of 15,220 students in sixth through tenth grade, Yu and her colleagues (2003) also found that Hispanic adolescents who primarily spoke a language other than English at home were at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied relative to youth who only spoke English at home. In contrast to the results of these studies, Carvajal and his associates (2002) examined a sample of 1,119 high school students from northern California and reported that Latinos in the marginalized acculturation group (e.g., those with fewer attachments and adaptations to Latino and other cultures) showed less desirable mental health outcomes (e.g., depression and low optimism) as compared to the bicultural group. However, there were no significant differences between Latino and non-Latino youth on reports of being injured, threatened, or fighting, and no significant association between acculturation and violence. These studies show that low acculturation, language difficulties, and lack of a connection to a cultural group may be risk factors for fear of victimization, internalizing mental health symptoms, and behavior problems. Given the limited attention to the association between acculturation and victimization, and the mix of findings in available studies, continued examination of the possible connection between low acculturation and risk is needed. Mediators between acculturation and youth violence have received some attention, and evidence has emerged that underscores the importance of family processes in mediating the relationship between acculturation and adolescent behavior. Gonzales and her colleagues (2006) reported that family conflict was an important mediator, and linked acculturation to increased youth externalizing symptoms. The direct relationship between family linguistic acculturation and adolescent conduct problems was not significant; however, linguistic acculturation was associated with heightened family conflict, which in turn, was related to increased adolescent conduct problems. Similarly, another study from the Southwest showed that the relationship between acculturation and problem behavior proneness was mediated by

The Relationship between Acculturation and Violence in Minority Adolescents

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parental investment (Dinh et al., 2002). Controlling for Time 1 problem behavior proneness, Time 1 acculturation was inversely related to Time 1 parental investment, which in turn, was negatively associated with Time 2 problem behavior proneness (Dinh et al., 2002). Smokowski and Bacallao (2006) explored family mediation pathways in a sample of 481 adolescents living in either North Carolina or Arizona. Adolescent U.S. cultural involvement and acculturation conflicts did not have significant direct effects on youth aggression. However, family processes, (e.g., familism and parent–adolescent conflict) mediated the effects of acculturation conflicts on adolescent aggression. The risk pathway led from acculturation conflicts to increased parent–adolescent conflicts to higher levels of adolescent aggression. In contrast, adolescent culture-of-origin involvement and familism were inversely associated with adolescent aggression. Familism not only buffered the effect of acculturation conflicts but also was associated with decreased adolescent aggression. In addition, an indirect effect was found for parent U.S. cultural involvement on aggression through lower parent–adolescent conflict. Similarly, Taylor and her colleagues (1997) underscored the importance of family in their findings from a multicultural sample of adolescents in Miami. Adolescent culture-of-origin involvement and familism were inversely associated with adolescent aggression. Self-directed violence. We found seven empirical studies examining the link between acculturation and self-directed violence for Latino youth. Three of these studies found that acculturation stress and strain was significantly positively related to suicidal ideation (Hovey, 1998; Hovey and King, 1996) or interacted with cocaine and crack use to predict suicide attempts among Latinos (Vega et al., 1993a). In their study of 70 Latino males in a California bilingual program, Hovey and King (1996) reported that acculturation stress explained 9% of the variance in depression and 6% of variance in suicidal ideation, representing a medium to large effect size for this predictor. Two additional studies that measured acculturation differently also found a positive association between acculturation and suicidal behavior. Swanson and his colleagues (1992) found that Mexican youth residing in the U.S. had significantly higher rates of suicidal ideation than peers living in Mexico, and that U.S. residency significantly predicted more suicidal thoughts. In a study of 242 Mexican American eighth grade students, Rasmussen and her colleagues (1997) examined acculturation as assessed by the Acculturation Rating Scale for Mexican Americans and found that acculturation significantly and positively predicted suicide ideation in stepwise regression models when combined with depressive symptoms and low self-esteem. Further, the female participants had significantly higher suicide ideation scores than male participants. Two studies failed to support the association between high acculturation and suicide risk among Hispanic youth. Ng (1996) found the opposite relationship with low acculturation demonstrating an increased risk of suicide. Ng examined medical records from 61 Mexican American adolescents and reported that living in the United States for a shorter period of time was a characteristic of the high suicide intent group. Differences across samples may contribute to these conflicting findings as the Ng study sample included youth who were previously admitted to a psychiatric facility, whereas the other studies examined general, nonclinical samples of youth. In a study of 158 Latino middle school students, Olvera (1997) also failed to support an association between high acculturation and suicide but for different reasons. Olvera did find a trend (p = .06) for Spanish language preference to predict increased

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Paul R. Smokowski, Corinne David-Ferdon and Nancy Stroupe

risk for suicidal ideation, but this link did not reach conventional levels of statistical significance.

Research on Asian/Pacific Islander Adolescents Research methods. Before our review, Le (2002) examined 34 studies of delinquency among A/PI youth. She used more liberal inclusion criteria than our review, and included masters‘ theses, doctoral dissertations, and conceptual articles. More important, Le did not require studies in her review to measure acculturation and aggression or violence as we have. Studies were included in her review if they discussed A/PI and some aspect of delinquency (e.g., official and self-reported arrests, violent and assault behavior, gang related activities, truancy, and other problem behaviors) whereas we focused on youth violence perpetration and victimization and suicidal behavior as the outcome measures. Notwithstanding this broad approach, Le (2002) concluded that dimensions of culture and the relationship between culture and delinquency for A/PI youth have thus far been undefined, undifferentiated, and minimally considered. We were able to find 13 studies (shown in Table 2) that examined the association between acculturation and interpersonal or self-directed violence among A/PI youth. There was no overlap between our analyses and Le‘s (2002). With the exception of one article, the A/PI articles that met our inclusion criteria were published after Le‘s review. There was one multiethnic study (two published articles) on dating violence and victimization that included an A/PI subgroup (Decker et al., 2007; Silverman et al., 2007). Nine articles reported on A/PI youth violence; however, five of these articles analyzed the same sample (N = 329) of 10- to 18-year-olds from California (Go and Le, 2005; Le and Stockdale, 2005, 2008; Le and Wallen, 2007; Ngo and Le, 2007). The final two studies examined suicidal behavior in A/PI youth. Sample sizes were moderate to large, and ranged from 217 (Shrake and Siyon, 2004) to 18,097 youth (Bui and Thongniramol, 2005). Consistent with the sampling approach of the Latino studies, a majority (69%) of the A/PI studies considered specific subgroups (Go and Le, 2005; Lau et al., 2002; Le and Stockdale, 2005, 2008; Le and Wallen, 2007; Ngo and Le, 2007; Shrake and Siyon, 2004; Willgerodt and Thompson, 2006; Yuen et al., 2000). However, this small group of studies gave relatively more attention to subgroup comparisons and demonstrated some between-group differences. Parallel to the Latino literature, the A/PI studies primarily measured acculturation with simple measures, such as language use (Decker et al., 2007; Silverman et al., 2007; Yu et al., 2003) and immigrant/generation status (Bui and Thongniramol, 2005; Willgerodt and Thompson, 2006). The more sophisticated studies used bidirectional or multidimensional measures that assessed ethnic identity, individualism, collectivism, and Hawaiian cultural orientation (e.g., Shrake and Siyon, 2004; Yuen et al., 2000). The two articles examining dating or sexual violence (Decker et al., 2007; Silverman et al., 2007) used items from the CDC‘s YRBS as outcome measures. For youth violence, six studies measured general to serious delinquency (Bui and Thongniramol, 2005; Go and Le, 2005; Le and Stockdale, 2005, 2008; Ngo and Le, 2007; Willgerodt and Thompson, 2006), one examined emotional and physical victimization (Le and Wallen, 2007), one looked at bullying victimization (Yu et al., 2003), and one considered externalizing behaviors measured by the Youth Self-Report (Shrake and Siyon, 2004). However, the two studies that examined

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the association between acculturation and self-directed violence assessed violence differently, with one study examining lifetime suicide attempts (Yuen et al., 2000) and the other measuring a history of suicidal ideation and self-harm from medical chart reviews (Lau et al., 2002). Data analyses tended to yield basic multiple regression models, few studies considered moderating or mediating relationships, and no study utilized a longitudinal design. Dating and sexual violence victimization. Recently, there have been two attempts to examine acculturation and dating or sexual violence in A/PI youth. The same research group produced both of the extant articles (Decker et al., 2007; Silverman et al., 2007). Using a multiethnic sample of 6,019 ninth and twelfth graders from Massachusetts, both of these studies found there was no significant association between language use or immigrant status and sexual violence or dating violence among Asian youth. Although this lack of association is noteworthy, these analyses used simple markers of acculturation, and only 3% of the sampled adolescents were Asian (approximately 180 youths out of 6,019). Therefore, we cannot draw firm conclusions about acculturation and dating and sexual violence in A/PI youth until more research has been conducted. Youth violence. We were able to locate nine articles focused on acculturation and youth violence of A/PI youth. Four studies included large multiethnic group investigations (Bui and Thongniramol, 2005; Shrake and Siyon, 2004; Willgerodt and Thompson 2006; Yu et al., 2003). The other five articles (Go and Le, 2005; Le and Stockdale, 2005, 2008; Le and Wallen, 2007; Ngo and Le, 2007) analyzed the same sample of 329 Chinese and Southeast Asian youth recruited from two public schools and five community-based organizations in Oakland, California. The majority of the youth in this sample were second-generation status (i.e., U.S.-born), except for Vietnamese youth who were nearly equally divided between first and second generations. Thus, much of what we know about A/PI youth violence comes from one moderate-sized sample from one city in California. Although it remains important to synthesize this knowledge, caution is warranted in generalizing these results. Several themes in the A/PI youth literature paralleled those described above for Latino adolescents. Assimilation, individualism, acculturation stress, and experiencing discrimination remain important risk factors for aggression and violence. Among Filipino youth, second generation adolescents had significantly higher delinquency than first generation youth (Willgerodt and Thompson, 2006); however, there were no differences relative to third generation peers. After examining data from 217 Korean American students in Los Angeles, Shrake and Siyon (2004) reported that perceived discrimination showed a strong positive effect on both internalizing and externalizing problem behaviors. In the sample of 329 Southeast Asian youth from Oakland, Le and Stockdale (2005) found that individualism was positively related to self-reported delinquency, with partial mediation through peer delinquency. Similarly, Ngo and Le (2007) reported that increased levels of acculturation, intergenerational/intercultural conflict, and individualism placed youth at increased risk for serious violence (e.g. aggravated assault, robbery, rape, and gang fights). Acculturation, individualism, intergenerational/intercultural conflict enhanced the impact of certain stressors (e.g., emotional hardship, physical abuse, emotional abuse) to predict violent behavior. In a third study using the same sample, acculturative dissonance was found as significantly predictive of serious violence, with full mediation through peer delinquency (Le and Stockdale, 2008). Ethnic identity was reported to be a cultural asset for A/PI youth by Shrake and Siyon (2004) who found ethnic identity was significantly and negatively associated with

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externalizing problems for Korean youth. Le and colleagues (Le and Stockdale, 2005; Ngo and Le 2007) found that collectivism was negatively related to self-reported delinquency, with partial mediation through peer delinquency, and that collectivism interacted with certain stressors (e.g., emotional hardship, physical abuse, emotional abuse) to predict violent behavior and dampened the impact of certain stressors on violent behaviors. However, in this same sample, ethnic identity was not a significant predictor of physical or emotional victimization or serious violence (Le and Stockdale, 2008; Le and Wallen, 2007) and among Cambodian youth in the sample, ethnic identity search (e.g., spending time to find out about one‘s ethnic group, being active in ethic group organizations) was a positive predictor of selfreported delinquency scores for males, but not for females (Go and Le, 2005). Furthermore, Yu and her colleagues (2003) found that, relative to English-only speaking Asian peers, Asian youth who spoke another language at home were significantly more likely to be bullied. Further research must be done to illuminate the roles of ethnic identity and collectivism as cultural assets or risk factors for A/PI youth. Attention to mediators among A/PI studies of youth violence was limited but revealed some interesting findings. Initial evidence suggests that peer delinquency fully mediated the relationship between acculturation dissonance and serious violence (Le and Stockdale, 2008). Peer delinquency also partially mediated the positive relationship between individualism and serious delinquency and the negative relationship between collectivism and serious delinquency (Le and Stockdale, 2005). Although not a focus in this review, Spencer and Le (2006) also reported that in this sample parents‘ refugee status was related to youth‘s serious violence and was fully mediated by peer delinquency and parental engagement. This mediation of acculturation dynamics by family processes paralleled findings from the Latino literature and suggested that acculturated behavior, collectivism, and intergenerational/ intercultural conflict interacted with certain stressors (emotional hardship, physical abuse, emotional abuse) to predict serious delinquency. Self-directed violence. Self-directed violence in A/PI adolescents is an understudied topic. We found only two articles that focused on acculturation and suicidality for this group, and these studies indicated that low acculturation levels may be a risk factor for suicidal behavior in A/PI adolescents. In a large survey of 3,094 youth in Hawaii, which encompassed 15% of Hawaiian high school students in the state, Yuen and her colleagues (2000) examined the association between Hawaiian cultural orientation and lifetime suicide attempts. Hawaiian youths had a higher suicide attempt rate than non-Hawaiians. Strong Hawaiian cultural orientation was a significant risk factor for suicide attempts and was a better predictor than ethnicity (Hawaiian versus non-Hawaiian). Lau and her colleagues (2002) analyzed suicidal ideation and self-harm in a sample of 285 Asian American children and adolescents who had received outpatient treatment in a mental health services clinic. Acculturation was a composite variable consisting of proficiency in English, language spoken at home, age at immigration, and proportion of life spent in the United States. The results indicated that youths who were less acculturated were at greater risk of suicidal ideation and attempts. However, there was a significant interaction effect between acculturation and parent–adolescent conflict, which significantly predicted suicidal ideation and attempts. When conflict was high, less acculturated youths were at higher risk of suicidal ideation and attempts than the more acculturated group. When conflict was low, there was no significant difference in risk for the two acculturation groups. Smokowski and Bacallao (2006) found a similar effect for Latino youth where the

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relationship between acculturation and internalizing symptoms was moderated by parent– adolescent conflict. Although intriguing, these mediation pathways and moderating relationnships need to be replicated in future studies.

Research on American Indian/Alaskan Native Adolescents There is a serious dearth of research examining how acculturation issues of AI/AN adolescents may be related to their experiences and perpetration of interpersonal and selfdirected violence. AI/AN adolescents are a neglected group that deserves more attention (Olson and Wahab, 2006). We did not find any articles studying the association between acculturation and dating violence or youth violence for AI/AN adolescents and only found four investigations, shown in Table 3, that considered suicidal behaviors—despite the fact that national data show these behaviors to be serious public health concerns for this ethnic minority group. Most surveillance systems and the U.S. Census Bureau typically report data for a combined American Indian and Alaskan Native group. In contrast, all four studies we located for this review focused on specific tribes of American Indians or American Indians in general, and Alaskan Native youth were not represented in these samples. The sample sizes in these studies ranged from 83 (Howard-Pitney et al., 1992) to 1,378 adolescents (Novins et al., 1999). Three of the studies sampled AI/AN youth from the Southwest region of the United States (Freedenthal and Stiffman, 2004; Howard-Pitney et al., 1992; Novins et al., 1999), and the other study‘s sample was from the Midwest (Yoder et al., 2006). Two studies considered specific tribal groups, and the other two studies sampled a general American Indian population. One study compared urban-reared with reservationreared youth (Freedenthal and Stiffman, 2004), but none conducted between-tribal-group comparisons. All four studies used multiple item scales to measure enculturation, ethnic identity, traditionality, and cultural identity. Unfortunately, none of the studies considered high acculturation as a risk factor. Measures of suicidal behavior varied across the studies and included single item assessments, such as history of suicide attempts and suicide ideation (Freedenthal and Stiffman, 2004; Howard-Pitney et al., 1992; Yoder et al., 2006), as well as standardized measures, such as the Suicide Probability Scale and the Suicide Ideation Questionnaire-Junior (Howard-Pitney et al., 1992; Novins et al., 1999). Analyses tended to be correlational, there were no longitudinal studies, and no studies considered mediators or moderators. Self-directed violence. A study conducted by Yoder and his colleagues (2006) examined a sample of 212 American Indian youth who lived on or near three reservations in the upper midwestern United States. Enculturation was first assessed with three subscales that measured the target youth‘s involvement in, and identification with, American Indian culture, and this enculturation score was then used to predict suicidal ideation. Results showed that enculturation was not significant in a bivariate model, but it became significant (with a negative association) in multivariate models. In the final multivariate model, enculturation was the second strongest predictor variable after drug use. In addition, perceived discrimination was found to be a significant predictor of suicidal ideation. Although this study found enculturation to be a significant cultural asset, three out of the four extant studies on acculturation and suicidal behavior in AI/AN youth reported that ethnic identity, cultural

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identity, or traditionality did not have a significant relationship with suicidal ideation or attempts (Howard-Pitney et al., 1992; Freedenthal and Stiffman, 2004; Novins et al., 1999). For example, using logistic regression models derived from a sample of 144 urban-reared and 170 reservation-reared American Indian adolescents, Freedenthal and Stiffman (2004) demonstrated that cultural identity was not a significant predictor of suicidal behavior. These contrasting findings underscore the importance of conducting more collaborative research in AI/AN communities. National data indicate that suicidal behavior is a serious public health concern for this ethnic minority group, but we have little empirical evidence mapping risk and protective factors for AI/AN interpersonal or self-directed violence.

DISCUSSION Many authors have hypothesized a link between acculturation and negative health behaviors, proposing positive, negative, and curvilinear associations (e.g., see Al-Issa and Tousignant, 1997; Delgado, 1998; Gil et al., 1994; LaFromboise et al., 1993; Szapocznik et al., 1980). For example, Rogler and his colleagues (1991) reviewed 30 investigations to determine whether consensus existed on the link between acculturation and mental health in Latino adults. Their review found conflicting and inconclusive evidence for the proposed relationships. Rogler and his colleagues concluded that acculturation is a complex process, and the association between this process and health behaviors warranted further research. Even less is known about the relationship between acculturation and violence in Latino, A/PI, and AI/AN adolescents (Gonzales et al., 2002; Le, 2002). The findings from our comprehensive review begin to illuminate this association and point to gaps that need to be filled by future research.

Acculturation, Interpersonal Violence, and Self-Directed Violence Dating and sexual violence. There is little extant data on dating and sexual violence in Latino and A/PI adolescents, and no information available for AI/AN youth. Most of the available information came from one multiethnic study that only surveyed females living in Massachusetts (Decker et al., 2007; Silverman et al., 2007), and one study of Mexican American youth in Texas (Sanderson et al., 2004). There were no significant associations between language use and sexual assault or dating violence for Latina or A/PI females in the Massachusetts study. However, group differences surfaced and demonstrated that Latinas reported significantly lower prevalence of sexual assault prior to the past year as well as significantly lower prevalence of dating violence victimization relative to peers. Yet, sexually active, immigrant Latinas reported significantly higher prevalence of sexual assault both prior to the past year and during the past year relative to peers, and this subgroup of Latinas were significantly less likely than peers to report dating violence victimization. For Mexican American adolescents living in Texas, Spanish-only speaking females were significantly less likely to report dating violence than peers who spoke both English and Spanish, or Englishonly in their homes. Experiencing racial discrimination was a risk factor for dating violence victimization for females, whereas both having a parent born outside the United States and

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reporting high salience of ethnicity were shown to be protective factors against dating violence victimization. No risk or protective factors surfaced for males. Although it is impossible to make claims based on two investigations, emerging evidence has suggested that low acculturated Latinas (e.g., those who speak Spanish at home, have a parent born outside of the United States, and have high salience for their ethnicity) report decreased risk for dating violence victimization; however, sexually active Latinas appear to be at higher risk for sexual assault. This pattern of effects appears reasonable given that low acculturated Latino parents tend to place more restrictions on their daughters as compared to their sons, and particularly in relation to dating (Bacallao and Smokowski, 2007). Thus, Latina adolescents who comply with close parental monitoring may be less likely to experience dating violence victimization, but those who do not comply and become sexually active may place themselves outside of their families, and focus more on peer interactions where sexual assault is more likely to occur. Future research is needed not only to clarify these patterns but also to examine risk and protective factors for dating violence victimization for A/PI and AI/AN adolescents. Currently, we only have beginning knowledge of dynamics for Latinas. Further, existing studies have focused on victimization and have provided no understanding of the perpetration of dating or sexual violence for Latino, A/PI, or AI/AN adolescents. Future studies should increase the scope of their investigations to fill in these substantial gaps in our knowledge base. Youth violence. The preponderance of evidence from studies on Latino and A/PI youth indicated that high adolescent acculturation (e.g., assimilation; measured by generation, time in the United States, English language use, U.S. cultural involvement or individualism scales) was a risk factor for adolescent problem behavior, aggression, and violence. Of the Latino studies, 75% of the investigations indicated a relationship between acculturation and youth violence, as did 69% of A/PI studies. The association between acculturation and youth violence for AI/AN youth has yet to be examined. The relationship between high acculturation, or assimilation, and youth violence was robust across studies that used samples of Latino and A/PI youth even when acculturation and youth violence were measured in a variety of ways. The assimilation and youth violence link is the most consistent finding in acculturation research. Further, assimilation has been found to be a risk factor for a number of negative health behaviors, including alcohol and substance use in Latino adults (Rogler et al., 1991) and adolescents (Gonzales et al., 2002), sexual promiscuity (Driscoll et al., 2001), high blood pressure (Steffen et al., 2006), and obesity (Khan et al., 1997). In comparison to less assimilated peers, more assimilated individuals display higher levels of alcohol use, less consumption of balanced, healthy meals, and more consumption of marijuana and cocaine (Amaro et al., 1990; Marks et al., 1990; Vega, Alderete et al., 1998). The association between higher acculturation and youth violence parallels the more established literature on alcohol use. Six out of seven studies on Latino alcohol consumption and abuse included in Rogler and his colleagues‘ (1991) seminal review found that high acculturation was associated with increasing alcohol use. For instance, Graves (1967) found assimilation was consistently associated with high rates of alcohol use and deviant behavior in Mexican Americans with low socioeconomic status. Similarly, Burnam and her associates (1987) found U.S.-born Mexican Americans had higher prevalence of alcohol and drug abuse and dependence than Mexican-born study participants. In addition, studies provide evidence

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that assimilation is associated with alcohol use in A/PI or AI/AN communities. Hahm and her colleagues (2003) found that more acculturated Asian American youth were at greater risk for alcohol use but only if they also had low parental attachment. Another study found that American Indian youth with lower levels of orientation toward American Indian culture and identity (i.e., more assimilated) were more likely to misuse alcohol than their counterparts with greater orientation to American Indian culture and identity (Herman-Stahl et al., 2003). Various hypotheses have been put forth to explain the relationship between high assimilation and negative health behaviors. One such hypothesis is a behavior adaptation theory, which states that assimilating individuals are adopting negative behaviors that are tolerated by the host society (Castro et al., 1996). Assimilating individuals initiate alcohol and substance use to fit into American peer groups. Latinas, for example, demonstrated markedly increased alcohol consumption as the traditional Latino sex role constraints against such behavior eroded (Caetano, 1987; Markides et al., 1988; Rogler et al., 1991). However, this behavior adaptation hypothesis does not easily apply to youth violence because, unlike alcohol use, violence is not a normative behavior widely tolerated by the host society. Furthermore, researchers have also suggested that negative health behaviors, such as alcohol use and youth violence, may be undertaken as a strategy for coping with acculturation stress (Gil et al., 2000). Maladaptive behavior is thought to derive from ―increased perceptions of discrimination, internalization of minority status, and/or socialization into cultural attitudes and behaviors that have a disintegrative effect on family ties‖ (Gil et al., 1994, p. 45). Acculturation stress is associated with self-deprecation, ethnic self-hatred, lowered family cohesion, and a weakened ego structure in the assimilated individual (Rogler et al., 1991). This acculturation stress hypothesis fits with our findings on youth violence. A number of studies found that the relationship between assimilation and youth violence was mediated by family conflict, and parental investment or engagement, especially for Latino youth. Acculturation conflicts appear to precipitate family stress, which in turn has an impact on parent–adolescent relationships. With lower family cohesion, support, and monitoring, youth may turn to gangs for affiliation and use violence as an outlet for their frustration. Additional studies identified ancillary factors, such as perceived discrimination and perceptions of a closed society, which may fuel the relationship between assimilation and youth violence by prompting acculturating youth to fight against societal injustices and marginalization. Further support for this stress hypothesis is provided by Schwartz and colleagues (2007), who found that the relationship between acculturation variables and externalizing behavior was mediated by self-esteem. Youth who identified with their ethnic group reported more positive feelings about themselves, and these youth in turn had more positive functioning. Assimilation was not the only risk factor identified in our review. Emerging evidence from four studies suggested that low acculturation, language difficulties, and lack of a connection to a cultural group may be risk factors for fear of victimization, internalizing mental health symptoms, alienation, being bullied, and displaying behavior problems. However, low acculturation also was found to be a cultural asset against dating violence victimization for Latina youth. In their national sample of more than 15,000 students in the sixth through tenth grades, Yu and her colleagues (2003) showed that, relative to Englishonly speaking peers, A/PI and Latino youth who spoke another language at home were significantly more likely to be bullied. These effects are understandable considering the low acculturated youth‘s vulnerability within a new cultural system that he or she does not fully

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understand. In this context of fear and alienation, many youths may see physically fighting as the only alternative for maintaining their dignity, especially when language difficulties limit communication (Bacallao and Smokowski, 2007). Our results also distinguished cultural assets, such as culture-of-origin involvement, ethnic identity, and collectivism, which counterbalanced the risk factors discussed above. Cultural assets positively influenced outcomes or mediated the impact of risk factors. Although there is emerging evidence from studies on A/PI youth, and beginning data on Latino youth, that ethnic group identity or culture-of-origin involvement appears to be a cultural asset associated with lower aggression or youth violence, this relationship requires more intensive study. Two out of three studies that tested ethnic identity or collectivism found these cultural assets to be related to lower youth violence in A/PI youth. The only caveat was that Go and Le (2005) also reported that ethnic identity was a positive predictor of delinquency for male, but not female, Cambodian youth and a sense of ethnic belonging was unrelated to delinquency for Cambodian youth. For Latinos, the Smokowski and Bacallao (2006) study was the only published work that examined an ethnic identity construct and youth violence. These researchers reported that Latino youth with stronger culture-of-origin involvement had significantly lower levels of aggression. These initial findings are encouraging because they reflect a growing body of literature showing the positive effect ethnic identity, enculturation, or culture-of-origin involvement has in minority adolescents‘ self-esteem (Phinney et al., 1995; Phinney et al., 1997). Self-directed violence. The literature on acculturation and self-directed violence in Latino, A/PI and AI/AN youth was not only limited but also filled with conflicting results. For Latino adolescents, most studies found high levels of assimilation and assimilationrelated conflicts and stress to be risk factors for suicidal behavior (Hovey, 1998; Hovey and King, 1996; Rasmussen et al., 1992; Swanson et al., 1992; Vega et al., 1993a). Only one of the seven Latino studies found the opposite relationship and showed low acculturation as a risk factor for suicide (Ng, 1996). Investigations of suicidal behavior in A/PI youth were rare. In contrast to the preponderance of Latino studies, the two investigations available for A/PI youth found a relationship between low acculturation and suicidal behavior (Lau et al., 2002; Yuen et al., 2000). Lau and her colleagues (2002) considered the moderating role of family conflict and found a significant interaction between acculturation and parent–adolescent conflict. When conflict was high, less acculturated youths were at higher risk of suicide than the more acculturated group. When conflict was low, there was no significant difference in suicide risk for the two acculturation groups. This moderation effect is interesting and again underscored the importance of family; however, the study requires replication. In contrast to both the Latino and A/PI literature, the four studies available on AI/AN youth showed that ethnic identity, enculturation, and traditionality were not related to suicidal behavior. Furthermore, when a recent study (Yoder et al., 2006) examined high enculturation in combination with other risk and protective factors, high enculturation was found to be significantly predictive of lower suicidal ideation among AI/AN youth. Overall, we know little about acculturation-related risk and protective factors for selfdirected violence in Latino, AI/AN and A/PI youth. More research is needed to increase our understanding of suicidal behavior in ethnic minority youths and the possible role acculturation factors play.

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STUDY METHODOLOGY AND FUTURE RESEARCH DIRECTIONS The available studies that examined the potential risk or protective role of acculturation for interpersonal and self-directed violence are limited, and clearly additional studies are needed before any strong conclusions can be drawn. Across the available studies, the sample sizes were generally moderate to large and allowed for sufficient power to examine the hypothesized predictive associations. The three minority groups that were the focus of this review are extremely heterogeneous, and in several studies specific subgroups were examined. However, in future studies, increased attention to the specific subgroups and between-group analyses are needed to assess for potential differences in the association between acculturation and the outcomes of interest. These more refined studies are necessary to determine whether violence and suicide prevention programs should attend to different predictive associations and risk and protective factors for various subgroups within a particular minority population. Without a universally accepted definition of acculturation, acculturation measurement strategies have varied and created controversy among researchers (Cabassa, 2003; Hunt et al., 2004). Some researchers advocate for the use of simple markers (e.g., generation, time in the United States) whereas others support implementing multidimensional scales to capture enculturation, assimilation, and acculturation stressors. The accurate assessment of adolescent‘s level of acculturation may also be influenced by the type of indicator and varying levels of acculturation within a family. For instance, use of a single indicator of acculturation, such as language spoken in the home, may be more indicative of the overall family‘s and/or parents‘ level of acculturation rather than the adolescent‘s level of acculturation. The varying type and quality of acculturation measures used may account for some of the conflicting findings described in this review (e.g., Brown and Benedict, 2004; Carvajal et al., 2002). Our review demonstrated the variable views and approaches to measuring acculturation, and none of our identified studies directly compared various approaches. In the broad acculturation field, the few investigations that directly compared different strategies for the same data showed multidimensional and bidirectional measurement superior for providing a refined view of how acculturation was related to health outcomes (Flannery et al. 2001; Phinney and Flores, 2002). Flannery and his colleagues (2001) conducted one of the few direct comparisons of single dimension versus multidimensional acculturation measurement models. In a sample of 291 Asian Americans, these researchers reported that both measurement strategies had adequate predictive validity for use in acculturation research. However, the multidimensional measures demonstrated stronger predictive validity, and their inclusion in studies was recommended to provide a detailed and thorough assessment of acculturation. The use of single item or linear measures (e.g., from Spanish preference to English preference) was recommended for large studies with limited capacity for lengthy assessments. In a separate work examining sex role attitudes of Latino adults, Phinney and Flores (2002) also showed that ―unpackaging‖ acculturation with multidimensional measurement was superior to single dimensional acculturation measures. After reviewing all of the extant literature, we concluded that the common use of simple single item acculturation measures allowed us to see the basic association between assimilation and violence; however,

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future studies using multidimensional measurement are needed to fully understand the nature and causal mechanisms behind this relationship. The preponderance of evidence from studies on Latino and A/PI youth indicated that adolescent, but not parent, assimilation (e.g., measured by time in the United States, English language use, U.S. cultural involvement, or individualism scales) was a risk factor for youth violence. Ethnic group identity or culture-of-origin involvement appeared to be cultural assets against youth violence based on supporting evidence from studies on A/PI youth, but more studies are needed to determine if this relationship holds for Latino and AI/AN youth. Low acculturation was found to be both a risk and a protective factor. Although some evidence showed low acculturation or cultural marginality to be a risk factor for higher levels of fear, victimization, and being bullied, other evidence demonstrated that low acculturation was a protective factor against dating violence victimization for Latino youth. Few studies examined the moderators and mediators of the relationship between acculturation and interpersonal and self-directed violence, but the available studies that included such variables point to the importance of future studies including consideration of mediating and moderating factors. For instance, an important trend emerging from both the Latino and, to a lesser extent, A/PI youth literature showed that the impact of acculturation processes on youth aggression can be mediated by family dynamics. As such, familism and family pride were significant cultural assets whereas parent–adolescent conflict and low parental investment heightened the influence of cultural risk factors. Identifying these common themes in research results is important because they directly inform the design, development, and dissemination of prevention programs for acculturating youth.

INTERPERSONAL AND SELF-DIRECTED VIOLENCE PREVENTION PROGRAMS FOR ACCULTURATING YOUTH Based on the research findings articulated above, prevention program planners should consider the benefit of slowing rapid assimilation and increasing cultural assets by encouraging ethnic identity and culture-of-origin involvement, which has the potential to lower risk for violence among adolescents. In addition, low-acculturated youth should be taught strategies for protecting themselves against victimization and the threat of being bullied without resorting to violent retaliation. Sexually active Latinas would benefit from prevention programs that increase their knowledge and skills for avoiding dating violence and sexual assault. Family-based strategies to lower acculturation stress and conflict would be particularly helpful given that family functioning appears to mediate the relationship between acculturation and youth violence. Our review also suggests that attention to acculturation issues in suicide prevention programs is important, but how prevention programs address cultural factors may vary when serving different populations. For instance, when serving Latino youth, programs may want to slow acculturation, whereas programs that promote stronger assimilation may prove more beneficial for A/PI youth. These multiple goals are most consistent with bicultural skills training interventions. LaFromboise and Rowe (1983) originally introduced bicultural skills training as a cultural adaptation to social skills training models. The goals of their bicultural skills training model were ―to promote communication skills that enhance self-determination, to teach coping skills

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to resist the pressure to assimilate or give up one‘s cultural identity, and to help participants develop discrimination coping skills to determine the appropriateness of assertive behavior in Indian and non-Indian cultures‖ (LaFromboise and Rowe, 1983, p. 592). Bicultural skills training groups have been used with a broad range of participants including Native American students (LaFromboise and Rowe, 1983; Marsiglia et al., 1998; Schinke et al., 1988), transracial foster parents and children (Mullender, 1990), middle school teenagers (Bilides, 1990), Asian American parents (Ying, 1999), preschool children (Arenas, 1978), Latina adolescents (Peeks, 1999), Cuban American families (Szapocznik et al., 1986), and Latino immigrant families (Bacallao and Smokowski, 2005). These programs commonly have the dual goals of slowing down assimilation and concurrently emphasizing the benefits of maintaining adolescent and familial ethnic identities (Bacallao and Smokowski, 2005). Bicultural skills training models applied to different settings and ethnic groups have shown promising initial results on a variety of outcome measures. Relative to youth in control conditions, adolescents who participated in bicultural skills training demonstrated higher ratings of self-control, ethnic identity, family functioning, self-concept, and healthy decision making when faced with peer pressure (Malgady et al., 1990; Schinke et al., 1988; Szapocznik et al., 1989). Additionally, participating youth have also demonstrated significantly lower rates of anxiety, depression, substance use, aggression, family conflict, and conduct problems relative to peers in control conditions (Constantino et al., 1986; Malgady et al., 1990; Pantin et al., 2003; Schinke et al., 1988; Smokowski and Bacallao, 2009). Consequently, bicultural skills training programs deserve further attention as a public health promotion strategy for acculturating adolescents and families. Although the current models have shown promising results, these programs have received little attention since the 1980s. This lack of attention has kept bicultural skills training models confined to Thomas and Rothman‘s (1994) design and evaluation stage of prevention program development. None of the tested models has received replication in diverse field settings to assess generalizability. Similarly, no bicultural skills training model has gone through Thomas and Rothman‘s (1994) dissemination stage of program development to promote widespread use. Future research in this area would benefit from the use of larger sample sizes, sophisticated data analysis strategies, and evaluation of proximal outcomes or mechanisms that make the programs effective.

CONCLUSIONS AND DIRECTIONS FOR FUTURE RESEARCH In summary, being an immigrant or less acculturated seems to be a protective factor against dating violence victimization; however, some evidence has indicated that low acculturation or cultural marginality can be a risk factor for higher levels of fear, victimization, and being bullied. A number of extant studies also found higher levels of assimilation, indexed by time in the country or U.S. cultural involvement, to be a risk factor for youth aggression and violence. Two studies showed ethnic identity to be a significant cultural asset associated with less aggression and violence in A/PI youth. An important emerging trend in the literature showed that the impact of acculturation on youth aggression and violence was mediated by family dynamics. Familism and family pride were significant cultural assets, whereas parent–adolescent conflict and low parental investment were family

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mediators that heighten the influence of cultural risk factors. Finally, acculturation stress and strain was shown as significantly and positively related to suicidal ideation, and most studies indicated that higher levels of assimilation were a risk factor for suicidal behavior among Latino youth. In contrast, emerging evidence from two studies with A/PI adolescents indicated that low acculturation levels may be a risk factor for suicidal behavior in this minority population. Across outcomes examined, only limited knowledge about the risk or benefit that acculturation level plays in AI/AN youth‘s interpersonal and self-directed violence behavior is available, and this area is in need of more attention. Although some consistent effects have emerged, the research area linking acculturation and interpersonal and self-directed violence is still in its infancy. Future studies are warranted, especially those including longitudinal data from multiple informants (e.g., at least adolescents and parents); using sophisticated multidimensional measures of acculturation; implementing advanced data analysis strategies (e.g., structural equation modeling, hierarchical linear modeling); and considering multiple areas of violence (e.g., peer violence, dating violence, family violence) to emphasize the high correlations between violent behaviors in the same study.

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In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 2

ACCULTURATION SUCCESS IN EMPLOYMENT AMONG CHINESE MIGRANTS FROM THE MAINLAND TO HONG KONG Chau-kiu Cheung City University of Hong Kong

ABSTRACT Migrants‘ successful acculturation occurs when they acquire class or occupational positions higher in the host place than in the origin. This is upward class mobility. Conversely, descending in the class hierarchy or downward mobility is an indication of acculturation failure. A longstanding but untested claim is the possibility of acculturation success in Hong Kong due to the openness and abundance of opportunity in the city. Moreover, gender differentials in acculturation success are still uncertain. For the clarification of the issues, a study of 622 adult migrants from the mainland of China to Hong Kong reveals the different forms of acculturation success or failure by log-linear modeling. Results demonstrate gender differences in patterns of class mobility. Essentially, male migrants were equally likely to experience upward and downward mobility. In contrast, female migrants were likely to fall out of employment and are unlikely to have upward mobility. Female migrants, furthermore, experienced less upward or downward mobility than did their male counterparts. To conclude, whereas male migrants are highly and equally likely to face acculturation success and failure in Hong Kong, female migrants are unlikely to exhibit acculturation success there.

Migrants‘ acculturation success often materializes in terms of upward mobility in employment or social class (Akresh, 2006). Conversely, downward class mobility signifies acculturation failure (Rooth and Ekberg, 2006). Whether migrants realize acculturation success in terms of upward class mobility as opposed to downward class mobility is at issue (Bean et al., 2004). Apparently, migration to different places culminates in different forms of class mobility (Akresh, 2006; Weinberg, 2001). Another possibility is that migration results in neither upward nor downward mobility, that is, either immobility or changing from an employee to a self-employed worker (van Tubergen, 2005). This possibility denies

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acculturation failure, as migrants at least locate a niche in the host place (Apitzsch, 2003). Such a niche tends to be rewarding, because it can benefit from migrants‘ ethnic, cultural capital to overcome obstacles and even exclusion in the host place (Li, 2000). Hence, mobility to various social classes and immobility are altogether of concern in assessing acculturation success. Such assessment is necessary in a Hong Kong as a host place, because of uncertainty in acculturation success and the need for clarifying relevant and competing assertions. One assertion is that Hong Kong is a paradise of opportunity for immigrants to reap their success (Chiu et al., 2005). A rival assertion is that immigrants to Hong Kong suffer from discrimination and obstacles to upward mobility and acculturation success (Raywani, 2004; Sautman and Kneehans, 2002). This assertion also applies to ethnic Chinese migrants from Mainland China to Hong Kong (Guan et al., 2009). Because such migrants represent the majority of newcomers to Hong Kong (Fung et al., 2009; Lin and Ma, 2008), their uncertain odds in acculturation success is particularly in need of clarification. They are therefore the target population of the present study. In addition, the study examines the related issue related to gender in order to shed light on conflicting contentions about gender differential in acculturation success. One contention implies that women migrated from Mainland China to Hong Kong suffer more than do their male counterparts because of reduced gender equality in Hong Kong than in Mainland China (Chan, 2000; Zhou, 2000). A rival contention purports that male workers in general and the male migrants in particular suffer more in the labor market because of cost reduction and downsizing in Hong Kong (Chiu and Lui, 2004; Meng, 2000). Ironically, gender inequality in Hong Kong may pose a disadvantage to male workers and migrants under economic restructuring (Lee and Warner, 2001; Sit, 2004). Reconciling these contentions about gender differential is an aim of the present study. Essentially, the study seeks to clarify acculturation success, in terms of class mobility or immobility, among migrants from Mainland China to Hong Kong. The migration is under regulation because of the policy of ―one country, two systems,‖ which allows for political, economic, and even cultural differences between the Mainland and Hong Kong as a special administrative region. In this connection, the regulation permits 150 migrants to cross the border daily. These migrants, since the reversion of Hong Kong to China, has already accounted for 9% (over 600,000) of the Hong Kong population in 2006. Because of the sheer number, their acculturation success or failure is crucial for clarification (Chiu and Lui, 2004). Acculturation success broadly means competence in living in the host society (Liebkind and Jasinskaja-Lahti, 2000; Sodowsky et al., 1997). A prominent demonstration of the competence is employment (Wentling and Wright, 2001). Conversely, migrants‘ inability to enter the labor market in host society is an indication of failure in acculturation (Holzer, 1998). Furthermore, a remarkable failure is downward class mobility (Rooth and Ekberg, 2006). In this regard, social class happens in the differential possession of means of production, including financial and physical capital, expertise or human capital, and managerial control (Wright, 1997). The differential possession arranges the following classes from the highest to the lowest: the ownership, capitalist, or bourgeois class of employers, petty bourgeois class of self-employed people, upper-middle or service class of professionals and administrators, middle class of supervisors or clerical workers, working class of ordinary workers, and surplus class of non-employed people. The ownership class holds financial or physical capital and self-employed people have lesser control over it, whereas the service class has expertise or managerial control and the middle class has lesser expertise or

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managerial control. In contrast, the working class has human labor as the means of production, whereas non-employed people do not have opportunities to demonstrate their means of production. These social classes altogether compose a hierarchy for upward and downward mobility. Upward class mobility is either (1) escalating to a higher class that is not self-employment or (2) moving from non-employment to self-employment. Conversely, downward class mobility is either (1) descending to a lower class that is not self-employment or (2) shifting to non-employment from self-employment. In addition, mobility from being an employee to self-employment is neither upward nor downward, because it is uncertain whether it represents an increase or decrease of means of production. The remaining possibility is immobility, meaning remaining in the same class before and after migration. These four mobility options represent the basic model of class mobility. In addition to basic model, a nuanced model is appropriate to clarify different forms of upward and downward mobility. Instead of glossing over upward and downward mobility, the nuanced model differentiates (1) upward mobility into those ascending to the upper-middle class and to another class, and (2) downward mobility into those descending to nonemployment, the working class, and another class. Each form of mobility and immobility has its basis in some research tradition.

BASES FOR CLASS MOBILITY Upward class mobility is relevant both personally and socially. Of personal relevance, upward mobility represents the acquisition of identity and the presentation of it, just like speech and dress (Kaufman, 2003). Relevant socially, upward mobility is an expectation of prominent social norms, which herald achievement, meritocracy, and individualism (Jones, 2003). Apart from upward mobility in general, mobility to the service or upper-middle class is critical and difficult (Chiu et al.. 2005). It is because upward mobility usually proceeds (1) step by step such that the middle class is a necessary step, (2) ascending to the service class means the acquisition of expertise or managerial control, which is difficult to obtain, and (3) the concern about the growth of the new class (DiMaggio et al., 2004; Peng, 2001; Whelan and Layte, 2002). The latter registers conflicting views concerning the growth of the service class as a new class. In one view, upward mobility in general and that to the service class in particular are plausible because of the expansion of education and continuing training (Dieckhoff, 2007). Another view indicates that economic restructuring furnishes opportunities for upward mobility (Diewald et al., 2006). For migrants particularly, upward mobility is feasible with the strengthening and rekindling of their social capital (Dominguez and Watkins, 2003). Essentially, exposure to and having a bridge to relate to native people in the host place are grounds for migrants‘ upward mobility. The securing of such grounds in turn benefits from the work of social service organizations that facilitate the ties. Alternatively, enhancing migrants‘ knowledge about the host place is a means to foster upward mobility (Akresh, 2006). In the case of Hong Kong, upward mobility is possible because of the open and mobile society, which provides opportunities, especially by virtue of economic integration with Mainland China (Lui, 2009). Hence, migrants are free to build up their knowledge and social capital to expedite their upward mobility there. A similar view applies to the United States, characterized by its exceptionally high upward mobility (Pisati, 1997).

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Nevertheless, such a view did not hold in East Germany and Soviet Russia some years ago (Marshall, 1997). Hence, upward mobility is possible but uncertain, given its variation across time and places. Downward mobility is also possible, notably in Germany (Diewald et al., 2006; McGinnity et al., 2005). Apparently, an open, capitalist society can breed people‘s downward mobility, as well as upward mobility (Diewald et al., 2006). The societal condition of economic restructuring, such as the use of temporary contracts, can also engender downward mobility (Diewald et al., 2006; McGuinnity et al., 2005). Paradoxically, when the economy fares well to leave a larger number of vacancies, downward mobility would be more prevalent (Gangl, 2004). A reason is simply that the availability of vacancies implies that people have quitted their jobs and thus experienced downward mobility. In this case, the availability of generous social welfare may urge people to quit their jobs to receive welfare benefits. At any rate, downward mobility is increasing with time (Diewald, 2006). Moreover, immigrants are particularly vulnerable to downward mobility (McGinnity et al., 2005). This happens because of discrimination and difficulty in transferring human capital across places (Rooth and Ekberg, 2006). Immigrants‘ language barrier may be responsible for their experience of discrimination and downward mobility (Akresh, 2006). Conversely, professional skills held by teachers or engineers would diminish these professionals‘ risk of downward mobility (Rooth and Ekberg, 2006). Immigrants‘ downward mobility commonly results in unemployment or proletarianization. Unemployment occurs because of the mismatch of human potential between the origin and host places (Wentling and Wright, 2001). Moreover, discrimination and exploitation encountered by immigrants would drive them out of employment (Fletcher and Jefferies, 1999; Holzer, 1998). Immigrants also lack social capital to help them find jobs and remain employed (Wong and Hsiao, 2002). More generally, immigrants tend to receive little help to prevent their down mobility (Wentling and Wright, 2001). Unemployment, joblessness, or being economically inactive is therefore common among immigrants (Bean et al., 1999; Portes and Rumbaut, 2001; Wilson and Jaynes, 2001). Besides, immigrants are likely to suffer from unemployment in a host place with fewer manufacturing jobs (Bean et al., 1999). This is just the case in Hong Kong, which has deindustrrialized its economy. In Hong Kong, migrants‘ unemployment is also likely because of the absence of a point system to admit skilled or employable migrants. Such a system would lessen immigrants‘ risk of unemployment (Hawthorne, 2005). Nevertheless, immigrants‘ downward mobility may be temporary, as they are waiting and queuing for upward mobility opportunity (Weinberg, 2001). Immigrants are also likely to experience downward mobility to the working class, because of the language barrier (Myers and Cranford, 1998). An alternative view, in contrast, holds that upward mobility rather than downward mobility is immigrants‘ norm (Bean et al., 2004). This may be particularly among Chinese immigrants, who aspire to secure jobs (Zhang and Sanders, 1999). Immigrants‘ unemployment also is less likely in a host place more similar with the origin (van Tubergen et al., 2004). In the case of migration from Mainland China to Hong Kong, unemployment may be unlikely because of similarity between the origin and destination. For the same reason, the sharing of ethnicity would reduce immigrants‘ chance of unemployment (van Tubergen et al., 2004). This also suggests a lower risk of unemployment among migrants from Mainland China to Hong Kong. Moreover, with the gradual shrinkage of the working class in postindustrial society, downward mobility to the working class becomes less likely (Myers

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and Cranford, 1998). In view of the postindustrial economy of Hong Kong, migrants‘ proletarianization is therefore not an expected trend. Mobility from being an employee to self-employment is neither upward nor downward mobility. Becoming self-employment tends to respond to the trend favoring entrepreneurship in the postindustrial or new economy (Allen, 2000; McManus, 2004). This trend dovetails with the trend toward outsourcing and lean production, which warrant self-employment (Luber and Leight, 2000). Downsizing also drives people to become self-employed (McManus, 2004). Such a trend also prevails in Hong Kong (Lui, 2009). Conversely, selfemployment may not be likely because of urbanization and economic development (Lin, 2001; Shu and Bian, 2002). These factors may discount the chance of self-employment in Hong Kong. To the immigrant, self-employment is a common mode of mobility (van Tubergen 2005). It occurs because of obstacles to immigrants‘ employment difficulty in their transferring of knowledge (Kanas et al., 2009; Li, 2000). Self-employment appears to be the second-best choice for immigrants. Some even regard self-employment as a success for immigrants (Alund, 2003). Furthermore, it tends to represent a way of emancipation for immigrants, such that they are free of exploitation in employment (Apitzsch, 2003). It usually takes place in ethnic enclaves (Li, 2000; van Tubergen, 2005). This is because of the concentration of ethnic resources or cultural capital in ethnic enclaves (Apitzsch, 2003). Immigrants‘ self-employment tends to prevail in a place with substantial retail business (Light and Rosenstein, 1995). This would be the case of Hong Kong, known for its fame as a shopping paradise. Nevertheless, immigrants‘ self-employment would be less likely in a place close to the origin (van Tubergen, 2005). This factor may reduce the chance of migrants‘ selfemployment, when they just cross the border to Hong Kong.

GENDER DIFFERENTIALS Women tend to experience more upward class mobility than do men (Diewald et al., 2006). This may be due to increasing gender equality and women‘s emancipation in the labor market (Lane, 2000). Accordingly, because of women‘s lower class before, they have greater latitude for advancement. The result is that women are more likely than are men to become professionals (Dickson and Rublee, 2000; Lin and Ao, 2008). Nevertheless, women are less likely to be managers and entrepreneurs or employers (Dickson and Rublee, 2000; Halaby, 2003). Women are also less likely to slide down the class hierarchy, and this echoes their higher chance of upward mobility (Diewald, 2006). However, this is not the case in immigrant women, who are more likely than their male counterparts to experience downward mobility, especially when the women get married (Weinberg, 2001). This case aptly applies to Hong Kong when marriage is a significant reason for many women to migrate to Hong Kong. Mobility to self-employment is less likely for women than for men. More men than women are self-employed (Diewald, 2006; Portes and Shafer, 2007). The gender difference may reflect the man‘s higher values of risk taking and independence (Coffe and Geys, 2007), which are conducive to self-employment (Aurahami and Lerner, 2003; Norris and Davis, 1994). Male immigrants are also more likely than are female immigrants to engage in selfemployment (Kanes et al., 2009; Portes et al., 2002). Moreover, male immigrants are more

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likely to contact coethnic people, and this contact is conducive to engagement in selfemployment (Light and Rosenstein, 1995). The differential may be attributable to the male immigrant‘s higher tendency of risk taking (Miller-Johnson et al., 2003).

HYPOTHESES As reviewed, some research and theory provide rationales for formulating the following hypotheses concerning the migrant from Mainland China to Hong Kong: 1. Upward mobility is very likely. 1.1. Upward mobility not to the service class is very likely. 2. Downward mobility is very likely. 1.2. Downward mobility to unemployment is very likely. 1.3. Downward mobility to the working class is very likely. 3. 4. 5. 6. 7.

Mobility to self-employment is very likely. Immobility is very likely. Upward mobility is more likely in the woman than in the man. Downward mobility is more likely in the woman than in the man. Mobility to self-employment is less likely in the woman than in the man.

Key to the above hypotheses is the determination of mobility or immobility as very likely. A very likely instance is one with a relative risk (i.e. probability) greater than 4 (or a log-linear coefficient of 1.386), which is a strong effect size (Ferguson, 2009). In the basic model estimating the four options, upward mobility, downward mobility, mobility to selfemployment, and immobility, upward mobility would be very likely if the probability of having upward mobility over the probability of having none of the four options is greater than 4. Essentially, all relative risks of the four options can be high.

METHODS In 2006, a survey of 622 Chinese mainland migrants in Hong Kong provided data for the study. Because mainland migrants dispersed in every place in Hong Kong, soliciting social service agencies that had contact with the migrants would be an efficient way to locate the migrants. The agencies, receiving support from the government, played a significant role in facilitating migrants‘ adaption to Hong Kong. As such, the agencies maintained contact with migrants once they arrived at Hong Kong. Among 50 such agencies approached, 30 lent support to locate 1,456 mainland migrants. Of these migrants, those 622 migrants who were neither students nor retirees constituted the study sample. These migrants completed survey questionnaires at the social service agencies, in the presence of research personnel, who administered the questionnaires. The sampled migrant, on average, had lived in Hong Kong for 4.5 years (see Table 1), with a minimum of 0 year and a maximum of 14 years.

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Table 1. Means and standard deviations (N = 622) Variable Duration of residence in Hong Kong Age at arrival at Hong Kong Age Grade before arrival at Hong Kong Grade increase after arrival at Hong Kong Fluency in speaking Cantonese before arrival at Hong Kong Fluency increase in speaking Cantonese since arrival at Hong Kong Work experience before arrival at Hong Kong Schooling since arrival at Hong Kong Parents upon arrival at Hong Kong Siblings upon arrival at Hong Kong Friends upon arrival at Hong Kong Female Having disability or chronic illness before arrival at Hong Kong Coming from Guangdong Province Coming from Fujian Province Class mobility since arrival at Hong Kong Upward Downward Becoming self-employed from others Immobility Upward, not to the upper-middle class Upward to the upper-middle class Downward, not to non-employment and the working class Downward to non-employment Downward to the working class

Scoring years years years years years 0-100 0-100 years months number number number 0, 100 0, 100

M 4.5 35.6 40.2 7.8 0.0

SD 3.7 8.8 9.4 3.1 1.2

61.9

36.3

6.1 6.1 8.8 0.1 0.5 4.0 83.3

29.5 7.3 27.5 0.3 1.0 10.7

0, 100 0, 100

4.3 81.5 5.1

0, 100 0, 100 0, 100 0, 100 0, 100 0, 100

12.2 29.3 0.5 57.1 11.8 0.5

32.8 45.5 6.9 49.5 32.2 6.9

0.5 25.9 3.7

6.9 43.9 18.8

0, 100 0, 100 0, 100

These migrants had an average age of 40.2 years at the time of the survey and an average age of 35.6 years at the time of arrival at Hong Kong. The majority of them were women (83.3%), probably reflecting the case that many were wives of residents in Hong Kong. This is because many men in Hong Kong chose to marry women in the mainland (Yip and Lee, 2000). Before arrival, their average school grade was 6.1 years (with Primary 1 as 1). Since arrival, they had an average of 8.8 months in schooling. This schooling, on average, was not sufficient to raise the migrant‘s education by one grade. Upon their arrival at Hong Kong, the migrants had an average of 0.1 parent, 0.5 sibling, and 4 friends reported in Hong Kong. Only 4.3% of them reported having chronic illness or disability before arrival at Hong Kong. Most (81.5%) of them came from Guangdong Province, which is adjacent to Hong Kong. Besides, 5.1% of them migrated from Fujian Province, which is adjacent to Guangdong Province. The migrants rated their Cantonese fluency, on average, as 61.9 on a 0-100 scale before arrival and 68.0 after arrival at Hong Kong. They therefore had an average increase of 6.1 in

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Cantonese fluency. In addition, social network size referred to the average of the standard scores of the number of parents, siblings, and friends that the respondent reported to have upon arrival at Hong Kong. Both before and after arrival at Hong Kong, more of the migrants were in a lower social class. About half of them had not been in employment before arrival, but nearly two-thirds of them were not in employment after arrival (see Table 1). The increase in non-employment was most salient. Conversely, fewer people were middle class or upper class members after arrival than before arrival. Some class mobility was therefore observable.

ANALYTIC PROCEDURE Log-linear analysis of the topological model was the statistical technique used to estimate relative risks, which were the exponentials of parameter estimates (Manzo, 2006). Such analysis was necessary to control for distributional differences in social class both before and after migration. The modeling was in eight folds, using either 2-way or 3-way table. The 2way table was the cross-tabulation of social classes before and after migration, and the 3-way table was the differentiation of the 2-way table according to gender, male and female. Moreover, the analysis involved a basic model, nuanced model, and modified basic model. With such variations, the eight models were: 1. 2-way table with the four basic options, upward mobility, downward mobility, mobility to self-employment, and immobility 2. 2-way table with seven nuanced options, having upward mobility to the upper-middle class and not the upper-middle class in place of upward mobility in general, and downward mobility to non-employment, downward mobility to the working class, and downward mobility to another class in place of downward mobility in general 3. 3-way table with the four basic options invariant between genders 4. 3-way table with the four basic options varying between genders 5. 2-way table for the male with the four basic options 6. 2-way table for the female with the four basic options 7. 2-way table for the female with the seven nuanced options 8. 2-way table for the female with the modified basic options, using downward mobility to non-employment instead of downward mobility in general In the modeling or identification of models, parsimonious fit was a consideration, which preferred models that fitted tabulated data with more degrees of freedom. Conversely, models fitting data with more parameters were less preferable. This consideration eventually guided the identification of the modified basic model, which was more parsimonious than the nuanced model. As such, topological modeling had the merit of presenting a holistic view about class mobility to verify if the basic, nuanced, or modified basic models and their mobility options adequately described the major patterns of mobility.

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RESULTS Most of the Chinese migrants were not in employment both before and after migration (50.6% and 65.0%, see Table 2). About a quarter of them had working-class jobs both before and after migration (28.6% and 26.6%). Nevertheless, the distribution in the male migrants was different. More male migrants had working-class jobs both before and after migration than being not in employment (42.9% and 47.6% vs. 25.7% and 28.6%). Anyway, the majority of the migrants had either working-class job or no employment before and after migration. More (58.5%) of the Chinese mainland migrants exhibited no class mobility (57.1%) than showing upward mobility (12.2%), downward mobility (29.2%), and other forms of mobility since migration to Hong Kong (see Table 1). Most of the upward mobility was not to the service or upper-middle class (11.8%) and most of the downward mobility was to nonemployment (25.9%).

Table 2. Percentages of classes before and after migration (N = 622) Class Not in employment Working class (manual) Middle class (routine non-manual, clerical) Upper-middle class (professional, managerial) Petty ownership class (self-employed) Ownership class (employer)

Before 50.6 28.6 12.1 4.1

All After 65.0 26.6 5.6 1.1

Before 25.7 42.9 15.2 7.6

Male After 28.6 47.6 17.1 2.9

Before 55.4 25.8 11.5 3.4

Female After 72.3 22.4 3.3 0.8

3.2 1.4

1.0 0.8

3.8 4.8

2.9 1.0

3.1 0.8

0.6 0.8

In contrast, very few migrants became self-employed (0.5%) or moving across ownership statuses (1.3%), from employees to employers or the self-employed and vice versa. Overall, 39.1% of the migrants remained not employed, and this number represented two-thirds of those migrants who did not show class mobility. These percentages, did not adequately reveal the chance of mobility, because of the uneven distribution in social class both before and after migration to Hong Kong. To estimate the chance, log-linear modeling was necessary, which controlled for the distributional differences.

MODEL FITTING Model 1, which fitted data in the 2-way table with four basic mobility options, did not attain a good fit (p < .01, see Table 3). This meant that the mobility was more complicated than that described by the basic model or its four mobility options. Possibly, something more than upward and downward mobility happened. This warranted the fitting of more complicated model, the nuanced model. Model 2, the nuanced model, fitted data in the 2-way table (p = .089), and this fit justified the specification of upward mobility to the upper-middle

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class and downward mobility to non-employment and the working class. The nuanced model was then a satisfactory model with parsimonious fit to mobility data. Table 3. Likelihood ratio chi-square tests Table 2-way

2-way

3-way

3-way

2-way: male

2-way: female

2-way: female

Test Upward mobility Downward mobility Becoming self-employed Immobility (basic model) Upward mobility to the upper-middle class Upward mobility not to the upper-middle class Downward mobility to non-employment Downward mobility to the working class Downward mobility to another Becoming self-employed Immobility (nuanced model) Gender invariant in Upward mobility Downward mobility Becoming self-employed Immobility (basic model) Gender differential in Upward mobility Downward mobility Becoming self-employed Immobility (basic model) Upward mobility Downward mobility Becoming self-employed Immobility (basic model) Upward mobility Downward mobility Becoming self-employed Immobility (basic model) Upward mobility to the upper-middle class Upward mobility not to the upper-middle class Downward mobility to non-employment Downward mobility to the working class Downward mobility to another Becoming self-employed Immobility (nuanced model)

L2 46.793

df 21

p .001

26.476

18

.089

65.296

46

.032

48.246

43

.492

5.002

22

1.000

37.521

21

.015

20.915

18

.284

Model 3, which fitted data in the 3-way table using the four mobility options of the basic model without gender differentials, did not attain a very good fit (p = .032, see Table 3). One

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way to find a better fit was to allow for gender differentials in the mobility options. Model 4, which allowed for the gender differentials, fitted the mobility data very well (p = .492). Further modeling revealed that while the basic model fitted male mobility data perfectly (Model 5, p = 1.000), it did not fit female mobility data very well (Model 6, p = .015). Instead, the nuanced model using seven mobility options fitted female data (Model 7, p = .284). A more parsimonious model, Model 8, which fitted female data, was the modified basic model (p = .113). This model specified downward mobility to non-employment instead of downward mobility in general. In all, while the nuanced model with seven mobility options was necessary to fit the 2-way table, which lumped together male and female data, the modified basic model most optimally fitted the 2-way table for migrant women. Importantly, a gender difference was evident to indicate the particular risk of downward mobility to nonemployment in female migrants.

SIGNIFICANCE OF MOBILITY OPTIONS Regardless of gender variation, immobility was most significant statistically and practically (log-linear coefficient = 2.243, or relative risk = 9.422, see Table 4). This was a highly likely option, consistent with Hypothesis 4. The next most significant option was upward mobility (log-linear coefficient = 1.560, or relative risk = 4.759). This was another highly likely mobility option, supporting Hypothesis 1. Downward mobility was also statistically significant (log-linear coefficient = 1.066, or relative risk = 2.904). This option was not highly likely, thus refuting Hypothesis 2. Besides, mobility to self-employment was not statistically significant (log-linear coefficient = 1.107, or relative risk = 3.025). It was also not a highly likely option, and this refuted Hypothesis 3. More elaborate mobility options maintained in the nuanced model were required to fit the 2-way mobility table, which lumped data from both sexes. Estimated according to the nuanced model, immobility was again the most likely (log-linear coefficient = 4.520, or relative risk = 91.836, see Table 4). This highly likely option supported Hypothesis 4. Upward mobility not to the service class was significant (log-linear coefficient = 2.955, or relative risk = 19.202). This was a high chance, in support of Hypothesis 1.1. In contrast, upward mobility to the service class was not statistically significant. All the three options of downward mobility were significant and highly likely (relative risk > 22.109). Hence, Hypotheses 2.1 and 2.1 received support. In addition, downward mobility not to nonemployment or the work class was also significant. Mobility to self-employment was also significant and highly likely (log-linear coefficient = 2.770, or relative risk = 15.959). This finding supported Hypothesis 3. For fitting male mobility data, the basic model was already adequate. Estimated for the basic model of male data, both upward and downward mobility were significant and highly likely (log-linear coefficient > 16.295, see Table 5). This finding led support to Hypotheses 1 and 2. Moreover, the man‘s upward mobility and down mobility was equally likely (common log-linear coefficient = 17.008, deviation from this = 0.712, p = .420).. In contrast, both immobility and mobility to self-employment were not visible in the male migrant (log-linear coefficient = 0.000). Hypotheses 3 and 4 did not describe the male migrant‘s mobility.

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Chau-kiu Cheung Table 4. Parameter estimates from two-way models Parameter Constant Social class after arrival at Hong Kong Not in employment Working class (manual) Middle class (routine non-manual, clerical) Upper-middle class (professional, managerial) Petty ownership class (self-employed) Ownership class (employer) Social class before arrival at Hong Kong Not in employment Working class (manual) Middle class (routine non-manual, clerical) Upper-middle class (professional, managerial) Petty ownership class (self-employed) Ownership class (employer) Class mobility since arrival at Hong Kong Upward Downward Becoming self-employed from others Immobility Upward, not to the upper-middle class Upward to the upper-middle class Downward, not to non-employment and the working class Downward to non-employment Downward to the working class

Basic -2.994***

Nuanced -5.093***

3.679*** 2.707*** 1.191* -.033 .226 -

2.487*** 2.494*** 1.120* .940 .643 -

2.602*** 2.561*** 2.045*** 1.048** .999* -

3.591*** 2.603*** 2.092*** .951* .834* -

1.560** 1.066* 1.107 2.243*** -

2.770* 4.520*** 2.955** 1.459 3.794** 4.385** 3.096**

Note: Reference categories were the ownership class before and after arrival and non-existent mobility. * p < .05. ** p < .01. ***: p < .001.

For fitting female mobility data, the modified basic model was preferable to the basic model. Estimated according to the modified basic model, downward to non-employment was significant and highly likely (log-linear coefficient = 2.044, or relative risk = 7.721, see Table 5). This was in support of Hypothesis 2.1. Instead, downward mobility in general was not significant (log-linear coefficient = 0.422, or relative risk = 1.522). The other significant finding was immobility (log-linear coefficient = 1.549, or relative risk = 4.707). The highly likely chance of immobility was consistent with Hypothesis 4. Besides, mobility to selfemployment for the migrant woman was highly likely but not statistically significant (loglinear coefficient = 17.651). Comparison of estimates from male and female data showed that upward mobility and downward mobility were both higher in the male migrant than in the female migrant. Moreover, mobility to self-employment was more likely in the female migrant than in the male migrant.

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Table 5. Mobility parameter estimates from three-way models Parameter

Male Basic

Female Basic

Female Modified basic

Class mobility since arrival at Hong Kong 16.295*** 1.262* -.180 Upward Downward 17.008*** .422 Becoming self-employed from 0.000 16.637 17.651 others Immobility 0.000 1.471** 1.549*** 2.044* Downward to non-employment Note: Reference categories were the ownership class before and after arrival and non-existent mobility. * p < .05. ** p < .01. ***: p < .001.

All these findings refuted Hypotheses 5, 6, and 7, based on existing research. Furthermore, immobility occurred in the female migrant but not in the male migrant.

DISCUSSION Acculturation success in terms of upward class mobility after migration is highly likely in migrants from Mainland China to Hong Kong, regardless of their gender. Meanwhile, acculturation failure in terms of downward class mobility after migration is also highly likely in the migrants. Specifically, acculturation failure is highly likely in the female migrants in terms of downward class mobility to non-employment. Despite the possibility of upward and downward mobility, immobility is also highly likely in the migrants. Mobility to selfemployment occurs only in the female migrants. In all, upward mobility, downward mobility, mobility to self-employment, and immobility are the four basic options descriptive of class mobility in the migrants. These options are all highly likely. Crucially, the mobility pattern differs substantially between the male and female migrants. Upward class mobility is highly likely, particularly in male migrants from Mainland China to Hong Kong. This is a finding echoing claims about the openness and paradise of opportunity in Hong Kong (Chiu et al., 2005). The paradise tends to build on a number of features in Hong Kong, including its immigrant economy, service industries, freedom, competitiveness, growth orientation, hardworking labor force, flexible labor market, and globalization (Chiu and Lui, 2004; Holliday, 2000; Jessop and Sum, 2000; Meng, 2000; Smart and Smart, 2008; Suen and Chan, 1997). Accordingly, Hong Kong is open and supportive of immigrants‘ acculturative success by offering abundant opportunities of upward mobility. Such opportunities have been noticeable for a long time (Wong, 1991). Female migrants from Mainland China to Hong Kong also enjoy upward mobility, especially relative to downward mobility. However, their upward mobility is substantially less likely than that of their male counterparts. This observation refutes Hypothesis 5, derived from existing research in other places. One obvious reason is that Mainland China is more egalitarian than is Hong Kong in the facilitation of female employment. This means that Hong Kong is not an egalitarian society supportive of female upward mobility more than is

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Mainland China. Another reason may be the female migrant‘s personal indifference in the pursuit of upward mobility. In this connection, the female migrant tends to have a lower demand for advancing her social status (Malcarne et al., 2006). That is, upward class mobility may not be an incisive concern for acculturation success in migrant women. Hence, she may make less action than may the male counterpart to climb up the class ladder. This is an explanation of action rather than opportunity available in society. Nevertheless, the migrant woman‘s lower upward mobility may also suggest a deficit in opportunity, probably due to discrimination (Portes, 1995). The reason for discrimination against women may be due to patriarchal ideology and male domination (Poole and Langen-Fox, 1997). Women‘s relative deficit in power in various domains of life would be a reason for their frequent experience of discrimination at work. To be fair, the gender disadvantage in upward mobility is attributable to both societal and personal causes, pertaining to structural opportunity and dispositional action respectively. Downward mobility or acculturation failure is also likely, especially in the male migrants, who experience no immobility at all. This finding does not contradict the assertion about the openness and availability of opportunity in Hong Kong society, as the openness can imply upward and downward mobility at the same time. Conceivably, in a vibrant society, upward and downward mobility need to occur simultaneously to leave room for each other. Downward mobility inevitably reflects the difficulty in transferring human capital across borders (Rooth and Ekberg, 2006). In contrast, the migrant woman experiences less downward mobility than does her male counterpart. Her downward mobility primarily occurs in the transition to non-employment. This transition aptly reflects the case that migrant women become homemakers after they have married in Hong Kong (Chiu et al., 2005). Nevertheless, such downward mobility is less likely than the male migrant‘s downward mobility. The discrepancy implies that difficulty in transferring skills is more serious in male migrants than in female migrants. Alternatively, the discrepancy may indicate that discrimination is greater against male migrants than against female migrants (Malcarne et al., 2006). This reason of discrimination, however, cannot explain why the male migrant experiences greater upward mobility as well. Another reason, proposed by social role theory and others, is that the man is more mobile than is the woman (Eagly et al., 2000). The mobility in general can supposedly affect social mobility in the class hierarchy as well. Conversely, the female migrant is more likely to be immobile in the class hierarchy, and this immobility would reflect the female preference for immobility in general. Mobility to self-employment only occurs in the female migrants, but not in their male counterparts. This finding contradicts Hypothesis 7, derived from research in other places (Kanas et al., 2009; Portes et al., 2002). Notably, the contradiction may reveal the unsuitability of the thesis about the ethnic enclave to Hong Kong. The thesis maintains that self-employment is likely to occur in an ethnic enclave with the concentration of ethnic resources and support (Portes and Zhou, 1999). However, no such enclave takes place in Hong Kong, as both migrant and native people are ethnic Chinese, who represent 97% of the population. As the ethnic enclave is not a contributor to mobility to self-employment, other factors are important instead. Conceivably, these other factors would be particularly in favor of female migrants‘ mobility to self-employment. One reason may be that female migrants maintain better social competence and relationships with people and potential clients (Kuperminc et al., 2009; Scott, 2004). Such relationships would be conducive to female migrants‘ self-employment (Kiong and Kee, 1998).

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FURTHER RESEARCH Results are not definitive because of limitations of the study in sampling and measurement. The limitation of sampling is evident in its reliance on social service agencies to recruit migrants for the study. Conceivably, the agencies are not able to contact migrants of different characteristics with an equal probability. Migrants contacted were likely to have certain relationships with the agencies, such as use of social services provided by the agencies and otherwise seeking help from the agencies. In what ways these relationships affect class mobility or acculturation success are unclear. One clear shortcoming in the sampling is the preponderance of female composition. It means that results concerning male migrants are limited and thus less certain than those of female migrants. Besides, the measurement or design of the study is a self-report, retrospective one. Such report is vulnerable to bias in recall. To minimize the limitations, further research needs to employ a prospective design to collect data more objectively from a representative sample. Notably, objective measurement can complement or corroborate self-report measurement. To obtain generalizable results, further research needs to analyze data not only from Hong Kong, concerning migrants from Mainland China, but also investigating migration from different origins to different host places. Moreover, further research can explore how contextual factors pertaining to different origins and hosts affect class mobility and acculturation success. It is to clarify the generality and specificity of findings drawn from the present study. Reasons are not transparent for gender differentials in mobility that contradict hypotheses based on research in other places. Conceivably, a mix of structural and dispositional causes can underlie the gender differentials. These causes include opportunity, discrimination, social roles, personal choice, and social competence and networking are all possible. Whether and how these causes are responsible for the gender differentials are in need of further research.

IMPLICATIONS Results indicate that women migrated from Mainland China to Hong Kong have only a low chance of upward mobility, and their downward mobility to non-employment is likely. These women would have a need for help to sustain their acculturation success. In contrast, male migrants generally do not necessarily succeed or fail in class mobility, as upward and downward mobility are equally likely in male migrants. Hence, the male gender is not an attribute for the need for help to achieve acculturative success. To male migrants, Hong Kong is particularly a place of opportunity and risk taking, for both upward and downward mobility. This feature tends to match male migrants‘ risk-taking orientation (Miller-Johnson et al., 2003). In all, the gender differential in acculturation success of migrants from Mainland China to Hong Kong is different from that expected from research in other places.

ACKNOWLEDGMENT This paper evolved from the research project (#9040851) funded by the Research Grant Committee of Hong Kong.

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In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 3

THE IMPLICIT COGNITIVE PERSPECTIVE IN ACCULTURATION a

Daisung Janga and Do-Yeong Kimb Olin School of Business, Washington University in St. Louis, USA School of Business Administration, Ajou University, South Korea

b

ABSTRACT In this chapter, the conceptual basis for the use of the implicit cognition paradigm in the acculturation domain is discussed. In particular, it is argued that the process of acculturation occurs in conscious (explicit) modes, but also in non-conscious (implicit) modes. In addition, implicit cognitions derived from such non-conscious processes may play an important role in determining the acculturation and well-being outcomes. First, we note that most research in the acculturation domain has been conducted using surveytype measures, which may only reflect explicit processes in acculturation. We also note a developing trend in applying the implicit cognitive perspective in the study of acculturation, by specifically defining implicit psychological acculturation (Kim, Sarason, & Sarason, 2006), by showing how it may complement existing conceptual frameworks of acculturation (e.g. Berry, 2003), and demonstrating how it may provide data about the fundamental processes of acculturation which are not available to introspection. Furthermore, we speculate about changes in the pattern of explicit and implicit cognitions in reaction to contact with another culture by providing a working model of explicit and implicit culture acquisition. Second, we examine the burgeoning literature on acculturation using implicit measures on three key topics, namely, identity, parental relations, and intergroup relations. Through a brief review of extant research, we show support for our arguments, highlighting the necessity for the implicit cognitive perspective in acculturation research. In addition, we provide evidence that implicit measures have implications for both psychological and social acculturation, namely implicit psychological acculturation. Finally, the potential for future research in acculturation issues using the implicit cognition paradigm, and implications for organizations are discussed.

Major themes: Intergroup relations, cultural assumptions, identity, differences, family relations

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INTRODUCTION Over the past decade, research on non-conscious cognitions have contributed to a more complex view of many social processes. In particular, the advent of the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998), and other measures which attempt to quantitatively assess implicit cognitions (e.g. word completion tasks; Hetts, Sakuma, & Pelham, 1999) has facilitated research examining both the pattern of explicit (that is, conscious), and implicit (non-conscious) cognitions, supplementing the understanding of social phenomena. In the current chapter, we aim to examine how the implicit cognition perspective can supplement the study of the acculturation process. According to one of the most often cited definitions, acculturation results when "groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original cultural patterns of either or both groups" (Redfield, Linton, & Herskovits, 1936). This implies that research in acculturation should focus on changes in levels of cultures over the duration of inter-group contact. Logically however, group level changes in culture should also be accompanied by individual level changes in culture. Thus, not only can there be changes at the group level, but changes at the individual level, with regard to how people think, behave and relate to each other. To this end, Berry (1980, 2003) extended the original anthropological definition of acculturation to posit the notion of psychological acculturation, indicating changes occur within the individual, with regard to their attitudes, values and behaviors as a result of contact between the culture one originally belongs to, and the new host culture. That the distinction between the cultural level and the individual level be maintained is a critical one, since while individuals are influenced by the culture at large and embody cultural values of their respective social groups, there are individual differences in the level of culture embodied by a particular individual, and hence, there may be individual differences in the amount of acculturation an individual might experience. Therefore, changes in levels of culture at a group level may not reflect individual experiences of acculturation (Taras, Rowney, & Steel, 2009). Methodological options to assess individual level experiences of acculturation began with measures developed from the lessons learned from the highly cited IBM employee studies investigated by Hofstede (1980, 2001) who used survey methods. Since then, there have been a proliferation of measures of culture, and for the most part, assessment methods has focused on survey methods (Taras, 2008; Taras et al., 2009), which access psychological processes and their consequences such as perception, cognition, evaluation, and behavior. This is largely consistent with Hofstede's original assertions that culture can be measured in terms of words (verbal responses) or deeds (behavior). However, the proliferation and frequent use of survey methods to assess culture and acculturation in the literature since Hofstede's work seems to indicate that researchers largely rely on verbal responses over behaviors; we are in no doubt that the logistical challenges in monitoring behavior for changes in culture have contributed to the popularity of survey methods. Furthermore, there is a justification that core cultural values and concepts are responsible for cultural differences in behavior, and it may be more productive to monitor such values and concepts over behavior, which may change with differing social and historical contexts. If we are to examine the survey method more closely, the fundamental assumption which is made when using such methods is that the acculturating person is able to reflect on their

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experiences through introspective processes (Devos, 2006). While we acknowledge that experiences of cultures different from one's own can be a salient experience and is available to the conscious mind to be verablized (and the commonly experienced 'culture shock' phenomena reinforces this belief), it may not necessarily represent the entire phenomena of acculturation. Researchers have long been aware of the introspective limit of respondents in responding to assessment items (Eagly & Chaiken, 2007; Greenwald & Banaji, 1995; Hasher & Zacks, 1984), and the suggestion has been made that asking questions via survey methods may not capture the overall experience of acculturation since the acculturating person many not be aware of all their experiences explicitly (Kim, Sarason, & Sarason, 2006; Taras et al., 2009). In short, we suggest that there are aspects of the acculturation process which occurs outside of the explicit, conscious mind, beyond what is merely unspoken, or explicitly verbalized, or difficult to recall; indeed, there may be more to the assessment of culture than measurements of words or deeds. In the next section, we review some of the empirical evidence supporting the consideration of non-conscious (i.e. implicit) processes and cognitions in the investigation of acculturation and provide a model of explicit and implicit acculturation.

DUAL PROCESS MODELS OF COGNITION IN ACCULTURATION Epstein (2003), along with other researchers (e.g. Hasher & Zacks, 1984) have proposed dual modes of information processing in which information is processed simultaneously in conscious as well as non-consious modes. More specifically, conscious processes, consisting of propositional reasoning may lead to the formation and maintenance of explicit cognitions (Gawronski & Bodenhausen, 2006). Thus, explicit cognitions can be conceptualized as being the product of one's consciously executed evaluative, perceptual, and cognitive processes of the acculturating person. In contrast, non-conscious processes, specifically associative processes between sets of concepts (i.e. processing of the degree of frequency that a consistent set of concepts are present in one's environment), may lead to the formation and maintenance of implicit cognitions (Gawronski & Bodenhausen, 2006). Attitudes and cognitions formed from such non-conscious processes are widely referred to as implicit attitudes or cognitions, and have been defined as being introspectively unidentified representations of past experiences (Greenwald & Banaji, 1995; Greenwald et al., 1998) which influence social cognition and behavior. To be more specific, implicit cognitions are thought to be the result of exposure to associations between two concepts, with the frequency of exposure to those associations reflecting the associative strength of the cognition, and in addition, such associative processes have been shown to have occured outside of the person's awareness (Betsch, Plessner, Schwieren, & Gütig, 2001; Greenwald et al., 1998; Hasher & Zacks, 1984; Karpinski & Hilton, 2001) warranting their label, implicit cognitions. Thus, while it is possible that one has awareness of the associative processes occuring, since the process itself is thought to operate outside the conscious awareness, the resulting cognitions themselves may not be available to introspection or remain unidentified. In the implicit cognition literature, this has been evidenced by the frequent observation that there appear to be either low or no correlations between explicit and implicit measures (e.g. Bosson, Swann, & Pennebaker, 2000).

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While a variety of attempts, including sophisticated experimental procedures, have been used to assess implicit attitudes (Hasher & Zacks, 1984; Hetts et al., 1999), it was not until the development of computer based, reaction time measures to assess implicit attitudes, such as the IAT (Greenwald et al., 1998), that a convenient way to assess specific constructs were available to researchers. Since then, there has been substantial evidence for the validity of such measures (Nosek, Greenwald, & Banaji, 2007; Greenwald, Poehlman, Uhlmann, & Banaji, 2009), with the general consensus being that explicit (i.e. self report) and implicit attitudes assess different constructs or different aspects of the same construct. In support of this idea, explicit and implicit attitudes have been shown to predict different behavioral outcomes of the same construct (Asendorpf, Banse, & Mücke, 2002; Dovidio, Kawakami, & Gaertner, 2002). The implication for acculturation is that the psychological acculturation process would have both explicit and implicit components, responsible for different acculturation and wellbeing outcomes. We would contend that current acculturation research has mainly focused on the explicit component of acculturation, since this field has been heavily reliant on survey or survey-like methods to draw data. In contrast, the investigation of the implicit aspects of acculturation has had a rather shorter history. We believe the first attempt to define and operationalize implicit psychological acculturation was made by Kim, Sarason and Sarason (2006) who defined implicit psychological acculturation as "a process in which aspects of cultural experience affect one's formation of cultural beliefs/values, attitudes, and identity without one's awareness". A key distinction that needs to be made is that the term implicit psychological acculturation refers to cognitions and attitudes formed through processes outside one's awareness, and the use of the word implicit does not refer to those aspects of culture or acculturation which are merely unspoken (such as a shared assumption) or difficult to explicitly verbalize (i.e. tacitly held beliefs which are still available to introspective efforts). This distinction is important since there have been different ways to operationalize the term implicit in the literature (e.g. shared implicit beliefs; Arends-Tóth & van de Vijver, 2004; Chiu, Morris, Hong, & Menon, 2000). To fully explain the definition of implicit psychological acculturation, it may be necessary to describe how we conceptualize both explicit and implicit culture acquisition from early developmental stages. This is because the acquisition of culture begins at childhood, where both the social environment of the child, and the kind of parenting would influence how the child acquires culture (Wang, 2001, 2004). These two sources of culture acquisition are posited to have independent effects, such that if one of the sources were to change, it may not necessarily affect the other; for example, migration to a host culture would change the sociocultural environment of the child, but it may not neccessarily change the fundamental influence of the parent in transmitting the original culture to the child. In addition, it is posited that acculturation at different stages of development would have different effects on explicit and implicit acculturation. Also, since implicit cognitions are thought to be the result of associations between concepts formed over a long period of time, due to their strength being determined by associative processes (Greenwald & Banaji, 1995; Greenwald et al., 1998), a similarly long term view of culture acquisition, and subsequent acculturation to another culture is necessary (LaFromboise, Coleman, & Gerton, 1993).

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THEORETICAL OUTLINE OF EXPLICIT AND IMPLICIT ACCULTURATION Stated in a simple way, before departing one's original culture, it is posited that explicit and implicit culture acquisition occurs in parallel throughout the developmental process, furnishing the child with explicit and implicit cognitions which are consistent with the values and norms of the original culture as a result of parental and societal sources of influence. During the course of this culture acquisition, development of important concepts such as the concept of self and identity, and attitudes toward others, and rules for interactions with other members of the society, in line with both the parental and societal norms would be imposed on the child. In fact, if there are no acculturation events, we would expect this to be the dominant scenario. Such patterns of culture acquisition may change with the move to a different host culture. While up to this point, both parent and child have been socialized in line with their original culture, the move to a host culture should have differential effects on parent and child due to the changing nature of the socialization pressures. Namely, the host culture's influence should no longer be consistent with the original culture. Instead, both the parent and child will be confronted with the wider host culture when dealing with people and institutions outside of the family (Devos, Blanco, Muñoz, Dunn, & Ulloa, 2008; Schein, 1996). Furthermore, while parents face normalization processes, their children would face not only normalization pressures from the wider host culture, but could also experience parental influences in line with their origial culture (Kim et al., 2006). In summary, while it can be expected that both parent and child would face normalization pressures from the host culture, children of migrants would experience pressures to be socialized in line with both their original culture, and the host culture. From this point, it is expected that elements of the host culture would start to be acquired, resulting in newly formed explicit and implicit cognitions. Due to the differences in the nature of explicit and implicit cognitions, we would posit that the changes in explicit cognitions would be more apparent than changes in implicit attitudes, as explicit attitudes are dependent on propositional processes which are consciously processed (Gawronski & Bodenhausen, 2006), leading to changes in explicit cognition in line with the rate at which the acculturating person is able to percieve and adjust to differences from their original culture (Gregg, Seibt, & Banaji, 2006). However, since implicit attitudes are dependent on the relative frequency of associations between concepts accumulated over time, the newly acquired associations in the host culture should have relatively lower impact on the overall associative strengths of the implicit cognition; consistent with this, one study reported that while it was possible to influence a theoretically weak implicit association, a theoretically strong implicit association was not influenced by the same procedure (Karpinski & Hilton, 2001). In line with such evidence, previous studies have shown that on implicit measures, first generation migrants were more similar to those in their original culture than those in the host culture (Hetts et al., 1999; Kim et al., 2006), and in addition, implicit cognitons of second generation migrants were closer to the levels of host culture groups than the first generation migrants or original culture groups (Boucher, Peng, Shi, & Wang, 2009; Hetts et al., 1999; Kim et al., 2006). We also expect the developmental stage of the acculturating person to be an important factor, such that those with less development in the original culture would be more open to developing implicit

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attitudes in line with the host culture (i.e. the associative strengths between concepts would be weaker than a more developed person), and would have a lower degree of consequences for behavior and for functioning in the host culture in general. Specifically, we would expect that concepts such as the self would be less associated with original culture consistent concepts with lower levels of development in the original culture, providing the possibility that associations with the self and host culture concepts would have greater impact than a person who has completed a significant amount of their development in the original culture. We would posit that this would be the case for all cognitions related to acculturation such that the level of development would influence the degree to which exposure to the host culture would influence highly embedded, implicit cognitions and subsequent behavior and functioning. From this, one might extrapolate age to be a determining factor in how implicit cogntions form during acculturation. That is, the level of existing accumulations, achieved through living in a certain culture or country will determine the relative strength of associations between the self/significant others and original/host culture consistent constructs. While we posit that age is an important and a conveniently operationalizationable variable, we believe the true causal variable to be the amount of exposure to culture consistent associations. That is, the differences between the parent and child response to newly created associatons to host culture consistent associatons are due not to age, per se, but to differences in the amount of accumulated exposures to original culture consistent associations that determines the degree of impact that the associations newly exposed in the host culture have1. Thus, in the case of acculturation, we believe that the pattern of aquisition of new associations and their subsequent impact follows the environmental association model as proposed by Karpinski and Hilton (2001). The environmental association model asserts that implicit cognitions are a function of the frequency with which one is exposed to associations in his or her environment. In the case of acculturation, we propose that the notion of the environment not only includes being passively exposed to culture consistent associations in either the original or the host culture, but also includes being exposed to actively maintained environments such as an acculturating parent's attempts to socialize a child in line with their original culture. One argument for exposure being the operant process in implicit psychological acculturation is that first and second generation migrants show patterns of cognitions which indicate a gradual change to similarity with host culture groups. That is, as previously discussed, while patterns of responses on measures show a clear difference between the original culture and host culture groups, first and second generation migrants showed responses in between those two groups, with more generations in the host culture resulting in greater similarity with host culture groups. What we believe is happening to the migrants is that while the sociocultural environment remains constant, the level of parental influence on their children could deteriorate with successive transmissions of the original culture from parent to child, and, thus, the children would be open to greater influence to exposures from the host culture. As children of those first generation migrants transmit their culture through the act of parenting, their mixed culture acquisition (i.e. deterioration of the original culture) should result in greater similarity to the host culture over succesive generations (Costigan, 1

We acknowledge the possibility of the influence of host culture consistent associations being moderated by the willingness of the person to be influenced by the host culture. This point is expanded on in the sections dealing with intergroup relations.

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Bardina, Cauce, Kim, & Latendresse, 2006). This pattern of change in implicit cognitions is in contrast to the change in explicit cognitions, where data was shown that first and second generation migrants were much more similar to host culture groups than original culture groups (Hetts et al., 1999), suggesting greater malleability of explicit cognitions compared to implicit cognitions, highlighting the embedded nature of implicit cognitions and their resistence to change in the acculturation domain. With a construct as complex as acculturation, we realize that many different kinds of acculturative experiences exist, such as those experienced by expatriate workers, exchange students, and tourists, but reviewing all cases of acculturation is beyond the scope of this chapter. However, it is posited that the fundamental effects of frequency of exposure in implicit psychological acculturation would be occuring in all cases of acculturation, albeit under different sets of circumstances. For the purposes of this chapter, we chose to describe what we believed was the most representative experience of the acculturation process, in terms of acculturative experiences and in terms of describing our model. This model of changes in explicit and implicit congition as a result of the acculturation process gives a description of the changes occuring at the individual level according to the properties of the cognitions themselves. But what has been demonstrated is that acculturation is an interactive process that occurs between the self, family and the wider society. That is, acculturation takes places within a context of interaction choices between the acculturating persons and of the wider society. To this end, Berry's model of acculturation strategy provides a comprehensive framework of the possibilities in the interaction strategies between acculturating persons and the host society. Namely, Berry (1980, 2003) posits that acculturating persons can vary in the degree to which they do or do not engage with the host society, and in turn, the host society can vary in the degree to which they do or do not allow engagement with the acculturating persons. Given that our model of implicit cognition change through acculturation hinges on the frequency of exposure to culture consistent associations, in our view, Berry's model of acculturation offers an account of how variations in acculturation could arise as a result of strategic choices. Specifically, we would argue that different acculturation strategies would moderate the amount of contact the acculturating person has with the host culture, resulting in different levels of exposure to the host culture, in turn, influencing patterns of explicit and implicit attitude formation. With regard to explicit cognition change, acculturating persons choosing a strategy leading to closer relations with the host culture (e.g. integration or assimilation strategies) would theoretically be more favorable towards host culture consistent cognitions, while those choosing a strategy leading to more distance with the host culture (e.g. separation or marginalization strategies) to be less favorable to host culture consistent cognitions. With regard to implicit cognition change, while we broadly expect similar attitude change as with explicit cognitions in terms of direction and valence of change, we suspect it would happen for entirely different reasons. Since implicit cognition formation is not a function of propositonal reasoning, but instead is reliant on the exposure to associated concepts, we expect that acculturation strategies would would be influential in the sense that they provide a source of regulation of exposure to host culture consistent associations. Specifically, integration/assimilation strategies, which take an amenable stance toward the host culture, should lead to greater exposure to the host culture, facilitating implicit attitude formation. In contrast, separation/marginalization strategies, which do not take an amenable stance toward the host culture, should hinder exposure to host culture consistent associations. Similarly, we would expect the acculturation strategy of the

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host culture to regulate the exposure to host culture consistent associations. Therefore, the strategic choices of both the acculurating person and of the host society could contribute to the formation of implicit cognitions leading to implicit psychological acculturation. We discuss and review available data on the implication of such interaction choices in a later section devoted to intergroup relations.

EXPLICIT AND IMPLICIT MEASURES OF ACCULTURATION Given the theoretical definitions and outline of explicit and implicit acculturation, the next pertinent topic should be the methodological properties of explicit and implicit measures. Here, we provide a brief overview of what aspect of acculturation each method theoretically captures, and discuss some methodological issues currently faced by using explicit measures, and provide a theoretical response as to how implicit measures would respond to the same issues. Regardless of the methodology chosen, one clear message that applies to both explicit and implicit measures is that assessment of variables related to culture should directly assess underlying psychological variables associated with that culture believed to be the cause of cultural differences (Betancourt & Lopez, 1993; Okazaki & Sue, 1995). Measures traditionally used in the investigation of acculturation are typically explicit in nature, and task participants to respond through introspection about their acculturation experience (Devos, 2006). Changes in cultural patterns are often assessed through the change in endorsement of cultural values or behavioral patterns consistent with the original culture compared to the host culture, and in measures where free responses are allowed, the content of their subjective experiences may be captured (Taras et al., 2009). In sum, the explicit measure of acculturation captures changes in the individual's cultural patterns through changes in the perceived level of endorsement of the host culture or through the change in content of one's responses to host culture consistent prompts. One related point is that explicit cognitions are influenced by temporary context effects (e.g. Jang & Kim, 2009; Kim, 2004) such that significant differences in explicit cognitions can be detected as participants change in their endorsement of cultural values of the host culture or in their level of host culture consistent behaviors over time. Since the investigation of acculturation hinges on changes in cultural patterns, the fact that changes in explicit cognitions can be detected is an important feature of this method, especially since trait-like properties are not expected. Another strength of explicit measures is that it is possible for the researcher to specify specific contexts and reasons for responses, through careful wording of items. For example, a researcher may ask not only to what degree they agree with the values of the host culture, but also to specify in detail what aspects and under what circumstances their endorsement applies. In sum, the properties of the explicit measure make it appear to be suited to acculturation research, but as we will review, there are significant issues faced by using this method, some of which may be ameliorated by the complementary use of both explicit and implicit measures. Implicit measures of acculturation may capture a very different aspect of acculturation than explicit measures. While a comprehensive review of all implicit methods are outside the scope of this chapter, we will focus on the computer-based, reaction time measures of cognitions, in particular the IAT (Greenwald et al., 1998) as it is the most widely used quantitative measure of implicit cognitions. In the IAT, there are usually two target

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categories, (e.g. self and other or, me and parent) and two evaluative (e.g. good or bad) or comparitive concepts (e.g. original culture or host culture) visible on a computer screen, with one of the target concepts paired with one of the evaluative or comparitive concepts presented on different parts of the screen (e.g. 'self + original culture' visible on the left side of the screen and 'other + host culture' visible on the right side of the screen). The participant is then tasked with categorizing stimuli items (which consist of exemplars of the target and evaluative or comparative categories), into the correct pairs of concepts presented via response keys. The speed with which stimulus items are classified into the pairs of categories presented at the top of the screen are interpreted as the implicit strength of association between the concepts, with lower latencies (i.e. faster response times) indicating stronger associations. A much more detailed account is available in the paper by Greenwald and colleagues. This method has demonstrated its ability to measure implicit social cognitions by demonstrating sound psychometric properties and has also demonstrated predictive validity across many domains of research (Greenwald et al., 2009). In particular, the IAT was shown to predict different aspects of the same target behavior than explicit measures, with studies showing that uncontrolled, or unplanned behaviors are predicted by implicit measures, while controlled, or deliberate behaviors are predicted by explicit measures (Asendorpf et al., 2002; Dovidio, et al., 2002). Coupled with the common pattern that explicit and implicit measures of the same construct do not appear to correlate (Bosson et al., 2000), and that explicit and implicit measures of the same construct appear to measure different aspects of the same construct or assess different constructs (Nosek, et al., 2007), this demonstrates that implicit measures may capture unique aspects of social behavior which are not easily captured by explicit measures. Furthermore, implicit measures have shown to reflect experiences accumulated over a long period of time. For example, Jang and Kim (2009) demonstrated that those who are known to have experienced chronically difficult life experiences showed a lower level of implicit life satisfaction compared to a group who did not have similar difficult chronic experiences. Furthermore, it was shown that the group known to have had chronically difficult life experiences showed a lower level of implicit life satisfaction even after being removed from such conditions for over a year, showing that deeply embedded experiences may be assessed using the IAT method. Indeed, if culture is the deeply embedded set of cognitions which have a global influence on attitudes, cognitions and behaviors (Markus & Kitayama, 1991), it is logical to assess culture with methods which assess the deeply embedded aspects of the self. One major limitation of the IAT method is that since only reaction times are being measured, there cannot be any interpretation of those results beyond those reaction times without appropriate theoretical contexts or empirically measured variables. For example, if a person shows a strong degree of implicit association between the self and the color red over the color blue, the researcher has no avenue of explaining this result without a detailed theoretical investigation or with supporting empirical evidence. That is, while the strength of association between a target concept and evaluative or comparative can be measured, it is the researcher's burden to define the context under which the strength of the associations should be interpreted. This issue also extends to measure development, where the researcher must define appropriate categories and stimuli in order to ensure comparable stimuli exist in both target categories. Furthermore, since the IAT typically uses images or words to represent both categories and stimuli, it may be difficult or not possible to represent complex ideas. In sum,

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implicit measures represent the nonconscious associative strength between concepts, but the researcher must be careful in how those strength of associations are interpreted.

CHARACTERISTICS OF EXPLICIT AND IMPLICIT MEASURES WITH REGARD TO ASSESSMENT ISSUES AN ACCULTURATION In this section, we discuss the issues faced by researchers when using conventional, explicit, means of assessment, and how inclusion of the implicit cognitive perspective could offer a different, complementary assessment of culture. One important consideration in the assessment of acculturation is that the levels of culture acquisition in both the original culture and in the host culture are needed as described above. One practical operationalization is to have two comparable measures assessing endorsement of values and behaviors on similar dimensions in both cultures, which assumes that cultures vary on a set of common cultural dimensions (Zane & Mak, 2003); and indeed, most measures of culture take such an approach (Taras et al., 2009). There is no unanimous agreement on whether such universal cultural traits exist, and it is a contested issue (i.e. the emic vs etic debate). The use of implicit measures may not help to resolve this issue, as researchers are free to assess associations between concepts which are both universal and specfic to both original and host cultures, via the deliberate selection of category and stimulus items. In sum, as with any method, the onus is on the researcher to appropriately operationalize important theoretical concepts, as use of implicit methods alone do not provide any validity or theoretical assurances. A related issue to the above is the notion of construct equivalence (Okazaki & Sue, 1995). In their investigation of acculturation, researchers may not only be interested in the change in levels of cultural dimensions, but also be interested in the properties of psychological constructs. But, as above, when one assumes that two cultures vary on the same cultural dimensions, an easy assumption to make is that a construct in one culture would have the same structure and properties as in another culture, but this may not be the case (Boucher et al., 2009; Suh, 2002). Markus and Kitayama (1991) provided a convincing thesis on how the notions of the self differ across culture through differences in cultural values, such that the boundaries of the self construct and the nature of relationships with others were different as a consequence of differing cultural values. As a result, explicit expressions of the construct in two different cultures may show consistent patterns of response bias, as survey items are interpreted from the perception of one's own culture (Okazaki & Sue, 1995; Okazaki & Tanaka-Matsumi, 2006). Thus, different cultures may explicitly interpret the same construct in different ways. Complementary use of the implicit measures alongside explicit measures may reflect a more detailed understanding of cultural issues, since they may assess different aspects of culture due to the differences in their properties. Since explicit cognitions are dependent on propositional processes, they are likely to reflect cultural differences in consciously held beliefs or practices, but since implicit cognitions are dependent on associative processes, they may not be as susceptible to such influences (Jang & Kim, 2009; Kim, 2004). In other words, implicit assessments could reflect cultural differences relatively free from culture-specific response tendencies which may affect survey methods (Okazaki &

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Sue, 1995). Therefore, reliance on explicit measures alone could lead to substantial portions of the person's non-conscious experiences being excluded from investigation. Use of the implicit method, however, does not guarantee a culture reduced assessment of the same construct, since differences in properties may or may not exist at an implicit level. In one case, despite differences in explicit cognitions due to differences in how the construct is explicitly interpreted, if the environments in both cultures support similar frequencies of associations between concepts, there may be no cross-cultural differences in levels of that construct. In demonstration of this, Oishi (2002) reports that while there were differences in explicit recall of well-being, demonstrating cultural response tendencies, the reported frequency of experienced well-being did not differ across East Asian and European Americans. Also, Jang and Kim (2009) report that despite East Asians reporting lower explicit life satisfaction than European Americans or European Australians, they reported similar levels of implicit life satisfaction, conceptually replicating the results of Oishi. In another case, cross-cultural research on the self-esteem construct showed that while outward expressions of the evaluation of the self on explicit measures tap culture specific response biases, positive implicit associations between the self and positive valences (i.e. positive implicit self-regard) did not differ across both a group which tend to display self enhancement (European Americans), and a group which tend to display self criticism (East Asians) (Yamaguchi et al., 2007). That is, levels of implicit self esteem were similar in both cultures. However, other differences at the implicit level may exist. For example, Boucher et al. (2009) demonstrated that while East Asian (Chinese) participants posess similar levels of implicit self-regard as European Americans, East Asian participants had shown greater levels of associations between the self and negative valences compared to the European Americans, with parallel results on explicit measures. What these results indicate is that differences can exist at the implicit level which may not be related to differences at the explicit level, depending on which constructs and which sets of cultures are being compared. A further challenge to conceptualizing explicit and implicit cross-cultural differences is that the context in which the assessment is made may also be important. In a set of creative experiments, Kitayama and Uchida (2003) showed that collectivists and individualists can be made to show the pattern of explicit and implicit self regard that would usually be expected from the other's cultural group, if the participants were confronted with a social context consistent with either collectivist or individualist cultures. This highlights the possibility that culture serves to act as a cue to activate different sets or explicit/implicit responses. In sum, it appears that researchers must be careful in conceptualizing and measuring explicit and implicit differences across cultures, since they may reflect differences in explicit/implicit domains as well as reflect differences in the cross-cultural differences in the construct. One final topic in assessment we will discuss is the level of measurement issue. In the construction of explicit measures of culture, survey items can be worded such that they either assess cognitions either at the individual or societal level, by asking participants to reflect on personal experiences or to appraise phenomena occuring in the wider society, which may lead to confusion of the level of analysis (Taras et al., 2009). In response, it can be logically argued that cultures differ with respect to how much they rely on social norms to inform their own cognitions (Okazaki & Tanaka-Matsumi, 2006; Suh, Diener, Oishi, & Triandis, 1998), and that inclusion of such norms are necessary to adequately assess this construct. While we can forsee that careful operationalizations of definitions and scale construction may

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ameliorate this problem on explicit measures, from a conceptual point of view, the picture for implicit methods is less clear. The reason for the lack of clarity is that despite the implicit measure assessing associations between concepts at the individual level, at the same time, it may be the case that the frequency of exposure between associated concepts are the result of the interaction between associations among concepts available to the person both in their environment (Karpinski & Hilton, 2001; Jang & Kim, 2009) and the person's interaction choices, such as acculturation strategies (e.g. Devos et al., 2008). In other words, we posit that implicit cognitions are both the result of exposure to concepts prevalent in one's environment (in which the individual is passive in processing associations), but also as a result of active strategic choices one makes to expose themselves to consistent messages in the environment (in which the individual takes an active role in exopsing themselves to particular environments). (Lowery, Hardin, & Sinclair, 2001). In addition, it has also been reported that differences in interaction patterns between men and women of a single migrant ethnic group may be responsible for differential responses in implicit attitude activation, and this result was explained in terms of the relative mobility of men and women in the host culture, resulting in different experiences of the same environment (Bohner, Siebler, González, Haye, & Schmidt, 2008). These findings suggest that within even the same country, (i.e. in the same social environment), differences in interaction patterns between different ethnic groups can influence the role of implicit attitudes. This gives some confidence to the notion that implicit cognitions and attitudes are a result of the environmental exposure to concepts prevalent in society, moderated by interaction choices the individual has with the environment. What this review indicates is that implicit associations are neither a sole product of exposure to associations, nor are they purely the result of conscious choices one makes; it is highly likely that implicit cognitions are represented by both processes, albeit more strongly influenced by the process which has had a greater influence on the frequency between the associated concepts. Overall, the use of the implicit measures, like all other methods, still require the researcher to employ theoretically justifiable operationalizations, as well as to demonstrate adequate reliability and validity. However, because of differences between explicit and implicit methods, use of implicit measures in tandem with explicit measures may reveal a deeper understanding of the acculturation process, through the assessment of theoretically different aspects of psychological constructs.

REVIEW OF EXTANT RESEARCH ON ACCULTURATION USING IMPLICIT METHODS In general, there is relatively less research of the acculturation process using the implicit cognition perspective than explicit, survey based research. In the next sections, we review some key findings revealed using the implicit cognition perspective in three important areas of acculturation research, namely identity, parental relations and intergroup relations, reflecting individual, family, and group level interactions between the acculturating groups and host culture. Furthermore, we provide directions for future research and a short outline of the importance of the implicit cognition perspectives in acculturation for organizations.

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IDENTITY As discussed, the model of implicit psychological accuration outlined above proposes the possibility of an acculturating individual to posess both the identity of their original culture and of the host culture, in line with previous research on the topic which also shows evidence for bicultural identities (Hong, Morris, Chiu, & Benet-Martínez, 2000). But beyond merely complementing the explicit perspective, we would argue that the inclusion of the implicit cognitive perspective could have important consequences for the properties and the nature of the identity concept in the acculturation domain. Conceptually, a notion of implicit identity would essentially be the strength of the association between the self concept and culture consistent stimuli. In the case of acculturating individuals, the acquisition of a bicultural identity would occur as a result of the self being exposed to both original (e.g., Korean) and host culture consistent stimuli (e.g., American), resulting in the self concept being associated with cultural values, icons, and symbols from both original and host cultures. Such bicultural identities may be a cause of ambiguity such that it may present barriers to adequately assess and report on cognitions via explicit measures, making the use of implicit measures desirable (Kim et al., 2006). Consistent with this position, Devos (2006) demonstrated that both Mexican Americans and Asian Americans showed a pattern of implicit identity which indicated greater association with their ethnic cultures than a neutral comparison point on an IAT-based measure, but also showed greater association with the dominant American culture than a neutral comparison point on a separate IAT-based measure. Additionally, when the relative strength between the self and ethnic culture was assessed, that is, an IAT was administered which compared the associative strength between the self and Mexican (Asian) culture with the association between the self and the dominant American culture, the overall IAT effect was not significantly different from zero, indicating both implicit identities to be of equal associative strength. This was in contrast to European American participants, who showed a proAmerican idenitity but showed lower implicit ethnic identities compared to Mexican and Asian participants. We would contend that such associations would originate from both associations prevalent in the environment of the host culture, and from the parents of migrants as a consequence of their socialization of their children. Indeed, if merely the societal influence were to impact implicit identity, we would not expect ethnic groups to retain their identity, or if merely parental influence were to impact implicit identity, we would not expect the existence of an implicit American identity. One other particularly interesting finding in Devos' (2006) investigation was that European American participants showed greater Mexican and Asian implicit idenitity compared to a neutral comparison point, with the interpretation of that result being that regardless of actual ethnic group status, living in an environment where they are exposed to Mexican or Asian culture (in this case, southern California) would contribute to their self being associated with cultural icons and symbols, quite possibly without conscious intent. This is consistent with the notion that the psychosocial environment, through propagation of associations between concepts can influence core processes relevant to psychological acculturation. This is also consistent with anthropological findings which indicate that cultural knowledge can be transmitted across generations without conscious intent (Gamradt, 1989).

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A greater differentiation of the source of identity acquisition may be gained through the investigation of successive generations of migrants. As discussed previously, the transmission of the original culture may deteriorate over time, as successive parents are socialized in the host culture to a greater extent. Consistent with this idea, Kim et al. (2006) demonstrated that first and second generation Korean migrants showed implicit identities which were more less Korean and more American with successive generations. This was despite the fact that on parallel explicit measures, migrants showed patterns of responses which indicated no greater idenitification to the original or the host culture. This pattern suggests that while on an explicit level, identities of acculturating persons may resemble that of the host culture, but nevertheless, due to previous exposures in the original culture, in the case of the first generation migrants, or by exposures to the original culture from the first generation parents, in the case of the second generation migrants, children may acquire implicit cognitions consistent with the original culture. This pattern of the relatively fast changes on explicit measures and relatively slow changes on implicit measures is in line with other research examining explicit and implicit acculturation (Hetts et al., 1999) and the observation that successive generations of migrants retained patterns of the original culture despite having a superficially adapted lifestyle (Johnson, 1977). This pattern also suggests that despite explicit indication of the contrary, acculturating persons may yet implicitly retain elements of their original culture (Devos, 2006). In sum, a tentative conclusion in investigation of the idenitity of acculturating persons would indicate that acculturating persons can acquire dual implicit identities, that implicit identities are both products of the cultural and parental influences and that the pattern of explicit and implicit acculturation could differ. A related and an important consequence of the self concept is the notion of implicit selfesteem. Self-esteem is a construct central to the well-being of the individual, however, due to differences in the concept of the self across cultures, the traditional definition of self-esteem as a positive evaluation of the self may not apply to all cultures, but instead, culture specific notions of positive self-regard may exist (Hetts et al., 1999). The pattern of data sugggest that while it is possible for acculturating persons to adapt to the host culture's pattern of norms within a relatively short period of time, on an implicit level, associations between the self and the host culture consistent set of positive self-regard concepts may be weaker than the self and original culture consistent set of positive self-regard concepts (Hetts et al., 1999). In fact, Hetts et al. found a positive relationship between the number of years spent in the host culture and implicit host culture consistent self-regard, indicating a gradual change in the pattern of well-being cognitions to be in line with the host culture. In light of this finding, the monitoring of self-esteem in acculturating groups may be important, since in the least, explicit self-esteem appears to be an outcome of ideal functioning and/or success in individualist countries (Baumeister, Campbell, Krueger, & Vohs, 2003). With respect to implicit self-esteem, it has been reported that the greater the degree to which a member of the ethnic minority held implicit associations between the self and their family (a construct theorized to be important to the ethnic group), the greater was their self-esteem, indicating that indivdual level psychological outcomes, such as self-esteem, may be a function of the strength of association between the self and concepts that are important to the acculturating person (Devos et al., 2008). Therefore, knowledge of both explicit and implicit self-esteem may be important in understanding acculturating groups' successful adjustment and psychological well-being in the host culture. In the next section, we discuss another

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consequence of implicit identity of acculturating persons, namely, relations between parent and child during acculturation.

PARENTAL RELATIONS As we have suggested, one of the salient sources of culture and identity acquisition may stem from the parents of migrant children. In fact, Wang (2001, 2004) demonstrated that the way in which the parents interact with and socialize their children are in line with the cultural values of their society. The use of implicit methodologies may be warranted in this line of research because while acculturating persons may be able to reflect the changes in their cultural environment on explicit measures, they may not be able to articulate implicit associations formed at an early age (DeHart, Pelham, & Tennen, 2006). Early experiences may be formative in the sense that they provide mental models of how one should interact with significant others, and thus furnish a child with a means to navigate the social environment around them (O'Reilly, Tokuno, & Ebata, 1986). Normally, adaptive parenting strategies at childhood may lead to healthy mental development, with different parenting styles predicting different patterns of explicit and implicit self-esteem at young adulthood (DeHart et al., 2006). However, when the parent does not share the cultural values of the wider society, their parenting may become a hindrance to adjustment with the wider culture, such as in the case of migrant children. We outline why this may be the case. Consistent with the logic we have presented thus far, it is reasonable to posit that the socialization of migrant children is a mixed environment, where in the family unit, the original culture is maintained and outside of the family unit, the host culture is prevalent. We have posited that such an environment would foster not only implicit bicultural identities (Devos, 2006; Kim et al., 2006), but also patterns of implicit cognitions which show gradual similarity with greater time in the host culture (Costigan et al., 2006). We believe that this scenario presents potential issues for acculturating children, which may have implications for not merely personal well-being, but also affect family and societal level relations. Specifically, being less acculturated and more in line with the original culture may foster positive parental relations, yet simultaneously have negative outcomes on their interactions with the host culture. In contrast, being more acculturated may have positive outcomes for interactions with the host culture yet hinder parental relations. In a study which investigated such a hypothesis, Kim et al. (2006) report that despite previous literatures on the positive outcomes of a positive parent-child relationship, when parents and children do not share the cultural values of the host society, it is associated with psychological distress. In particular, the effect of the positive parent-child relationship on distress was mediated by implicit, but not by explicit child ethnic attitudes, indicating that implicit measures, which may be less influenced by contextual influences during acculturation (Hetts et al., 1999), to be a more appropriate predictor of psychological distress. Despite the fact that explicit measures did not predict distress, these results are not to suggest that conscious responses did not play a role; it was also found that those who showed discrepancies between their explicit and implicit ethnic attitudes to have greater psychological distress, suggesting that explicit and implicit cognitions do not operate in isolation, but a discord between the two cognitions may be a source of conflict that could have negative

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outcomes in the acculturation process. In contrast, for a European American comparison group, who had no reason to show conflict with the cultural values of their parents and the wider society, or conflict with regard to their own explicit and implicit cognitions, explicit and implicit ethnic attitudes did not predict psychological distress. One of the key points from these findings is that for individuals in an environment likely to foster bicultural idenitities, the notion of ethnic identity, and even ethnic attitude may be ambiguous, and that the development of a coherent identity and attitude can be difficult, given that children of migrants are expected to maintain both their original cultural heritage as well as being adjusted to the host culture. The resulting ambivalence about their culture, identity, and attitudes, reported across the studies reviewed above (Devos, 2006; Hong et al., 2000; Kim et al., 2006), suggest that the conflict between these idenitities and attitudes may be what is reflected in the explicit/implicit inconsistency. In sum, while this line of research is in need of further investigations, we posit that formative experiences for children of migrants to have different trajectories than children of the host culture. When there is no conflict between the cultural values of the parent and wider society, we may expect that there is no configuration of one's explicit or implicit ethnic attitudes which predict psychological distress. In fact, as would be commonly accepted, adaptive parenting strategies in that culture may facilitate development later on in life. However, for children of migrants, conflicts between cultural values of their parents and the host culture could potentially create conflict between parent and child or between society and child, despite the use of adaptive parenting strategies consistent with the original culture. We propose that much more research is required to disentangle the effects of not just the parental, but societal level influences on the child's development, and their ultimate impacts on the well-being and adjustment of the child. Another outcome of child-parent relations is the transmission of attitudes toward other ethnic groups. Relatively recent research points to data which suggest that without intent, parents may be transmitting their intergroup attitudes to their children, resulting in either implicit ingroup preferences or implicit attitudes in line with prevanent social norms about relative hierarchies of different ethnic groups (Dunham, Baron, & Banaji, 2008; Griffiths & Nesdale, 2006). However, this relationship may depend on the strength of the parental relationship itself; it has been reported that children who report a higher level of identification with their parent tend to have implicit associations of the outgroup positively related to their parents' prejudices (Sinclair, Dunn, & Lowery, 2005), indicating that parental relations may moderate the formation of implicit attitudes which consequently influence intergroup relations. This suggests the possibility that, not only at the intergroup level, but also at the individual level, interaction choices may influence the degree to which implicit attitudes are formed. In the next section we discuss the role of implicit cognitions in intergroup relations in more detail.

INTERGROUP RELATIONS Beyond the individual and family levels, implicit cognitions may also influence the acculturation process by influencing the way in which both acculturating groups and host culture groups perceive and interact with one another. We review findings which relate to the

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acquisition of implicit cognitions regarding migrants, the properties of such implicit cognitions, their consequences, explore the conditions under which they may be activated. When considering intergroup relations, it is important to consider how the groups involved think of each other, as it is the basis from which subsequent interactions may occur (Cuddy, Fiske, & Glick, 2007; Lee & Fiske, 2006). Thus, it is important to know both how knowledge structures are formed and to know what the content of those knowledge structures entail. In particular, we will examine the role of stereotypes since they represent a salient means by which groups inform their attitudes about each other. While stereotypes can intuitively be thought of as consciously transmitted and acquired knowledge about a group of people, some particular characteristics of stereotypes indicate that they also exist as implicit cognitions. Specifically, stereotypes are relatively sparse in information content but are pervasive in the social environment, and as such, lends itself to being automatically processed (Florack, Scarabis, & Bless, 2001). In an important study, Devine (1989) revealed that prevalent beliefs about subgroups, despite being explicitly rejected by those who disagreed with the stereotype, were nevertheless evident implicitly. In addition, after initial implicit attitude formation toward unknown social groups had taken place, providing counteracting evidence altered explicit, but not implicit attitudes (Gregg et al., 2006), suggesting ingroup/outgroup processing is particularly influential to implicit cognition formation, and that they can be formed with relative ease, and appear to be persistent. Consistent with this, when participants were shown an article of news about a known ethnic group, it influenced explicit, but not implicit attitudes (Florack, Piontkowski, Rohmann, Balzer, & Perzig, 2003), which is in line with findings that implicit attitudes may be less susceptible to contextual influence. As such, stereotypes can exist not only in the conscious mind, but also exist as implicit cognitions, outside of the person's awareness. Another reason for the utilization of implicit perspectives is that people may be motivated to provide socially desirable responses when asked about ethnic migrants (Dovidio et al., 2002; Kim, 2003), which calls into question the validity of explicit measures on such sensitive issues. A salient source of information about ethnic groups is the local news, which may be troubling since the media may overrepresent rates of ethnic involvement in crimes, or underrepresent their rate of victimization (Dixon & Linz, 2000). Such widely disseminated associations between a group and systematic knowledge lead to the formation of stereotypes shared among many in the community (Lee & Fiske, 2006). But more than merely biased exposure to associations about a migrant group, the content of stereotypes may depend on other factors. Lee and Fiske (2006) suggest that stereotypes about migrants are largely based on existing stereotypes of people from their original nations, and furthermore, the content of stereotypes are likely to vary with national, racial, ethnic and also socioeconomic status, along with perceived common occupations, with the suggestion that acceptance of migrant groups could depend on how much of a threat they are perceived to be to the host culture groups. On a related note, Rohmann, Florack, and Piontkowski (2006) report that differences in cultural values may contribute to a perception of threat in host culture groups toward the acculturating group, as well as to contribute to a perception of threat in the acculturating group toward the host culture group. In addition, negative intergroup contact contributed to the perception of intergroup anxiety between the two groups. Therefore, to understand intergroup relations, it is important to understand the attitudes of both the acculturating group and of the host culture groups (Rohmann et al., 2006).

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The stereotype itself may have significant consequences on the relationship between migrant and host groups. Pérez (2010) reports that implicit attitude toward migrant groups was able to uniquely predict attitudes toward immigration policy, with magnitudes of those implicit attitudes comparable to indicators of explicit migrant intolerance. In addition, Cuddy et al. (2007) report that groups with positive stereotypes may lead to positive intergroup interaction outcomes, but conversely, being attributed with negative stereotypes may lead to negative intergroup interaction outcomes. Another consequence of stereotypes is that implicit attitudes formed as a result of the stereotyping process may subtly affect interaction quality with members of other ethnic groups. It has been known for some time that explicit attitudes predict controlled behavior, while implicit attitudes predict spontaneous behavior (e.g. Asendorpf et al., 2002). The same has been found for interactions with ethnic outgroup members (Dovidio et al., 2002; McConnell & Leibold, 2001; Unkelbach, Forgas, & Denson, 2008), suggesting that quite apart from what members of ethnic groups' conscious belief, their actions may unintentionally result in discriminatory (either positive or negative) behavior. When are implicit cognitons about migrants likely to be activated? This question essentially asks under what motivational states are easily retrievable stereotypes made salient in decision making processes regarding migrant groups. In our review of the literature, we find that mood states and need for cognition may provide the conditions to influence the effect of implicit attitudes. Consistent with previous findings which demonstrated that positive affect could result in less motivation to attend to detailed information (Carver, 2003), it can be supposed that positive mood results in less critical distinctions between an individual and their stereotyped group, resulting in greater incidence of discrimination along stereotyped lines. Accordingly, Unkelbach et al. (2008) report that being in positive mood states resulted in greater discriminatory behavior toward a negatively stereotyped group, compared to being in a neutral or negative mood state. Interestingly, while being in a negative mood state (anger) resulted in greater negative behavior overall, it did not result in selective targeting of the negatively stereotyped group. Thus, positive mood states may encourage decision making with reference to easily retrieved cues about ethnic groups. Negative mood states may also influence processing with regard to stereotypes. When perceiving a member of an ethnic outgroup, a challenge to the stereotype is presented if one perceives that person to be either representative or unrepresentative of their ethnic group, which may have consequences for how the actions of an outgroup member is interpreted. Florack, Bless, and Piontkowski (2003) report that if negative mood were directed at a representative member of the ethnic group, it may result in negative outcomes for explicit and implicit attitudes toward that group, however, if negative mood were to be directed at a unrepresentative member of the ethnic group, it may result in greater explicit acceptance and implicit attitudes toward that group. The implication is that the consequence of mood directed at migrant group members depends on the perceived representativeness of a particular person. Another motivational state which may influence implicit cognition activation is the level of need for cognition. With respect to the idea that explicit responses to attitudes about ethnic groups may be masked by socially desirable responding, it seems reasonable to believe that the level of the need to oversee one's own beliefs would be related to the level of explicit/implicit attitude agreement. In line with this, implicit attitudes toward ethnic outgroups were able to predict explicit attitudes when there there was a lower need for cognition (Florack et al., 2001). This may indicate that in general, low motivation to process information about the ethnic outgroups may result in the activation of implicit attitudes since

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Florack et al. also report that implicit attitudes are related to explicit social judgements when the amount of processing about the target ethnic group is low compared to when it is high. As an aside, it would appear that not only can implicit cognitions have consequences for intergroup relations, but also for interpersonal interactions with outgroup members. Richeson, Trawalter, and Shelton (2005) have reported a particularly interesting finding which showed that those with less favorable implicit attitudes toward an outgroup member faced greater depletion of cognitive resources as a result of attempts to mask implicit attitudes during interactions with outgroup members, highlighting a fascinating interplay between explicit and implicit responses to interactions with outgroup members. Such findings would be useful in an increasingly globalized world, where contact with outgroups will inevitably increase in frequency. In sum, implicit perspectives in the investigation of intergroup relations provide information about latent belief systems which may have serious consequences for both individual level interactions and group level construals about other groups. Furthermore, attention to the implicit aspect may be particularly important since the outcomes of implicit processes, such as latent nagative attitudes and unintentional discriminatory behaviors may not be apparent to the self, or be activated in transient motivational states over which conscious control may not be easy.

FUTURE RESEARCH We see potential for much more research uncovering the role of explicit and implicit cognitions in the domain of acculturation. Namely, we find particularly interesting possibilities in investigating the discrepancy between explicit and implicit cognitions, and the explicit/implicit paradigm is yet to be applied to the full set of acculturation processes (with explicit and implicit attitudes to work and education being a notable exception in the literature). Furthermore, we are yet to discover the consequences of existing dispositions (such as personality), external factors (such as social support) in their influence over the pattern of explicit and implicit cognition formation, maintenance, and activation. We also see room to re-examine past findings, in particular exploring the pattern of explicit and implicit cognitions in relation to acculturaton outcomes (e.g. Sue & Zane, 1985), to understand the role of implicit cognitions in successful acculturation. To take a slightly different perspective, we observe that the vast majority of studies conducted using the implicit psychological perspective to be conducted in Western, individualist cultures, which raises the question as to whether the patterns of results would be the same when acculturating in collectivist cultures, since there may be important differences in the way in which acculturation occurs in different cultures (Jang & Kim, 2010). Finally, while we have posited that accumulations of experiences moderated by interaction choices are responsible for implicit cognitions, there is relatively little direct evidence to support our central thesis. While we have stipulated that associations prevalent in the environment or the society, or parental relations may be responsible for implicit cognition formation and maintenance, we realize that this is a relatively vague way of describing the environment under which such cognitions form. Also, previous attempts to find moderators or mediators of implicit cognitions relevant to acculturation have not been successful (e.g.

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Turner, Hewstone, & Voci, 2007). However, a lack of such factors does not imply the absence of such factors altogether. It may be the case that we are simply unaware of the factors, or have inadequate means to assess the moderators/mediators of implicit cognitions. What seems reasonable is that processes which moderate/mediate explicit cognitions may not moderate/mediate implicit cognitions since they are dependent on different mechanisms in their formation and maintenance. Related to this, more research may be needed to find the factors and mechanisms which lead to the formation and maintenance of implicit cognitions. In the next section, we provide one possible practical means to understand how associations are made prevalent, available for exposure, and subsequently, lead to implicit cognition formation.

ORGANIZATIONAL IMPLICATIONS When providing implications for the process of acculturation, we believe that one of the most productive ways is to provide organizational implications. This is because we believe that outside individual and family interactions, interactions with organizations and their constituents through activities such as work and education are likely to be salient sources of culture acquisition and adjustment, acting as a distinctive source of acculturation experiences (Devos et al., 2008; Jang & Kim, 2010; Schein, 1996). Furthermore, providing implications to organizations is much more likely to result in systematic changes in the behavior of the organization, its constituents, and consequent interactions with acculturating persons inside and outside the organization, which has the potential for greater impact than providing implications for casual social encounters. Also, official organizations, such as the government, weld the power to confer the status of particular groups, which can have profound effects on their perception and ultimately formation of cognitions like stereotypes, as in the case of illegal migrants who are viewed in a much more negative light than documented migrants from the same origin (Lee & Fiske, 2006). This is above and beyond the fact that organizations posess subtle (e.g. attraction-selection-attrition framework; Schneider, 1987) and obvious (such as reward and punishment strategies) means to reinforce or discourage social behavior. In short, organizations posess a powerful influence which can be welded to shape both individual and group level perceptions, interactions, and other behaviors. Organizations are dealing with an increasing number of cross border interactions, and the value of such interactions has been increasing, and as a result, acculturation issues have been becoming more important (Taras et al., 2009). In concert, there have been efforts in the organizational behavior domain to understand acculturation from an organizational perspective (see Gelfand, Leslie, & Fehr, 2008 and Tadmor & Tetlock, 2006 for extensive reviews). However, such efforts have mainly focused on the explicit components of culture and acculturation. Here, we aim to provide a few recommendations based on the literature reviewed. We posit that organizations can play a role in the creation and mainenance of both explicit and implicit attitudes. It may seem somewhat ironic that we are recommending the approach originally taken by Hofstede (1980) in the future research of acculturation. But the very nature of the implicit cognition requires that researchers should be aware of salient

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sources of repeated, consistent messages involved in important social activities. Organizations, by their power to create policies, and to create consistent environments where social interactions can take place, have the capacity to influence propositional information and associative exposures which can inform explicit and implicit cognitions with time. Organizations can also operationalize tactics, such as direct and indirect contact with other ethnic members, which have been shown to influence implicit cognitions toward ethnic outgroups (Aberson & Haag, 2007; Binder et al., 2009; Turner & Crisp, 2010; Turner, Hewstone, & Voci, 2007) in order to bring about desireable changes such as reduced prejudice and discrimination, with the hope of such improvements extending beyond the place of employment, and into the wider society. Organizations may also be in a better position to understand that social attitudes and consequent behavior can be the result of non-conscious propositonal processes than ordinary individuals, who may be affected by introspective limits (e.g. Devos et al., 2008). While we are not suggesting that the development of implicit measures have reached a stage where diagnostic applications can be recommended, organizations may be in a place to inform its constituents that the conscious mind may not be where all of psychological functioning takes place. In short, organizations can play a role in asking constituents to be aware of the fact that people from backgrounds who have chronically experienced different sets of values may think and behave in ways different to their own despite their conscious intent to adjust to the host culture. This could be the case for multi-national companies and organizations. Another way in which organizations can respond to implicit psychological acculturation is by being aware when explicit or implicit cognitions are likely to contribute to processes such as decision making or social behavior. As discussed, different mood and motivational states are likely to influence the extent of their role, making it possible to regulate when they are likely to influence outcome behavior through implementation of policy. One relatively straightforward mechanism which we have not discussed is time constraints, where greater time constraints appear to facilitate the use of implicit cognitions, and lower time constraints appear to facilitate the use of explicit cognitions (e.g. Hasher & Zacks, 1984). Organizations may also have to re-evaluate the way in which it assesses its employees. Traditional measures of the relationship between the organization and its members were assessed principally using survey methods, and as such, may not assess implicit cognitions also relevant to the organization. This may be particularly pertinent in global organizations, since constructs in one culture (such as organizational commitment, and organizational identity) may not have the same form or have the same meaning in different cultures (i.e. lack of construct equivalence) (Linowes, Mroczkowski, Uchida, & Komatsu, 2000). In terms of implicit evaluations (i.e. the degree to which the organization is associated with positive or negative valences) may nevertheless be equivalent, reflecting disparate explicit experiences due to culture, but similar positive versus negative experiences. Knowledge of such possibilities alone may provide motivation to reduce intergroup misunderstandings, conflict or other negative outcomes. One final way in which organizations can have implications for implicit psychological acculturation is by regulating the nature of intergroup relations. Organizations can influence the economic status, and level of sanction provided to its constituents, as well as being able to influence the nature of interactions (e.g. casual/formal, task/relationship orientations, hierarchical/non-hierarchical, individual/group oriented, etc...) between migrant and host culture groups. Thus, one could argue, by having influence in the conditions under different

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ethnic groups interact, organizations could influence perceptions, stereotypes and implicit attitudes about other ethnic groups at the individual level. Furthermmore, with reference to Berry's model (2003) of acculturation strategies, the conditions under which migrant or expatriate workers, or even entire foreign subsiduaries or partner organizations interact could also influence how groups perceive and interact with each other, with subsequent implications for patterns of individual level cognitions.

CONCLUSION The cirumstances under which we are exposed to prevalent messages in society, and conscious choices in interacting with that society could have more powerful effects on the acculturation processes. This is because congitions and behaviors in the acculturation process may be occuring outside of conscious awareness, and may be activated by motivational and emotional states in complex and introspectively unidentified ways. This chapter has suggested a working model outlining the processes involved in implicit psychological acculturation, along with a short review of some of the key findings in the field. It is our hope that future investigations of the acculturation process incorporate the implicit psychological perspective in the hopes that it will provide a fuller picture of the acculturation process and be useful in understanding how to aid in the acculturation of individuals, families and their integration into host societies.

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Okazaki, S. & Tanaka-Matsumi, J. (2006). Cognitive-behavioral assessment with multicultural populations. In P. A. Hays & G. Y. Iwamasa (Eds.), Cognitive behavioral therapy with culturally diverse populations (pp. 247-266). Washington, DC: APA. Oishi, S. (2002). Experiencing and remembering of well-being: A cross-cultural analysis. Personality and Social Psychology Bulletin, 28(10), 1398-1406. doi:10.1177/014616 702236871 O'Reilly, J. P., Tokuno, K. A., & Ebata, A. T. (1986). Cultural differences between Americans of Japanese and European ancestry in parental valuing of social competence. Journal of Comparative Family Studies, 17(1), 87–97. Pérez, E. O. (2010). Explicit evidence on the import of implicit attitudes: The IAT and immigration policy judgments. Political Behavior. doi:10.1007/s11109-010-9115Redfield, R., Linton, R., & Herskovits, M. J. (1936). Memorandum for the Study of Acculturation. American Anthropologist, 38(1), 149-152. Richeson, J. A., Trawalter, S., & Shelton, J. N. (2005). African Americans' implicit racial attitudes and the depletion of executive function after interracial interactions. Social Cognition, 23(4), 336–352 Rohmann, A., Florack, A., & Piontkowski, U. (2006). The role of discordant acculturation attitudes in perceived threat: An analysis of host and immigrant attitudes in Germany. International Journal of Intercultural Relations, 30(6), 683–702. doi:10.1016/ j.ijintrel.2006.06.006 Schein, E. H. (1996). Culture: The missing concept in organization studies. Administrative Science Quarterly, 41(2), 229-240. Schneider, B. (1987). The people make the place. Personnel Psychology, 40(3), 437-453. Sinclair, S., Dunn, E., & Lowery, B. S. (2005). The relationship between parental racial attitudes and children's implicit prejudice. Journal of Experimental Social Psychology, 41(3), 283-289. doi:10.1016/j.jesp.2004.06.003 Sue, S., & Zane, N. W. (1985). Academic achievement and socioemotional adjustment among Chinese university students. Journal of Counseling Psychology, 32(4), 570–579. Suh, E. M. (2002). Culture, identity consistency, and subjective well-being. Journal of Personality and Social Psychology, 83(6), 1378–1391. doi:10.1037//0022-3514 .83.6.1378 Suh, E., Diener, E., Oishi, S., & Triandis, H. C. (1998). The shifting basis of life satisfaction judgments across cultures: emotions versus norms. Journal of Personality and Social Psychology, 74(2), 482-493. Tadmor, C. T., & Tetlock, P. E. (2006). Biculturalism: A Model of the Effects of SecondCulture Exposure on Acculturation and Integrative Complexity. Journal of CrossCultural Psychology, 37(2), 173-190. doi:10.1177/0022022105284495 Taras, V., (2008). Culture survey catalogue: Original items, scoring keys and psychometric properties of 134 instruments for measuring cultural values and behaviors. from http://ucalgary.ca/~taras/_private/Culture_Survey_Catalogue.pdf. Taras, V., Rowney, J., & Steel, P. (2009). Half a century of measuring culture : Review of approaches , challenges , and limitations based on the analysis of 121 instruments for quantifying culture. Journal of International Management, 15(4), 357-373. doi: 10.1016/j.intman.2008.08.005 Turner, R. N., & Crisp, R. J. (2010). Imagining intergroup contact reduces implicit prejudice. British Journal of Social Psychology, 49(1), 129–142. doi:10.1348/014466609X41990

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Turner, R. N., Hewstone, M., & Voci, A. (2007). Reducing explicit and implicit outgroup prejudice via direct and extended contact: The mediating role of self-disclosure and intergroup anxiety. Journal of Personality and Social Psychology, 93(3), 369–388. doi:10.1037/0022-3514.93.3.369 Wang, Q. (2001). ―Did you have fun?‖ American and Chinese mother–child conversations about shared emotional experiences. Cognitive Development, 16(2), 693–715. Wang, Q. (2004). The emergence of cultural self-constructs: Autobiographical memory and self-description in European American and Chinese children. Developmental Psychology, 40(1), 3–15. Yamaguchi, S., Greenwald, A. G., Banaji, M. R., Murakami, F., Chen, D., Shiomura, K., Kobayashi, C., et al. (2007). Apparent universality of positive implicit self-esteem. Psychological Science, 18(6), 498–500. doi:10.1111/j.1467-9280.2007.01928.x Zane, N., & Mak, W. (2003). Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and an alternative empirical strategy. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 39–60). Washington, DC: American Psychological Association.

In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 4

ACCULTURATION AND MENTAL HEALTH STATUS, HELP-SEEKING, SERVICE USE, AND OUTCOMES FOR LATINO AND ASIAN/PACIFIC ISLANDER YOUTH Judy Ho and Shantel Daniels Pepperdine University, USA

ABSTRACT Acculturation is the psychosocial adaptation of persons from their culture of origin to a new or host cultural environment, and can include relearning language, incorporating new values, expectations, and beliefs. Research has demonstrated that acculturation can relate to a variety of mental health issues for youth and their families, including mental health status and well-being, knowledge and attitudes towards professional mental health services, the mental health help seeking pathway, and mental health treatment engagement and outcomes for ethnic minority children with emotional/behavioral problems. This chapter will review the literature on acculturation, traditional values and beliefs, and mental health status in Latino and Asian/Pacific Islander youth, and examine attitudes of immigrant families towards mental health illness and treatment. Literature on how acculturation relates to mental health help service use, and treatment engagement and outcomes for Latino and Asian/Pacific Islander youth will also be explored. We will examine barriers likely to be encountered in the mental health service pathway for ethnic minority families, and conclude with recommendations for acculturation research and future research directions in minority mental health, and provide recommendations for culturally sensitive practice.

INTRODUCTION An estimated 7.5 million U. S. youth have unmet mental health needs (Kataoka, Zhang, & Wells, 2002), and within this underserved population of children and adolescents, ethnic minorities are of particular concern. Although unmet mental health need affects all U. S. children, research suggests that African American, Asian/Pacific Islander, and Latino youth

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have an even higher level of unmet need than non-Hispanic White youth (Hough et al., 2002; Kataoka et al., 2002). For example, one study of at-risk youth found that 31% Non-Hispanic White youth, 47% of Latino, 48% of African American, and 72% Asian/Pacific Islander youth had unmet mental health needs (Yeh, McCabe, Hough, Dupuis, & Hazen, 2003). These disparities are troublesome because African American youth (e.g., Siegel, Aneshensel, Taub, Cantwell, & Driscoll, 1998) and Asian Pacific/Islander youth (Edman et al., 1998; Makini et al., 1996) have similar community rates of mental health problems compared to Non-Hispanic Whites, and some evidence show higher rates of mental health problems in Latino youth (Glover et al., 1999; Roberts & Sobhan, 1992) and American Indian youth (Costello et al., 1997) compared to their non-Hispanic White counterparts. Adding to the urgency of addressing these racial/ethnic disparities is the rapid diversification of the U. S. population; ethnic minority youth residents will continue to experience more rapid growth than nonminority youth (U. S. Department of Commerce, 1999). Current estimates indicate that 48% of U. S. children are from ethnic minority backgrounds, and this figure is projected to increase to 62% by 2050 (U.S. Department of Commerce, 2008). In the past two decades, National task forces have recognized the need to address racial/ethnic disparities in current mental health care and improve mental health treatment for ethnic minorities through several country-wide initiatives. The Surgeon General recommends that the nation place studying and understanding minority mental health and mental health care as a top priority in Mental Health: Culture, Race, and Ethnicity (USDHHS, 2001), and urged the nation in Healthy People 2010 to address disparities in health care access and outcomes, encouraging the field to strive toward the highest quality of care and health outcomes across groups of all ethnic backgrounds. In addition, the President‘s New Freedom Commission on Mental Health recommends that empirical research should be conducted to examine racial and ethnic disparities in access, availability, quality, and outcomes of mental health treatments, and that the resulting body of knowledge should be incorporated into Comprehensive State Mental Health Plans (The President‘s New Freedom Commission on Mental Health, 2003). The Commission builds on the National Institute of Health (NIH) Revitalization Act of 1993, which requires all NIH-supported research projects to include women and ethnic minority groups in clinical trials and other human research studies. These guidelines from national agencies underscore the importance of building on the mental health evidence base for various cultural groups. In line with these national initiatives, and as a result of documented racial/ethnic disparities for ethnic minority youth and expected population growth patterns for immigrant children, there has been an growing attention to the role of cultural factors in mental health service utilization for minority families (Cauce et al., 2002; Vega, Kolody, Aguilar-Gaxiola, & Catalano, 1999). Researchers have hypothesized that certain cultural attitudes, values, beliefs, and/or behaviors may act as barriers to mental health service use for these populations and thus help to explain documented differential use across cultural groups (Cauce et al., 2002; Vega et al., 1999). One way to study how individuals subscribe and adhere to cultural attitudes, beliefs and values is by measuring acculturation, which refers to the psychosocial adaptation of persons from their culture of origin to a new or host cultural environment or the ―process whereby attitudes and/or behaviors of persons from one culture are modified as a result of contact with a different culture,‖ and can include relearning language, incorporating new values, expectations, and beliefs; and altering behaviors (Burnam, Telles, Karno, Hough, & Escobar, 1987 , Moyerman & Forman, 1992). To assess the acculturation construct, many

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existing scales are multifaceted, with language as the most robust and most frequently used indicator of acculturation (Cuellar, Harris, & Jasso, 1980; Marks et al., 1987; Padilla, 1980). Other facets of these acculturation scales include questions to measure process factors such as the cultural orientation of daily life practices such as food, music, and friends (Burnam et al., 1987; Mendoza, 1989), and questions to measure ethnic self-identification (Montgomery, 1992). The idea that acculturation may predict health inequalities is based in a behavior/lifestyle model (Dressler, 1993), which proposes that culturally based knowledge, attitudes, and beliefs lead people to choose or reject behaviors based on their cultural worldviews, and that these choices profoundly impact their health. Indeed, it has been hypothesized that individuals who are less acculturated to American culture and/or highly tied to the culture of their ethnic origin tend to subscribe to attitudes that discourage health and mental health service use. The extant literature is fairly consistent in reporting that low levels of acculturation to American culture are associated with lower usage rates of general health/medical (Wells et al., 1987), specialty medical (O‘Malley, Kerner, Johnson, & Mandelblatt, 1999), and medical inpatient services (Wells et al., 1989). However, when examining mental health services specifically, studies have found inconsistent relationships between acculturation and mental health help seeking. Studies that examine attitudes toward professional mental health services report that Asian/Pacific Islanders, African Americans, and Latinos individuals who are less acculturated to American culture have less favorable attitudes toward U. S. mental health services (Atkinson & Gim, 1992; Ying & Miller, 1992; Kung, 2003; Zhang & Dixon, 2003). These negative attitudes have been reflected in actual mental health service utilization for adults, in that those with lower levels of acculturation to mainstream American society utilized specialty mental health services at lower rates than more acculturated individuals, even after controlling for sociodemographic and economic factors, health status, and insurance coverage (Wells et al., 1989). Conversely, acculturation has also been found to have the opposite of the hypothesized effect on help-seeking. In one study, attitudes of Mexican Americans toward help-seeking become less favorable as they become more acculturated to mainstream American culture (Ramos-Sanchez, 2001). Although acculturation has served as an important variable in health and mental health literature, models of acculturation are often implicit or poorly defined, leading to controversy about the robustness of acculturation as a construct (Arcia, Skinner, Bailey, & Correa, 2001) discussion about the construct‘s central assumptions (Hunt, Schneider, & Comer, 2004), and questions about how it‘s defined across various studies. These inconsistencies have led to discrepant findings across various research studies and somewhat premature generalizations to minority populations. To address these shortcomings, several alternative conceptual models of acculturation have been formulated, and newer measures have been developed to test and represent these models. Earlier models assumed that acculturation was inevitable and that acculturation implied assimilation to the American culture (Teske & Nelson, 1974). Thus, acculturation was viewed as a single dimension ranging from exclusive involvement in one‘s indigenous culture to exclusive involvement in American culture, and older acculturation measures reflected this conceptualization (Szapocnik et al., 1978). More recent models view acculturation as an interaction between at least two cultures simultaneously (Mendoza, 1989). Thus, acculturation involves two independent and orthogonal dimensions, for which participation in one‘s indigenous culture is distinguished from participation in the host American culture. Correspondingly, more recent acculturation scales reflect the embodiment

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of the bidimensional model (Berry, 1997), and while the evidence base has used both the unidimensional and bidimensional model in examining relationships to mental health, recent trends have shifted toward the bidimensional model of acculturation in research investigations. For example, one current model suggests that individuals low in acculturation to both American (or host) culture and traditional culture of origin are ―alienated,‖ and that those high in acculturation to both American and the indigenous culture are ―bicultural.‖ Those highly acculturated to the indigenous culture and low on acculturation to American culture are classified as ―traditional,‖ and those highly acculturated to American culture and low in acculturation to the culture of origin are ―assimilated‖ (Berry, Poortinga, Segall, & Dasen, 2002). The general measurement strategy corresponding to this conceptualization involves asking the respondent to complete two identical scales of acculturation, once in reference to the culture of origin, and once in reference to the host culture (e.g., Mendoza, 1994). The bidimensional model may be more useful in delineating the specific role acculturation plays in affecting mental health service use, due to a theoretically clearer separation of individuals who demonstrate a high adherence to cultural values and beliefs of their indigenous culture, while at the same time endorsing values of the host culture, and those who only evidence high orientation to only one of the cultures. Bidimensional models, on the other hand, point out the acculturative process is more complex, and that mainstream and heritage cultural identities are relatively independent. This alternative to the unidimensional approach of acquiring and relinquishing culture along a continuum shows that the process of acquiring the mainstream culture need not entail individuals having to give up their heritage culture.

ACCULTURATION OF PARENTS AND CHILDREN In the youth mental health literature, the involvement of caregivers and families in the receipt of services also complicates the measurement of acculturation. There is some debate about whether youth acculturation level or parental acculturation level is more influential in the youth service utilization pathway. Although youth acculturation level most certainly play a role in youth treatment process and eventual outcomes, it is likely that parental acculturation level plays a more significant role in the access of youth mental health services in the first place. Youth rarely refer themselves for treatment, and instead, rely on parents to act as gatekeepers to their care (McMiller & Weisz, 1996). Thus, it is informative to examine both youth and parent acculturation levels in determining how cultural values affect decisions for youth mental health. Another consideration regarding the acculturation construct is whether acculturation should be viewed as a series of external events imposed on the individual, forcing the individual to shift beliefs and behaviors; or if it is regarded as a more internal process that relates to development. Sam and Oppedal (2002) posit that when the acculturation process is applied to children with immigrant parents, it should be viewed as an integral part of life span development, and that acculturation changes are genuine developmental changes. Thus, acculturation may be better understood as a developmental process towards adaptation and gaining competence within complex cognitive, affective, and behavioral processes, likened to getting info about codes and languages, verbal and nonverbal ways of expression, motivation

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and attitudinal issues, and skills to utilize the acquired knowledge in the appropriate ways and situation (Kim, 1987) As the field continues to develop acculturation as a variable, researchers and clinicians build on their knowledge of how this important concept shapes the service use patterns of U.S. youth. Acculturation has been found to relate to a variety of mental health issues for ethnic minority youth and their families, including mental health status and well-being, knowledge and attitudes toward professional mental health services, mental health help seeking behaviors and actual service use, and mental health treatment engagement and outcomes. This chapter will provide a sampling of the literature on acculturation and mental health status in Latino and Asian/Pacific Islander youth, and examine how traditional cultural values of immigrant families intersect with attitudes toward mental health illness and treatment. We will also explore the literature on how acculturation relates to mental health care decisions, including help seeking, service use, treatment engagement, and outcomes for Latino and Asian/Pacific Islander youth. We will discuss examples of barriers immigrant families are at higher risk of encountering in the mental health care pathway, and two specific examples of culturally sensitive treatment programs that aim to address some of these barriers to treatment for immigrant families. Finally, the chapter will conclude with recommendations for clinical practice and suggestions for future research endeavors.

ACCULTURATION AND LATINO YOUTH Historical Background of Latinos in the U. S. The Hispanic Population in the U. S. has grown from 35.6 million in 2000 to 44.3 million in 2006 (U. S. Census, 2006), with higher concentrations in the South and west parts of the U. S. Among diverse Latino groups, the largest ethnic group is Mexicans (64%), followed by other Hispanics (7.7%), Central Americans (7.6%), South American (5.5%), Cubans (3.4%), and Dominican (2.8%). In 2006, 40% of the surveyed Latino population was foreign born (U. S. Census, 2008). To prevent stereotyping and overgeneralizations, we should first begin with the caveat that Latinos as a group is quite heterogeneous with many subgroups each unique in its linguistic, cultural, and sociodemographic background and immigration histories to the United States. The following sections represent an overview of trends observed in the research base, and some generalizations are stated although we appreciate the heterogeneity of cultures that this group represents.

Models of Acculturation and Latino Youth in the U. S. The importance of the relationship between acculturation and Latino mental health has been underscored through dozens of investigations that examine these variables over the past few decades. Overall, the literature shows an overall pattern of inconsistent findings. In the empirical literature, two predominant relationships between acculturation and mental health

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have emerged as summarized by Rogler et al., 1991). The arguments underlying these competing hypotheses can be summarized as follows: 1. A negative relationship with poorer mental health resulting from stress of inadequate social networks and unfamiliar cultural norms and dynamics from clients who have low acculturation to American culture. Immigrants who exhibit low acculturation to American culture have usually been recently uprooted from traditional supportive interpersonal networks in their native society, and have not yet had enough time or resources to rebuild and strengthen these networks in the American society where they now reside. As Latinos tend to hold interpersonal worldviews, social support is paramount to both daily function and identity formation. In addition, the lack of instrumental skills such as proficiency in English keeps the unfamiliar world from becoming familiar and controllable. These factors may lower self-esteem and eventually put the individual at higher risk for mental health illness. 2. A positive relationship with clients who have high acculturation to American culture showing high levels of mental health problems, possibly from internalization of racist cultural norms, stereotypes within the host society, and disinhibition of behaviors. For example, Mexican immigrants who report low acculturation to American culture evidence lower lifetime prevalence rates of psychiatric disorders compared to their more acculturated counterparts. And higher acculturation to American culture for Mexican adults was associated with higher lifetime rates of phobias, alcohol abuse/dependencies, drug abuse/dependencies, and major depression/dysthymia than Mexican adults with lower acculturation. In regards to these types of findings, Escobar (1998 - ) posited that Mexican immigrants have mental health advantages over Mexican Americans due to a ―protective buffering‖ that affords lower divorce rates, a more harmonious, interdependent family life, and greater retention of their traditional culture. These family protective variables are important and culturally relevant because Latino cultures tend to be highly familistic and hold interdependent worldviews (Vega, 1990). Also, specific to Mexicans who immigrate to California, Burnam et al. (1987) adds that the selectivity of this particular migration stream tends to create a psychological robust first-generation of immigrants who feel less deprived, because migration has increased their standard of living and represent an opportunity seeking venture. Conversely, Mexican Americans born in the U. S. may feel deprived because of their much higher but unrealized aspirations from being acculturated to the ideals and values of the ―American dream.‖

FAMILY FACTORS AND TRADITIONAL VALUES RELATED TO LATINO MENTAL HEALTH STATUS Latino youth in the U. S. are exposed to specific psychological and social stressors such as higher rates of poverty and family disruption, which puts them at risk for the development of serious emotional problems (Angel & Angel, 1996), higher rates of youth violence, teen

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pregnancy, school dropout, and suicide attempts (National Coalition of Hispanic Health and Human Services Organization, 1994). As current evidence demonstrates the importance of the acculturation experience in Latino mental health status (although the direction of the relationship is somewhat inconsistent throughout literature), it is important for mental health researchers and clinicians to understand factors relating to the Latino cultural experience, specifically, the immigration process.

THE IMMIGRATION EXPERIENCE Latino families tend towards kinship networks in keeping with their interdependent worldviews and traditions (Mindel, 1980). Several traditional cultural scripts identify with a familistic orientation: First, personalismo stresses interdependent relations and a warm style of relating to others; second, simpatia emphasizes harmonious social relationships and avoidance of interpersonal conflict; and, third, respeto highlights respect and dignity towards parents, elders, and authority figures (Keefe & Padilla, 1987). In addition, Hispanic mothers on self-reports characterize their families as more cohesive than Anglo American mothers, and report themselves as taking a more authoritarian orientation to parenting than Anglo American families (Dornbusch et al., 1987). Research demonstrates that individuals tend to feel threatened when moving from a traditional, extended family into a new culture where independence is expected and family networks are not necessarily central to an individual‘s social circle (Landau et al., 1981). Moves for Latino families are particularly stressful when they involve settling in a new culture without the family supports they are accustomed to from their traditional culture. In addition, certain Central American immigrant groups may experience a more intense level of stress due to their escape from scenarios of violence, torture, and war, and other situations where their lives have been directly threatened (Cervantes, Salgado de Snyder, & Padilla, 1989). Another consideration is that some Latino families who enter the U. S. do so illegally, which may contribute to poor employability, exploitation in jobs, financial problems, and insufficient housing (Irwin,1991). These challenges, combined with practical barriers such as poor proficiency in English, may lead to the development of mental health symptomatology such as anxiety and depression, and acting-out behaviors in youth. Furthermore, these experiences may add to distrust of people outside of the cultural group and self-harming behaviors (e.g., substance abuse).

THE ACCULTURATIVE PROCESS, FAMILY ADAPTATION, AND ADOLESCENT ADJUSTMENT PROBLEMS In the process of learning and adjusting to American culture, norms, and values, changes in the family occur relating to family structure, roles revisions and conflicts, and intergenerational interactions. For example, Latino children may be adjusting to relating to the nuclear family only as opposed to the extended family network in their country of origin. Children who immigrate to this country without parents/guardians may face even more severe cultural adjustment and mental health problems. Each member of the family also deal with major role changes as a result of immigration. Many switch careers completely, and both men

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and women may face unemployment. It may be easier for women to find work (e.g., as domestic employees) than for men, resulting in shifting family dynamics in a highly paternalistic cultural milieu (Leslie & Leitch, 1989). As children adapt more readily to the new environment due to their quicker grasp of the English language and socialization with non-Latino peers in school settings, they may be called upon by parents to assume adult responsibilities, such as serving as an interpreter, negotiating with health service providers, and handling family finances and other important decisions that impact the family structure. These ―power inversions‖ (Garcia-Preto, 1996b) results in a blurring of generational boundaries and increased strain for both youth and parents. As a by-product of the different rates of acculturation between parents and children, conflicts can arise among family members due to now competing cultural orientations and values regarding social relations and family structure. Evidence supporting this view includes a study that demonstrates children of immigrants who are exposed to competing cultural orientations may be more likely to exhibit behavioral problems and develop other mental health concerns (Vega et al., 1994). For example, immigrant Cuban boys who acculturated more quickly than their parents created a clash of values and expectations between parents and teams termed intergenerational acculturation gaps, resulting in an increase in domestic conflicts which destabilized parental authority, created parent-child alienation, and disordered family communication . These adolescents, caught up in the personal and social dynamics of acculturation differences with their nuclear family, are at increased risk for a variety of adjustment problems including deviant behaviors and conduct concerns (Szapocznik et al., 1979). The acculturation-discrepancy model proposes that the combination of high youth acculturation to American culture coupled with low parental acculturation to American culture leads to maladjustment. Another hypothesis is that increase in levels of acculturation to American culture for both parents and their children as they acclimate to life in the U. S. may predict increase in parent-child conflict as well . These conflicts are due to the fact that more acculturated individuals of both generations are less likely to adhere to cultural values that discourage conflict. Thus, whereas less acculturate family members may be more strongly invested in preserving harmonious and respectful relationships, more acculturated individuals may value direct communication, a value of American culture, to a greater extent than their less acculturated counterparts, resulting in more familial conflict being expressed.

ACCULTURATION, CULTURAL FACTORS, AND MENTAL HEALTH STATUS, SERVICE USE, AND OUTCOMES FOR LATINO YOUTH Latino Children and Mental Health Status The high poverty rate among Latino children, along with the impact of being a minority, acculturative stress, and problems with discrimination (Gee et al.), all contribute to the development of health and mental health problems for this population (Guendelman, 1985). Overall, Latino children are at equal or higher risk for developing mental health problems compared to their Anglo American counterparts (USDHHS, 2001), and stress arising from the

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cultural adaptation process has been related to more negative health and mental health outcomes for children and women than for men (Rogler, Cortes, & Malgady, 1991). Furthermore, the mental health of child immigrants is strongly linked to that of their parents, especially their mothers, suggesting that the highly familial and interdependent worldviews of Latinos may result in stronger associations in mental health status among kin. Immigrant youth are diagnosed with a variety of mental disorders that include anxiety, depressive, and conduct disorders (Karno, 1994). The development of Post Traumatic Stress Disorder (PTSD) among immigrant Latino youth may be tied to the risk factors encountered during the immigration experience, as the process itself may be a very intense and stressful event. For children, the range of PTSD related symptoms include cognitive delays, school difficulties, concentration difficulties (Malmquist, 1986 - , Cervantes et al., 1989) and regressive behaviors (Chimienti, Nasr, & Khalifel, 1989). Latino children are more likely to experience separation anxiety disorder than children of other cultural groups (Ginsburg & Silverman, 1996) and were the racial/ethnic group of youth most likely to have attempted suicide (National Coalition of Hispanic Health and Human Services Organization, 1994). In addition, studies have found higher rates of CD in Mexican Americans (Vaszonyi & Flannery, 1997) and higher incidences of official juvenile delinquency (Farrington, 1987 - 3; Rutter & Giller, 1983) compared to Caucasian Americans.

Latino Youth and Mental Health Service Use Latino youth have been found to be underrepresented in mental health services compared to their representation in the local population (Bui & Takeuchi, 1992), and were underrepresented in school-based services for children with severe emotional disturbance (SED) children in a study of a large urban area (McCabe et al., 1999). Studies examining utilization rates across various cultural groups generally show evidence of lower rates of service use by Latino youth compared to non-Hispanic White youth in public outpatient and school-based mental health services (Pumariega, Glover, Holzer, & Nguyen, 1998; Yeh et al., 2002). With regards to acculturation, a study demonstrated that high levels of parental acculturation to their traditional culture predicts lower rates of mental health service use for their youth at 2-year follow-up, possibly due to parents‘ role as the gatekeepers to youth treatment (Ho, Yeh, Mccabe, & Hough, 2006). These low usage rates are concerning as there is evidence of higher levels of unmet mental health needs for Latino youth (47.2% compared to 30.7% for non-Hispanic children; Yeh et al., 2003); and these higher unmet need rates were found even when socioeconomic and insurance status were accounted in analyses (Kataoka et al., 2002). Adding to these troubling findings for Latino youth are the patterns of higher prevalence of depressive/anxious symptomatology and higher rates of suicidal thoughts and attempts compared to non-Hispanic White youth (Centers for Disease Control and Prevention, 2000). The service use disparities evident in literature suggest that Latino youth may encounter a greater number of barriers in mental health service entry than other youth.

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Quality of Services Received by Latinos Although research on quality of mental health care with Latino youth is less available, findings with Latino adults suggest disparities. In one study, 24% of Latino adults received appropriate care for depression and anxiety compared to 34% of non-Hispanic White adults (24% and 34% received appropriate care, respectively; Young et al., 2001). Differential service sector utilization patterns by Latinos may also lead to a lesser likelihood of receiving adequate care. Latino adults were less likely to receive services in the specialty mental health sector than their non-Hispanic White counterparts, and instead sought services in the general medical setting (Vega, Kolody, Aguilar-Gaxiola, & Catalano, 1999), which is concerning because a greater likelihood of misdiagnoses and inadequate mental health treatment may occur in the primary care setting due in part to lack of specialty knowledge (Borowsky et al., 2000; USDHHS, 2001; Sclar, Robison, Skaer, & Galin, 1999). With regard to the experience of Latino adults in mental health services, perception of mistreatment and attitudes of mistrust has been endorsed (USDHHS, 2001); Latino were more likely than non-Hispanic Whites to feel that a doctor or health provider judged them unfairly or feel that they were disrespected because of their ethnic background (Brown et al., 1999; LaVeist et al., 2002). These findings suggest that the experience of Latinos mental health care may be significantly compromised.

Treatment Retention of Latino Youth Cultural factors impeding entry into mental health care, along with the receipt of poorer quality services or the perception of mistreatment in care by Latinos, may lead minority families to exit services prematurely before emotional/behavioral problems of the youth are resolved. Latino families are hypothesized to have poorer treatment retention compared to non-Hispanic Whites in mental health services, due to adherence to values, beliefs, attitudes, and behaviors that may be incompatible with Western conceptualizations of mental health treatment (USDHHS, 2001). Although only a handful of studies for minority youth are available, current evidence suggests that Latino families exhibit higher rates of dropout than non-minority families and that negative attitudes towards professional mental health services predicted premature termination (Morrisey-Kane & Prinz, 1999; McCabe, 2002). These findings are problematic because families who drop out are not likely to receive the maximum benefits services offer, and youth may continue to experience significant levels of impairment (Kazdin, Holland, & Crowley, 1994; Larsen, Nguyen, Green, & Atkinson., 1983).

Outcomes for Latino Youth There is evidence that Latino youth do benefit from services delivered in clinical trials and in more generalized settings, and a handful of studies regarding treatment of conduct problems with Latino youth demonstrate efficaciousness and effectiveness (e.g., Santisteban et al., 2003, Henggeler, Pickrel, & Brondino, 1999; Reid, Webster-Stratton, & Beauchaine, 2001; as reviewed by Ho, McCabe, Yeh, & Lau, 2010), but there is inconsistent evidence when comparing their treatment gains with non-Hispanic White youth. For example, a study that evaluated the effectiveness of a parenting program found that youths of Latino mothers

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exhibited a reduction in behavioral problems after treatment, and that there were no significant differences in treatment effects between youths of Latino and non-Hispanic White mothers. (Reid et al., 2001). Similarly, no significant ethnic differences in outcomes were found between Latino and non-Hispanic White youths with anxiety disorders who received CBT treatment (Silverman et al., 1999), and no differences were found on ADHD and ODD symptoms between Latino and non-Hispanic youths after receiving behavioral and medication treatment (MTA Cooperative Group, 1999). However, a parent training program demonstrated differential effects on outcomes for Latino and non-Hispanic White youths; specifically, that teacher-rated internalizing problems was reduced in the non-Hispanic White sample but not for the Latino sample (USDHHS, 2001). This illustrates the possibility that racial/ethnic disparities in outcomes exist for Latinos, thus, further research is needed before any generalizations can be made.

ACCULTURATION AND ASIAN YOUTH Historical Background of Asian/Pacific Islanders in the U. S. In 1970, Asian/Pacific Islanders accounted for only 0.7% of the U.S. population. By 2000, there were 11.9 million Asian/Pacific Islanders, comprising 4.2% of the total population (U.S. Bureau of the Census, 2002). Among diverse Asian American groups, the largest proportions are Chinese, Filipino, and Asian Indian, followed by Vietnamese, Korean, and Japanese. About 88% of Asian/Pacific Islanders currently residing in the United States are either foreign born or have at least one foreign-born parent (U.S. Bureau of the Census, 2003). To prevent stereotyping and overgeneralizations, we begin with the caveat that Asian Americans as a group is quite heterogeneous with over 20 subgroups (e.g. Chinese, Japanese, Filipino, Korean, Vietnamese, Laotian, Cambodian) each unique in its linguistic, cultural, and sociodemographic background and immigration histories to the United States (Leong, 2001; Sue & Morishima, 1982). The following sections represent an overview of trends observed in the limited research base with Asian/Pacific Islanders, and some generalizations are stated although we understand the heterogeneity of cultures that this group represents.

Acculturation Models and Asian/Pacific Islanders in the U. S. The acculturation process is stressful for Asian and Pacific Islander immigrants due to difficulties in attaining language proficiency, separation from familiar social networks, and potential cultural incompatabilities. The significance of the impact of acculturation on Asian American mental health has been increasingly studied. With the stereotype of being a ―model minority,‖ Asian Americans are often perceived to experience few if any social and psychological problems in their adjustment in the United States (Sue & Morishima, 1982). Yet research over the last three decades have shown (e.g., Sue & Morishima, 1982; Uba, 1994) that Asian American immigrants do suffer from a range of mental health problems, which indicates that acculturative processes in this group are worthy of further investigation.

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In addition, two common important patterns have emerged in the literature on the mental health of Asian Americans; namely, they tend to underutilize mental health services and when treatment is sought, they prematurely terminate at a much higher rate than nonminority clients (Leong, 2001), similar to patterns observed in the Latino literature. Much of the acculturation-health literature is focused on understanding the relationship between level of acculturation and risk of health problems (Escobar & Vega, 2000; Hwang et. al., 2005). However, findings from this area of research remains mixed, with evidence for two primary hypotheses that present contrasting views regarding its effects on emotional functioning with Asians/Pacific Islanders, similar to the Latino literature. Some researchers suggest that the acculturation process has a negative impact on immigrants and increases their psychological distress (Roger et al., 1991; Sanchez & Fernandez, 1993), while others report that acculturation is related to improved psychological well-being (Flaskerud ; Uman, 1996). 1. In concordance with the notion that acculturation is a process of adaptation to a new cultural environment, acculturation is conceived to be positively correlated with mental health status (Shen, 2001). In this perspective, acculturation is regarded as the evidence that the individual has successfully adjusted to the new environment and, in fact, has become a member of the mainstream society, demonstrating competence in social and occupational functioning. Asian American immigrants who experience significant challenges in the acculturation to Westernized American culture are more closely tied to eastern influences and traditional practices and have been reported to have underdeveloped relationships with mental health resources and the ability to link somatic, physical symptoms to psychological health. The less acculturated Asian Americana are, the higher the likelihood they will be more stressed and challenged in how they deal with psychological stressors. 2. On the contrary, a second perspective hypothesizes that high level of acculturation may heighten the individual‘s sense of dissonance and conflict. In other words, in attempts to achieve a balance between two cultures, individuals may experience more psychological distress that leads to deterioration in mental health, demonstrating a negative correlation between acculturation to the U. S. and mental health status for Asian/Pacific Islanders (Shen, 2001). Specifically, there is epidemiological literature that suggests that immigrants may be at greater risk for developing mental and physical illnesses as they acculturate, increase their length of stay in the U.S., and live in the U.S. across multiple generations (Berry, 1998; Burnam Hough, Karno, Escobar, & Telles, 1987; Escobar, 1998; Escobar & Vega, 2000; Hwang et. al., 2005; Kessler et. al., 1994; Rogler, Cortes, & Malgady, 1991; Vega et. al., 1998).

FAMILY FACTORS AND TRADITIONAL VALUES RELATED TO LATINO MENTAL HEALTH STATUS As Asians/Pacific Islanders engross themselves in the acculturation process, family is seen as the most essential resource in providing a sense of emotional support and emotional well-being. Conversely, family can also at times create an obstacle to seeking mental health services and placing added psychological stress on minority youth and increasing the

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likelihood of the individual developing psychological difficulties without receiving professional help. Although coping might be a universal process, culture shapes the way individuals evaluate their stressors and coping resources (Lazarus & folkman, 1984; Tweed & Conway, 2006). Research highlights that the process for immigrant youth to adapt to a new surrounding can often test psychological strength, and scholars have speculated that Asian‘s health and mental health coping strategies are shaped by Asian cultural values and worldviews. These include the ideals of Confucianism and the collectivistic notion that one should adjust one‘s feelings to fit one‘s environment to preserve social harmony, the importance of accepting rather than confronting one‘s problems, and the need to save face by not disclosing one‘s problem to others (Inman & Yeh, 2007; Morling, Kitayama, & Miyamoto, 2002; Tweed & Conway, 2006; Yeh, Arora, & Wu, 2006).

Confucianism Although there are significant differences among Asian groups, many of them share relatively common values, beliefs, and parenting styles that originated from the philosophical principles of Confucianism. Confusion principles emphasize the importance of social order and hierarchy, loyalty, respect for and deference to older family members, obedience, and obligation to the family (Kitano & Daniels, 1995; Min, 1995). The adopting of this value system may lead minority youth to hold sentiments that their thoughts and ideas are not allowed free expression, and that the family‘s needs and goals take precedence before their own. Ethnic minority immigrant adolescents face difficulties of successful psychological adjustment to the new social environment as they attempt to manage traditional values along with new values of the host society. They are expected to value and uphold their heritage and, at the same time, to learn another language quickly and to acclimatize to life in America. For example, immigrant Asian parents emphasize obedience and conformity with parental expectations and yet paradoxically as they themselves acclimate to American culture, recognize and encourage the importance of individual autonomy and self-assertion for the academic and social success of their children (Rhee, 1996; Uba, 1994, Ying, 1998). This dual expectation within the family and acculturation stress experienced by ethnic minority adolescents can have a significant impact on their self-esteem and life satisfaction, and can contribute to a variety of psychological adjustment problems (asakawa & Csikszentmihalyi, 1998; Florsheim, 1997; Gil et al., 1994; Padilla et al., 1986). Depending on how important the youth views ideals of individualism, he/she may either rebel against this notion resulting in acting out behaviors, or continue to hold these ideals with outward behaviors but deal with emotional distress that results in private.

Accepting Rather Than Confronting and Somatization The manner in which individuals cope with mental health stressors is inherently connected to their culture. Although coping might be a universal process, culture shapes the way individuals evaluate their stressors and coping resources (Lazarus & Folkman, 1984; Tweed & Conway, 2006). Coping strategies can be categorized into two broad categories:

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engagement coping, which refers to coping by actively negotiating with stressful situations, for example, problem solving and seeking social support, and disengagement coping, which focuses on the behavior, thoughts, and feelings that avoid stressful situations, for example, social withdrawal and self-criticism (Tobin, Holroyd, Reynolds, & Wigel, 1989). Consistent with Asian values and worldviews, Asian Americans have been found to be less likely to use engagement coping strategies and more likely to use disengagement coping strategies as compared to European Americans. Studies have also shown that Asians‘ and Asian American‘ attributions regarding mental illness are related to their preferred coping strategies (Umemoto, 2004; Xia & Jiang, 2007). For instance, Umemoto (2004) found that Asian American university students who conceptualized mental illness as controllable and something that should be tolerable were more likely to use avoidance related methods for dealing with psychological difficulties. Studies have found that Chinese Americans tend to view mental illness as a problem remediated by willpower and the avoidance of morbid thoughts (Arkoff, Thaver, & Elkind, 1966; Lum, 1982; root, 1985; Sue et al., 1976). Since Western models of psychotherapy often call for intense exploration of highly emotional content, this intervention would seem highly incongruous to many Asian Americans‘ beliefs about problem solution. To a significant amount of Asian Americans, mental health professionals should not have to address psychological issues that they themselves are capable of handling. As a result, Asian Americans present their psychological stress in physical manners that often go unrecognized as mental health issues. For many Asian Americans, psychological illness can present itself in unrecognizable forms. The tendency toward somatization is probably the strongest example of expression of symptoms among Asian Americans. Marsella, Kinzie, and Gordon (1973) identified Chinese, Japanese, and white Students who had scored high on the Zang Self-Rating Depression Scale and administered a symptoms checklist to them., and found that the Chinese American students were most likely to exhibit somatic symptoms in depression. Factor analysis of the checklist revealed that both the Chinese and Japanese groups had more gastrointestinal complaints, such as poor appetite, indigestion, and gas, whereas the Whites felt a need to continue to eat even when they were not hungry. The tendency to somatize is rooted in several cultural beliefs about disease and illness. First, traditional Chinese medicine emphasized an organ-oriented concept of pathology, viewing the human body as a microcosm of the universe. Body organs and human emotions were believed to correspond to various phases in nature. Such cultural concepts of diseases readily argued that psychic distresses were expressed through bodily organ symbols. Second, expression of physical complaints is much more socially acceptable than that of emotional complaints in Chinese culture because of their medical belief system. Third, the Chinese are reluctant to express emotion (particularly sexual or negative feelings) openly to others, preferring more subtle forms of communication. Fourth, there is social reinforcement for concerns about bodily symptoms, but nor for psychological problems, because of the shame associated with the view that they are signs of personal weakness. Thus, the mental health status of immigrant Asian Americans in the U. S. who hold their traditional values and beliefs in high regard may be erroneously estimated as higher than it actually is, and this group may appear to be more ―mentally healthy‖ than the actual picture. As Asian Americans often somaticize their emotional/behavioral stressors, these expressions of bona fide mental health related issues may be missed on customary assessment tools for mental health status. The

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manner in which mental health problems are expressed in this population also affect care options. The use of alternative services such as general medical practitioners and spiritualists to address these physical complaints would be highly probable and culturally acceptable

Saving Face and Private Thoughts Asian Americans have traditionally been conditioned to preserve family honor and to keep problems within the family. This idea has traditionally been held as a badge of honor within the Asian community and highlights the need to preserve family secrets to save face while maintaining the culturally acceptable stance of withholding family problems and information from outside forces. For example, for someone suffering from psychological illness seeking mental health services would convey to the family a sense of dishonor. Asian Americans have internal conflicts that affect their beliefs about how to manage and cope in a traditionally accepted manner. These beliefs can potentially determine their mode of help seeking behavior as a result of their value system. With respect to the conflict between cultural values and psychotherapy, Ruth (1985) suggested that talking to a mental health worker about psychological problems may be viewed by Asian Americans as bringing disgrace on the family. Instead, Asian Americans may try to resolve their problems on their own, believing that mental health can be maintained by avoiding bad thoughts and exercising will power (Root, 1985). In an attempt to save face and seeking to manage bad thoughts by suffering in silence, Asian Americans may develop physical symptoms that are a direct result of mental distress, thus affecting their mental health status. Asian Americans internalize stress and express symptoms through somatization and may therefore seek help from medical professionals as opposed to specialty mental health care (Sue & Morishima, 1982; Tseng, 1975).

Family Adaptation, the Acculturation Gap, and Adolescent Adjustment Issues The development of an ―acculturation gap‖ among family members may lead to possible mental health issues for quickly acclimating youth with parents who hold close ties to traditional Asian values that oppose westernized models of adolescent autonomous development. Children have greater exposure to mainstream American culture through the educational system and peer interactions, and are more easily influenced developmentally than their parents (Hwang, 2009), and parent-child value discrepancies develop over time as parents continue to uphold traditional ideals over the value system of the host culture. These discrepancies may encompass disagreements on how old they should be when they are able to date, what they should study for school, adherence to cultural practices, and perception of appropriate parent-child relations. Such strict rules for adolescents can often cause unfavorable results. For example, Kim and Ge found that adolescent reports of being exposed to more traditional Chinese parenting practices (e.g. harsher, more intrusive, and less collaborative parenting) were linked with greater depressive symptoms among Chinese American adolescents. One of many possible threats to the overall outcomes and development of youth reared under such traditional parental influences. Studies examining Asian American

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college students have shown that parental orientation to traditional Asian culture and Asian values gap (i.e., difference between parents‘ and children‘s adherence to traditional Asian cultural values) are associated with increased family conflict (Ahn, Kim, & Park, 2008; Lee, Choe, Kim & Ngo, 2000; Park, Vo, & Tsong, 2008), especially in the areas of academic and career, dating and marriage, and family expectations (Ahn et al., 2008).

ACCULTURATION, CULTURAL FACTORS, SERVICE USE, AND OUTCOMES FOR ASIAN/PACIFIC ISLANDER YOUTH Asians/Pacific Islander Youth and Service Use Although there is a paucity of data concerning Asian/Pacific Islander youth, available data shows underrepresentation and lower rates of use of specialty mental health services and school-based services compared to non-Hispanic Whites. Some studies have found that Asian/Pacific (Bui & Takeuchi, 1992; McCabe et al., 1999). Asian/Pacific Islander youth underutilize special education services for youths with emotional disturbance compared to non-Hispanic White children (Yeh, Forness, Ho, McCabe, & Hough, 2004), and Asian/Pacific Islander youth have the lowest utilization rates in mental health services compared to African American, Latino, and non-Hispanic White youth, even when analyses controlled for caregiver strain and socioeconomic status (Garland et al., 2005). In addition, Asian/Pacific Islanders are most severe in their symptom presentation at time of initial service use (USDHHS, 2001), which suggests that Asian/Pacific Islander youth may delay services until problems become too difficult to manage without professional help, or until a certain severity of problem is reached. Asian/Pacific Islander youth also demonstrate a high level of unmet mental health need (71.8% compared to 30.7-47.7% for youth from other cultural backgrounds; Yeh et al., 2003). Literature indicating underutilization and higher levels of unmet needs compared to other cultural groups, coupled with evidence that Asian/Pacific Islander youth delay seeking services until symptoms are very severe, suggest that many challenging barriers to mental health service use exist for this population.

Quality of Care Received by Asian/Pacific Islanders There is a dearth of studies examining quality of care for Asian/Pacific Islanders, although evidence suggests that they are less likely to receive evidence-based care (Miranda et al., 2005). The widely held stereotype of Asian Americans as ―problem free‖ may lead to providers to overlook potential mental health related issues and intervention needs (Takeuchi & Uehara, 1996). For example, Borowsky and colleagues (2000) provided tentative evidence that primary care doctors may not identify depression in their Asian American clients as often as in non-Hispanic White clients. Regarding perception of treatment received, Asian American adult clients reported less satisfaction with outpatient mental health care than their non-Hispanic White counterparts (Zane, Enomoto, & Chun, 1994). Further investigations

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need to be conducted to evaluate quality of services for this group, including both Asian/Pacific Islander adults and youth to address these gaps in the evidence base.

Treatment Retention and Asian/Pacific Islanders Youth Limited evidence suggests that there are differential patterns of beliefs regarding the etiology of youth emotional/behavioral problems. Asian/Pacific Islander parents were more likely than non-Hispanic Whites to cite American culture as causes of their child‘s problems, and both African American parents and Asian/Pacific Islander parents were more likely to endorse prejudice (Yeh, Hough, McCabe, Lau, & Garland, 2004) that may not necessarily lead to service-seeking in the mental health sector. It is possible that these beliefs, which may be incompatible with Western conceptualizations of mental illness, will subsequently reduce treatment retention.

Outcomes for Asian/Pacific Islander Youth Limited research with Asian American adults suggest that they had poorer short term results than Whites in mental health care (Zane, Enomoto, & Chun, 1994). In regards to children, one study reported a reduction in behavioral problems for children of Asian American mothers after completing a parent management program, and that there were no significant differences in outcomes between youths of Asian and non-Hispanic White mothers (Reid et al., 2001).

BARRIERS TO CARE FOR ETHNIC MINORITY YOUTH IN THE U. S Latino and Asian/Pacific Islander youth and families encounter an increased number of barriers in the help-seeking pathway (USDHHS, 2001; Cauce, 2002). We provide examples of some of these barriers in the following section, categorized under general umbrellas of barrier types.

Logistical Barriers Concrete obstacles such as inaccessible locations (Baekeland & Lundwall, 1975; BoydFranklin, 1993), lack of funds to pay for care, and general financial shortcomings (Leong, Wagner, & Tata, 1995; McNeil & Kennedy, 1997; Tolan & McKay, 1996), lack of private insurance and lack of knowledge about insurance plans (Kataoka et al., 2002; Smedley, Stith, & Nelson, 2003), transportation problems (Koroloff, Elliot, Koren, & Frisen, 1994), lack of time (Tolan & McKay, 1996), and lack of child care (Hahn, 1995; McKay, McCadam, & Gonzales, 1996) have been found to be significant barriers to obtaining mental health care for low-income minority families as well as low-income families of any cultural group.

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Social Network and Resources Barriers Lack of social support, stress associated with poverty, family dysfunction, and negative life events have been linked with lower initial service use, ongoing engagement of families, treatment retention rates, and outcomes in youth and family treatment for various cultural groups including non-Hispanic Whites (Harrison, McKay, & Bannon, 2004 - 1; MorriseyKane & Prinz, 1999; McKay, Pennington, Lynn, & McCadam, 2001). Mothers‘ social networks (both in terms of quality and quantity) were important in the decision to enter professional mental health treatment. Parents tended to consult family members and friends for feedback about how to handle their youth‘s problems (Arcia & Fernadez, 2003), and parents who attended at least one service appointment had spoken to their primary social support person prior to entering treatment (Harrison et al., 2004). In addition, encouragement from social support networks to seek professional help was significantly associated with keeping a first appointment at an outpatient mental health clinic, and was correlated with longer length of stay in services for youth and their families (McKay et al., 2001; Harrison et al., 2004). Conversely, it may be hypothesized that lack of social support systems for families in distress may act as an impediment to receiving needed services.

Referral Barriers Children rarely seek services on their own and are often referred by and brought to treatment by adults (e.g., parents, school personnel, county officials). As parents often act as gatekeepers to their child‘s care, the receipt of services may be determined by whether the parent recognizes the problem as needing intervention (McMiller & Weisz, 1996; Cauce et al., 2002). Thus, delays in recognition or decision-making on the part of parents can act as barriers to referral for youth. Schools are also a primary gatekeeper to enrollment in youth mental health services (Forness, 2003), but there is evidence that school psychologists and educators were ―back-loading‖ most of their efforts, only referring children to needed intervention long after the diagnosis was fully realized and symptoms were severe (Hoagwood & Johnson, 2003). Also concerning, research suggest that misidentification of youth‘s emotional/behavioral difficulties by adult referral sources was common (Forness, 2003); for example, fewer than one in four youth identified for school-based services was correctly detected as having emotional or behavioral disorders by a school personnel (Redden et al., 1999; Lopez, Forness, MacMillan, Bocian, & Gresham, 1996). Such misidentification of mental health problems may result in a lack of specific treatment for these problems, and there is support to show that ethnic minority children are more susceptible to misdiagnoses and delays in referral until emotional/behavioral problems are severe (USDHHS, 2001), suggesting that referral barriers may be increased in ethnic minority children.

Cultural Barriers to Treatment For minority families, a number of cultural factors may act as barriers to youth mental health care. We adopt Cauce‘s model (2002) to describe cultural variables identified in the current literature that profoundly impact decisions for youth mental health care. Cauce states

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that culture plays an important role in three key junctions of the service utilization pathway: 1) problem recognition and definition, 2) the decision to seek help, and 3) service selection (Cauce et al., 2002).

PROBLEM RECOGNITION AND DEFINITION Problem recognition is the first step to help-seeking, and families may be less likely to seek services in the mental health sector if they do not believe their child‘s emotional/behavioral problems are mental health related. Indeed, there is evidence that cultural groups differ on what is perceived to be a mental health problem (Fabrega, Ulrich, & Mezzich, 1993). For example, Asian Americans‘ attributions about psychological problems have been shown to be connected to broader cultural norms (Cheung, 1986; Kawanishi, 1995; Mallinckrodt, Shigeoka & Suzuki, 2005). For instance, Kawanishi (1995) found that consistent with Japanese cultural beliefs in fatalistic resignation to problems in life, Japanese immigrants living in Southern California were more likely than European Americans to attribute successful coping with emotional stressors to good luck. In another study, Mallinckrodt et al. (2005) found that many of the perceived etiology beliefs favored by Asian American students were internal causes such as a weak mind or a brain disorder. Ethnic minority parents are more likely to identify their child‘s emotional/behavioral problems as non-mental health related than non-Hispanic White parents or not identify them as emotional/behavioral problems at all (USDHHS, 2001). For example, some cultures may be more accepting of certain mental health symptoms and have different ―distress thresholds,‖ of what is considered undesirable or abnormal (Weisz & Weiss, 1991). For example, Thai parents rated their child‘s emotional/behavioral problems as less worrisome, less likely to reflect stable traits, and more likely to improve with time compared to American parents (Weisz, Walter, Chaiyasit, Anderson, 1988). Parents who hold these beliefs may not be likely to seek help of any sort, as they do not view their child‘s behaviors as problematic or needing intervention. There are also cultural differences in the etiological explanations of youths‘ emotional/behavioral problems. Asian/Pacific Islander parents held causal beliefs about their child‘s emotional/behavioral problems that were more sociological and less consistent with biopsychosocial explanations compared to non-Hispanic Whites (Yeh, Hough et al., 2004). Thus, the link between cause of problems and type of treatment needed to address issues does not point parents toward the direction of mental health treatments. Indeed, parental beliefs about their child‘s problems helped in part to explain racial/ethnic disparities in the utilization of special education services for youth with emotional disturbance (Yeh, Forness et al., 2004 1) and specialty mental health service use (Yeh et al., 2005). Evidence suggests that Mexican American parents value parental authority (Rosello & Bernal, 1996), and Latino parents are more likely to endorse the use of an authoritarian style parenting compared to non-Hispanic Whites. Thus, Latino parents are more likely to view their child‘s problems as a matter of ineffective discipline (e.g., requiring more strict discipline) rather than a mental health concern to be resolved with psychotherapy (McCabe, 2002). These cultural differences in the problem recognition stage illustrate how minority parents may be less likely to recognize their

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child‘s emotional/behavioral problems as needing intervention in the mental health sector or needing intervention of any type.

The Decision to Seek Help Once a mental health problem is recognized as abnormal, undesirable, and/or needing intervention, cultural factors again play a key function in whether families actually seek professional help. Attitudes toward mental illness and mental health interventions are influential barriers to youth mental health care because they predict actual service use rates and treatment outcomes (Corrigan, 2004; Gonzalez, Alegria, & Prihoda, 2005). Many nonWestern cultural groups hold negative attitudes toward individuals with mental illness, believing they are dangerous and treating them as outcasts of society (Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999). Evidence shows that minorities are less likely to seek help even when a mental health problem is distressing and unlikely to resolve on its own due to negative attitudes and stigma toward mental health problems and toward seeking help for problems (for mental health concerns as well as problems in general). In many East Asian cultures, requiring help from sources outside one‘s family for any problems is regarded as shameful, resulting in ―loss of face‖ (Zane & Yeh, 2002; Cheung & Snowden, 1990; Liao, Rounds, & Klein, 2005). Therefore, Asian American families exhaust efforts to deal with the child‘s emotional/behavioral problems within the family in private before considering outside resources (Lin, Inui, Kleinman, & Womack, 1992). This is supported by research that shows only 12% of Asians mentioned their mental health problems to friends/relatives, and only 7% consulted a mental health professional or a physician (Zhang, Snowden, & Sue, 1998). These rates are much lower than those of non-Hispanic Whites. In addition, APIs are the most severe in their symptom presentation at initial service entry compared to other racial/ethnic groups (Brown et al., 1973; Bui & Takeuchi, 1992; Durvasula & Sue, 1996; Sue & Sue, 1974), supporting the notion that Asians make every attempt to deal with emotional/behavioral problems on their own before risking bringing shame upon themselves and their family. Latino families value stoicism and favor handling all problems within the family, similar to Asian cultures (Alvidrez, 1999; Martinez, 1993; Rosello & Bernal, 1996). These cultural values and beliefs encourage many individuals to deal with problems on their own or within the immediate family, leading to a lesser likelihood of seeking help in any setting, mental health or otherwise, formal or informal. There is some evidence that acculturation is related to help-seeking behaviors. Findings with Asian adolescents and young adults show that those more aligned with values of their traditional culture were least likely to recognize a need for professional treatment, least tolerant of stigma associated with the decision to enroll in mental health services, and least open to discussing emotional/behavioral problems with a professional clinician (Atkinson & Gim, 1989). Results of this study suggest that acculturation is important to consider in understanding help-seeking for a particular family.

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Service Selection Once a problem is recognized and the decision to seek help of some type is made, cultural factors may yet again present barriers for minority families to select services in the mental health sector. Minority families are more likely to hold stigma specifically towards the mental health sector (USDHHS, 2001), and thus are less inclined than Whites to seek services in specialty mental health (Gallo, Marino, Ford, & Anthony, 1995; Chun et al., 1996). Latino families felt that help care providers have treated them badly because of their race/ethnicity (LaVeist et al., 2002), and minority parents tend to be fearful that family members will be inappropriately labeled, medicated, or hospitalized by mental health providers (Staggers, 1987) Once enrolled in treatment, minority families are more likely to continue to hold these negative attitudes toward mental health care and tend to endorse negative expectations of treatment outcomes and lower rates of satisfaction with services received (Richardson, 2001, USDHHS, 2001). Negative expectations may act as an important barrier to staying in services, as studies show that this outlook predict subsequent barriers to participation in services, premature dropout, poor outcomes (USDHHS, 2001; Nock & Kazdin, 2001), and a type of ―self-fulfilling prophecy,‖ looking for reasons to confirm one‘s initial attitudes and expectations towards mental health care. These results underscore the importance of parental attitudes toward mental health care, as these views may not only influence parents‘ initial decisions to select seek services in the mental health sector, but also impacts their interest in ongoing mental health treatment for their child (McKay et al., 2004). Many minority families prefer other sources of care that are more consistent with their traditional cultural practices, norms, and/or beliefs, and often seek informal sources of care such as family, friends, clergy, and traditional healers as opposed to formal sources of care such as general health care in the medical setting or specialty mental health care (Harrison et al., 2004; Snowden, 2001; Peifer, Hu, & Vega, 2000). Latinos adolescents and adults often use folk remedies or indigenous healers for their psychiatric concerns (Novins et al., 2004; Keegan, 1996), and Asian/Pacific Islanders often used Chinese medicine and other complementary treatments (USDHHS, 2001). The utilization of alternative care in lieu of specialty mental health services (e.g., as delivered by psychologists or psychiatrists) may be influenced by culturally based beliefs about the etiology of mental health problems (Cheung & Snowden, 190; Leong, wagner, & tata, 1995; U.S. Department of Health and Human services, 2001), holistic beliefs about illness (Sue & Sue, 1999; Sue & Morishima, 1982), and the shame and face loss associated with mental illness (Zane & Yeh, 2002). Few investigations have examined how other types of care may constrain or facilitate mental health service use among Asian Americans. Two ideas of how these factors interact are summarized with a) the inhibition hypothesis, that other types of health care (e.g., primary or alternative care) inhibit individuals from seeking specialty mental health services, and b) the facilitation hypothesis, that other types of care are positively associated with the use of specialty mental health services. While use of alternative services in itself a barrier to mental health service use (as it does not necessarily preclude concurrent use of specialty mental health services), there is evidence that minority groups utilize informal social networks or traditional healing treatments in lieu of services in the mental health sector. For over twothirds of parents of minority youth, seeking help from professionals was not their first choice (McMiller & Weisz, 1996), and these families often exhibit a reluctance to utilize and

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participate in mental health services (Tolan & McKay, 1996). In addition, minority parents were about one-third as likely as their non-Hispanic White counterparts to contact professionals during the initial stages of help-seeking and service selection, and much more likely to make initial contact for assistance with social networks such as family and community members (McMiller & Weisz, 1996). When minority groups do decide to seek any type of mainstream professional help, they are twice as likely to seek treatment in general health care settings as opposed to mental health settings (Cooper-Patrick et al., 1999). This service selection is partially related to unfamiliarity with psychotherapy and mental health service options. Different cultural groups may be less informed about available mental health treatment options and how to receive them (USDHHS, 2001; McCabe, 2002), which may be due in part to other factors such as an unfamiliarity with American culture and Westernized mental health care, especially for recent immigrants or the less acculturated (Yeh et al., 2003; Keefe & Casas, 1980; USDHHS, 2001). This lack of knowledge, which may be related to some of the aforementioned cultural or contextual factors, may act as an additional barrier to service selection in the mental health sector. Beyond unfamiliarity, minority families also seem to have essential differences when compared to non-Hispanic White families regarding expressions of illness and views on the types of treatments that may be appropriate for their symptoms. Specifically, minority individuals seem to have different symptom experiences and idioms of distress from White individuals (USDHHS, 2001) and are more likely to view mental disorders as physiological problems that should be treated by primary care physicians (Acosta et al., 1983, Vega et al., 1999). However, primary care providers may not be equipped to recognize mental disorders in the medical setting and may not be trained to provide the specific services patients need for their mental health problems (Rost et al, 2000). Research demonstrates that minorities are at greater risk than non-minorities for missed and/or incorrect diagnoses in primary health care, resulting in subsequent inappropriate interventions in the general health setting (Borowsky et al., 2000).

SYNTHESIS OF ACCULTURATION LITERATURE AND BARRIERS IN MENTAL HEALTH HELP-SEEKING PATHWAY Review of the current evidence base suggests that there Latino and Asian American/Pacific Islander youth experience mental health symptoms at equal or greater rates than that of non-Hispanic White children, yet are less likely to seek help in the professional mental health sector and less likely to stay in services once enrolled, partially due to immigrant parents‘ adherence to traditional cultural beliefs, values, and attitudes that are incongruent with Western conceptualizations of mental illness and treatment models. In addition, there are a number of barriers that minority families experience in the help seeking and service use pathway. These barriers range from logistical issues such as lack of insurance and transportation to culture-related issues such as acculturation status, mistrust of the professional mental health system, stigma regarding mental illness, and preference for interventions that are more in line with traditional cultural values and beliefs of the family. We suggest recommendations to improve upon the acculturation - mental health literature,

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and strategies to reduce barriers, promote access, and improve outcomes for minority youth in mental health services.

EXAMINING THE CONCEPT OF ACCULTURATION IN EMPIRICAL STUDIES Instead of focusing on improving the measurement and definition of acculturation, which has been deemed a ―fuzzy‖ construct which can include almost a limitless set of elements and functions (Escobar and Vega, 2000), it may be more useful to examine the specific cultural factors within their actual cross cultural and historical context. Future studies should include the examinations of the underlying cultural variables that are hypothesized to produce racial/ethnic disparities in mental health care for youth. For example, some current investigations have examined specific cultural variables such as language preference, parenting beliefs and practices, and beliefs about child‘s mental health problems to identify relationships to mental health help-seeking, service use, and outcomes. These studies may provide info on possible intervention points and aid in designing interventions to reduce disparities. Another alternative to examining acculturation as a quantifiable variable is to investigate acculturative processes in qualitative, descriptive research. As culture is extremely complex and context specific, it is no surprise that it has been difficult to standardize the construct of ―acculturation‖ across studies, and to reduce all of its components to a measurable variable. In line with the anthropological roots of this construct, it may be helpful to return to observational, descriptive field studies that allow for more detailed and context-rich examinations of acculturation across smaller samples or even single families.

IMPROVING ACCESS, DELIVERY AND ENGAGEMENT AMONG LESS ACCULTURATED FAMILIES We make several recommendations for improving access, delivery, and engagement, which are described in more detail in the following section. Our recommendations include: 1) Address logistical barriers to access such as availability of services, increasing financial support for services, providing same language/same ethnic background therapists 2) Providing evidence-based services and culturally adapt existing protocols when necessary 3) Provide services in socially acceptable settings and integrate with alternative services when applicable and possible 4) Encourage practice of cultural competence in clinical settings 5) Invest special effort in engaging the family in mental health treatment

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Address Logistical Barriers to Access. Effective mental health treatment options are available for youth emotional/behavioral problems, but they are disproportionately accessed and used by minority families, and may not be available to certain populations, such as families living in rural areas, families who are poor, and families who are uninsured. It is important to increase the availability of less invasive treatment options in the community whenever possible. Creating incentives for providers to service underserved areas, to provide a percentage of pro bono or sliding scale services, and to utilize innovative methods of treatment in non-traditional settings such as the client‘s home or school would be helpful to increase the delivery rates of services to ethnic populations that have historically underutilized services. For persons with limited English proficiency, the language barrier is an important deterrent to receiving care (Sue, Fujino, Hu, & Takeuchi, 1991). Providers should identify and document the language needs of the client at the start of the treatment process, provide a range of translation options and ensure their quality, provide written materials in languages other than English free of charge, and provide ethnically-matched clinicians whenever possible, and especially if requested by the client. Research demonstrates that ethnicity-specific programs and cultural matching of therapists to clients seem to increase service utilization and retention among African Americans, Latinos, Mexican Americans, and Asian Americans (Takeuchi, Sue, & Yeh, 1995). These modifications may facilitate access for racial/ethnic minorities, particularly recent immigrants and those less acculturated to American culture.

PROVIDE EVIDENCE-BASED CARE AND CULTURALLY ADAPT INTERVENTIONS WHEN NECESSARY Racial/ethnic minorities are less likely than non-Hispanic whites to receive state of the art, evidence-based care (USDHHS, 2001) and there are only a small collection of studies examining minority youth outcomes for evidence-based treatments (Miranda et al., 2005). Results from available studies appear promising, as reviews of evidence-based care for depression, anxiety, and conduct problems result in improved mental health status for African Americans, Latino, Asian, American Indian, and Alaskan Native children (Miranda et al., 2005; Ho, McCabe, Yeh, & Lau, 2010). As culture and language may significant affect the perception, utilization, retention, and outcomes of youth and families in services (USDHHS, 2001), evidence exists for the development of culturally adapted interventions to increase acceptability and accessibility of services to minority families (Miranda, Makamura, & Bernal, 2003). Given the documented racial/ethnic disparities in the help seeking pathway and the high number of logistical and cultural barriers to mental health service use, researchers and clinicians have become increasingly interested in developing culturally adapted interventions that may help service the needs of minority youth populations. Encouragingly, several dozens of treatment programs to date have been constructed that emphasize cultural sensitivity, and some of these treatments have demonstrated efficacy and effectiveness in clinical trials and community studies (as reviewed by Ho, McCabe, Yeh, & Lau; 2010). A useful framework for identifying circumstances where cultural adaptations of evidence-based interventions may be most needed was proposed by Lau (2006). Specifically,

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Lau stated that ethnic-specific treatment adaptation may be warranted when evidence points to significant variability across cultural groups in (a) contextual processes influencing vulnerability and protection from the target problem and/or (b) response to standard evidencebased treatment strategies for the target problems (Lau, 2006). Once a culturally adapted version has been developed, it should be tested with a research design that will evaluate its outcomes in comparison to the original, unadapted protocol to establish whether cultural adaptations can incrementally improve outcomes and engagement for specific cultural groups. This type of comparative design allows us to determine whether the investment made in cultural adaptations is worthwhile, unnecessary, or even harmful. One example of an evidence-based culturally adapted treatment approach for Latino children is the GANA Program for Mexican Americans (McCabe et al., 2005). The GANA program is a modification of Parent Child Interaction Therapy (PCIT), an empirically supported behavioral parenting skills program for treating young children with disruptive behavior based on Baumrind‘s (1966) developmental theory. Parent Child Interaction Therapy teaches authoritative parenting – a combination of nurturance, good communication and firm control. Authoritative parenting style has been linked to fewer child behavior problems in multiple studies (Linver, Brooks-Gunn, & Kohen, 2002) including ethnic minority children (Querido, Warner, & Eyberg, 2002). The efficacy of PCIT has been established in studies with predominantly Caucasian American samples demonstrating its superiority to wait-list control (Nixon, Sweeny, Erickson, & Touyz, 2003) and to parent group didactic training (Eyberg & Matarazzo, 1980). The GANA program adopts a public health approach to mental health problems (Bruce, Smith, Miranda, Hoagwood, & Wells, 2002), in which the provider plays a dynamic role in engaging families in the program, addressing barriers to involvement, and preventing treatment dropout. Thus, the GANA program aims to address many of the issues that Latino families are at risk of encountering in specialty mental health care as discussed in this chapter. In addition, the GANA program recognizes that Mexican Americans are heterogeneous, and includes a detailed assessment in the first treatment session of a number of culturally influenced ideas that may have profound effects on how parents respond to the program to better address needs of individual families. For example, parents are asked to provide information on their beliefs about the causes of their child‘s problems, the role of extended family members in raising the child, beliefs about discipline, attitudes and expectations for the program, and use of alternative treatments (McCabe et al., 2005). These concepts are referenced throughout treatment so that the program can be presented in ways harmonious with the parents‘ belief system about the causes of their children‘s problems and the types of treatment that they believe will be effective. Other adaptations to the program include: (a) framing the program as an educational/skill building intervention to reduce stigma with receiving mental health treatment, (b) showing families video presentations that describe the phases of the program and show examples of families in PCIT sessions (Zebell & Urquiza, 2002a, 2002b) before treatment to reduce unrealistic expectations that have been found to predict treatment dropout for Mexican American families (McCabe, 2002), (c) increasing therapist training about Mexican American culture and associated cultural values, (d) giving GANA therapists time during each session to focus on rapport building with Mexican Americans, (e) eliciting complaints during each session to ensure that respect for authority does not prevent the parent from voicing complaints that might lead to treatment dropout, (f) translating and simplifying written handouts used in each session of PCIT, and (g)

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implementing a comprehensive engagement protocol based on McKay et al.‘s (1998) approach that explicitly targets important individuals in the youth‘s social network (mothers, fathers, and grandparents). A randomized clinical trial of the comparative type recommended by Lau (2006) was conducted with50 Mexican American families whose 3 to 7- year old child suffered from clinically significant behavior problems. These families were randomly assigned to receive either GANA, standard PCIT, or Treatment as Usual (TAU). Results demonstrated that all three treatment approaches produced significant pre-post improvement in conduct problems across a wide variety of parent-report measures. There were no significant differences between the three groups on treatment dropout, and families were more satisfied with both GANA and PCIT than with TAU. These results suggest that both PCIT and GANA are ―probably efficacious‖ with Mexican American youth. This comparative research design represents a standard for developing culturally sensitive applications of PCIT that retain the effectiveness (i.e., retention, outcome, and satisfaction) of the empirically established treatment (Butler & Eyberg, 2006). Cultural adaptations such as those incorporated in the GANA program may offer therapists specific options for adapting existing EBT models to the cultural characteristics of families in their practice, and increase the appeal of evidence based therapies such as PCIT to therapists with ethnic minority families in their caseload.

PROVIDE SERVICES IN SOCIALLY ACCEPTABLE SETTINGS AND INTEGRATE WITH ALTERNATIVE SERVICES WHEN APPLICABLE AND POSSIBLE To further reduce the impact of barriers, it is important to provide needed services in community settings where diverse populations feel more comfortable (Pumariega, Rogers, & Rothe, 2005). Associating services with institutions that are viewed favorably in the community or are more in line with traditional cultural values such as religious institutions, primary care settings, and schools, are usually viewed as less threatening and provide an alternative route of access to receiving mental health care (Pumariega et al., 2005). Many minority families prefer to enter services through primary care settings as it is more easily accessed and there is a lower level of stigma associated with receiving care through primary care physicians. Efforts to strength the capacity of primary care providers to address mental health issues at intake and provide proper referral would be useful, and encouraging the delivery of integrated care in primary care settings will help meet the needs and preferences of families who are less acculturated to American culture. With regards to the school setting, strengthening the identification and referral process in schools by providing training to school personnel may help to reduce current service use disparities. When appropriately designed and implemented, school-based mental health programs can reduce barriers to care such as limited finances, lack of health insurance, language differences, and stigma with receiving mental health care at a specialty mental health clinic. These programs, as they are based in the school setting, are also ideal for encouraging and facilitating family and teacher/school personnel involvement. This type of intervention meets the mental health needs of Latino children within the context of their

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family, school, and community, focuses on the family as the preferred point of intervention, and recognizes the importance of bilingual and bicultural providers, An example of a program that utilizes the strengths of the school setting in delivering mental health treatments to high-need immigrant Latino youth is the AMIGO program (Garrison, Roy, & Azar, 1999). The AMIGO program was developed to respond to concerns raised by bilingual counselors in the school about the need to address the challenges faced by the growing numbers of at-risk Latino immigrant youth and their families, especially those who are poor and without insurance. The AMIGO program aims to improve students‘ personal, social, and academic development, improve family communication and reduce stress, facilitate cultural adjustment of recent arrivals to the U. S. It is rooted deeply in a prevention/early intervention model, and targets outcomes such as reducing incidence of violence, substance abuse, school drop-out, and teen pregnancy, outcomes that occur in higher rates among Latino youth in the U. S. The authors provide specific strategies for replicating this program model in other culturally diverse settings and provide useful details about engaging the school system in this type of venture (Garrison, Roy, & Azar). Other types of immersion methods to bring needed services to the youth‘s social environment should also be considered. For example, adopting components of evidence-based Multisystemic Therapy (MST) which administers interventions in the child‘s community and family setting can increase access by bringing treatments to the family‘s sociocultural milieu. Many racial/ethnic minority families prefer to utilize traditional, indigenous care in lieu of professional mental health services, or sometimes use alternative treatments as adjuncts to professional mental health treatment (Peifer et al., 2000). Investigations of indigenous healing practices, including rationale and therapeutic components, may facilitate a better understanding of how these services may contribute to improving mental health outcomes for specific cultural groups. Clinicians should consider including alternative practitioners in treatment planning and consultation to develop a well-rounded, holistic treatment plan that may be more palatable to the family and thus increase treatment retention.

ENCOURAGE PRACTICE OF CULTURAL COMPETENCE IN CLINICAL SETTINGS. Clinicians are encouraged to embrace and utilize cultural competence in the delivery of services. Cultural competence includes three general areas: 1) Cultural awareness and beliefs, 2) Cultural knowledge, and 3) Cultural skills (Sue, Ivey, & Pederson, 1996). These three general areas have been adopted by APA‘s Multicultural Guidelines (APA, 2003) to improve quality of care for minority groups and reduce disparities in care (Brach, 2000). Sue (2006) suggests concrete steps in treatment that present opportunities for providers to adopt and utilize cultural competent techniques in treatment, and clinicians are encouraged to prioritize learning which techniques are most useful for facilitating greater engagement and enhancing outcomes for minority families.

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INVEST SPECIAL EFFORT IN ENGAGING THE MINORITY FAMILY IN MENTAL HEALTH TREATMENT Evidence suggests that minority families, particularly those recently immigrated or those reporting low levels of acculturation to American culture, are particularly difficult to engage. Engaging families in treatment, especially highly resistant ethnic minority families, is best addressed with a comprehensive, ecological, multilevel approach which combines interventions at the child, parent, social network, school, agency, and community level (Walker, 2005). Successful engagement strategies include letter writing (Lown & Britton, 1991), intensive telephone contact for reminders and follow-up (McKay et al., 1998), parent orientation meetings (Wennings & King, 1995), modifying treatment to address parents‘ needs (Prinz & Miller, 1994), involving the client‘s extended social and familial networks (Pescosolido, 1996), and strategies such as motivational interviewing to encourage parents‘ commitment to bring youth to treatment (Morrissey-Kane & Prinz, 1999). The effectiveness of engagement strategies depend heavily on the therapist‘s own motivation to retain the family and the degree of cultural competence in administering these techniques, thus, providing engagement training to clinicians is crucial for success (McKay et al., 1998).

CONCLUSION The goal of reducing racial and ethnic disparities in mental health care, especially for those recently immigrated or those who state low acculturation to American culture, is extremely challenging. Developing programs that emphasize public awareness of mental illness and effective treatments, and those that utilize educational efforts to overcome shame, stigma, discrimination, and mistrust for minority families will be helpful (USDHHS, 2001). Research should continue to examine specific cultural factors that relate to service use and outcomes for ethnic minority youth, and clinicians are encouraged to apply cultural sensitivity and be open-minded toward other worldviews in order to effect progress in the youth mental health care system of the U. S.

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Assessment theories and methods. International and Cultural Psychology Series, 123138. New York, NY, US: Kluwer Academic/Plenum Publishers. Zebell, N. (Producer), & Urquiza, A.J. (producer), (2002b). relationship enhancement ―fortaleciendo la Relacion Familiar – ―A Diario‖ Spanish Language Version). [Video]. (Available from UCDMC CAARE Center, PCIT Training Services, 3300 Stockton Blvd. Sacramento, CA, 95812. Zhang N, Dixon DN (2003) Acculturation and attitudes of Asian international students toward seeking psychological help. Multicultural Counseling and Development, 31, 205222.

In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 5

WORLDS APART: BICULTURAL IDENTITY DEVELOPMENT IN LATINO ADOLESCENTS Martica Bacallao1 and Paul R. Smokowski2 1

2

.University of North Carolina – Greensboro, NC, USA University of North Carolina at Chapel Hill, NC, USA

ABSTRACT Specific Aims: This paper focuses on the dynamics of second-culture-acquisition for Latino immigrant adolescents. In-depth qualitative interviews were conducted to examine: (a) adaptation to life in the United States, (b) bicultural identity development, and (c) environmental influences that affected both cultural adaptation and bicultural identity development. Methods: Standardized, open-ended interviews were conducted with four adolescents and three parents who represented two different Latino subgroups (Mexicans, and Columbians). All of the participants immigrated to the United States within the last five years. Interview transcriptions were analyzed using Atlas.ti. The text was coded, categorized, and an extensive process of network mapping was performed. A network map was drawn to display a model for describing adolescent bicultural identity development processes. Results: Latino adolescents thought that they had three worlds to balance. (1) Their Latino world was primarily driven by dynamics within the home. This world was particularly invested in maintaining the adolescent‘s sense of familism and pride in her or his culture of origin. (2) School and American friends dominated the American world. These American influences were Assimilationist, pushing the adolescent to become increasingly integrated into American culture. The third world (3) was characterized by an emerging sense of self for the adolescent. This represented the internal process for 

Correspondence may be addressed to the second author at School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro, CB 3550, Chapel Hill, NC 27599 or by electronic mail at [email protected]. This research was supported by grant number R49/CCR421722-01 from the Centers for Disease Control and Prevention.

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Martica Bacallao and Paul R. Smokowski integrating these disparate influences and making personal identity decisions. Each of these worlds has specific dynamics that help or inhibit bicultural development. Implications: This model can help social work researchers and practitioners understand the systemic dynamics behind adolescent acculturation. Practitioners can help Latino adolescents adjust by lowering assimilation pressures in the school environment and by targeting acculturation issues in Latino family systems.

Keywords: Latinos, Biculturalism, Acculturation, Adolescence, Identity Development This paper focuses on the dynamics of second-culture-acquisition for Latino immigrant adolescents. In-depth qualitative interviews were conducted with four Latino adolescents and three Latino parents in order to examine: (a) how these individuals adapted to life in the United States, (b) the process these individuals went through to develop bicultural identity, and (c) the role that environmental influences played in affecting both cultural adaptation and bicultural identity development.

BACKGROUND: WHY IT IS IMPORTANT TO STUDY LATINOS Immigrants from Latin America have significantly contributed to the rapidly changing ethnic mosaic in the United States (Portes and Rumbaut, 1990) and are currently the fastest growing sociodemographic group in the nation (Gil, Wagner, and Vega, 2000). In 2000, the United States Census Bureau counted 35.3 million Latino people, comprising 12.5% of the U.S. population (US Census Bureau, 2001a). In 2003, the U.S. Census Bureau announced that Latinos had surpassed African Americans as the largest ethnic minority group in the nation. According to the U.S. Census, in 1999, nearly 66% of the nation‘s Latinos were of Mexican origin, 14% were Central and South Americans, 10% were Puerto Rican, 4% were Cuban, and 6% were of mixed ancestry. From 1990 to 2000, seven states saw their Latino populations increase by 200% or more. At least twenty-five other states saw increases between 60 and 199% percent. North Carolina is one example of the seven states where the Latino population burgeoned during the past decade, increasing nearly 400% from 76,726 individuals in 1990, to 378,963 individuals in 2000. With an increase of 655%, Mexican immigrants are the largest subgroup driving this trend in North Carolina. In contrast, North Carolina‘s overall rate of population growth during the same time period was almost 15% (U.S. Census Bureau, 2001a). The Latino population is important not only because it is growing rapidly, but also because of the risk factors this heterogeneous group faces. Compared to non-Latino Whites, Latinos are more likely to be under age 18, unemployed, reside in large family households, and live in poverty (U.S. Census Bureau, 2001b). Latinos have a lower median age (25 years compared to 27 for African Americans and 31 years for Non-Latino Whites), lower educational attainment, and lower income levels than African Americans or Non-Latino Whites. Low educational attainment is a critical concern for Latinos. The estimated proportion of the U.S. Latino population age 25 and over with at least a bachelor‘s degree in 1999 ranged

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from 25% for Cubans to 7% for Mexicans (U.S. Census Bureau, 2001b). This disparity is serious when you consider that 64% of the Latino population in the U.S. is Mexican and only 7% of this group is prepared for employment in skilled occupations. These statistics show some of the problems Latino immigrant families face in trying to adapt to their new environment. They must come to terms with a loss of social supports, deal with cultural change, facilitate the social mobility of their children, and avoid the family dysfunction that is linked with differential levels of acculturation (Lorenzo-Hernandez, 1998; Szapocznik et al., 1984; Organista, Organista, and Kurasaki, 2003). We do not know enough about what helps or hinders immigrant Latino families in navigating through this difficult process. It is appropriate to begin by considering different models of second culture acquisition.

SECOND CULTURE ACQUISITION: ACCULTURATION, ASSIMILATION, AND BICULTURALISM Acculturation is a macro-level process in which cultural change results from contact between two autonomous and independent cultural groups (Berry, 1998). Acculturation was first defined as ―phenomena which result when groups of individuals having different cultures come into continuous first hand contact with subsequent changes in the original culture patterns of either or both groups‖ (Redfield, Linton, and Herskovits, 1936, p. 149). This original definition stressed continuous, long-term change and allowed for the process to be bidirectional (i.e. both interacting cultures could make accommodations). During the Cold War era, this definition was gradually modified to denote linear, unidirectional change (Trimble, 2003). This unidirectional adaptation process considered interactions between dominant and non-dominant groups, and was commonly characterized by non-dominant groups taking on the language, laws, religions, norms, and behaviors of the dominant group (Castro, Coe, Gutierres, and Saenz, 1996). Researchers are now reconsidering linear conceptualizations of acculturation and are revisiting the original definition that allowed for dynamic bi-directional change (Trimble, 2003). Within this overarching macro process of acculturation, several mezzo and micro-level theoretical frameworks have been developed to describe what happens to individuals and families during acculturation (Lafromboise, Coleman, and Gerton, 1993). The range of theoretical approaches that have been advanced can be categorized in two divergent frameworks. These two competing frameworks are assimilation theory and alternation theory. While proponents of these two frameworks agree that acculturation has to do with two criteria – whether or not the acculturating individual or group retains cultural identity and whether or not a positive relationship to the dominant society is established (Berry, 1998) – they posit different views on how the acculturation process should end. Assimilation theorists say that individuals lose cultural identity in order to identify with the dominant cultural group. The assimilation model assumes that an individual sheds her or his culture of origin in an attempt to take on the values, beliefs, ways, and perceptions of the target culture (Berry, 1998; Trimble, 2003). The dominant culture is seen as more desirable while the culture of origin is seen as inferior for the individual. In this model, change is directional, unilinear, nonreversible, and continuous. Assimilation theory is so pervasive that many acculturation theorists (incorrectly) use the terms acculturation and assimilation

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interchangeably (Lafromboise, Coleman, and Gerton, 1993). This assimilation concept is captured by the notion of America as a ―melting pot‖ where immigrants become ―American,‖ leaving their prior culture behind to come to this ―Land of Opportunity‖. When emphasis on assimilation is overly intense, researchers suggest that the melting pot becomes a pressure cooker (Berry, 2001). Increasing levels of assimilation are associated with negative health behaviors and mental health difficulties (Miranda, Estrada and Firpo-Jimenez, 2000; Organista, Organista, and Kurasaki, 2003). In comparison to less acculturated peers, more assimilated Latinos display higher levels of alcohol use, less consumption of balanced, healthy meals, and more consumption of marijuana, cocaine or both (Amaro, Whitaker, Cofman and Heeren, 1990; Marks, Garcia and Solts, 1990; Vega, Kolody, Aguilar-Gaxiola, Alderete, Catalano and Caraveo-Anduaga, 1998). Furthermore, six out of seven studies on Latino alcohol consumption and abuse included in Rogler, Cortes, and Malgadi‘s (1991) seminal review of this literature found that acculturation was associated with increased alcohol use. Consequently, assimilation, perhaps manifested in the form of acculturation stress, is an important risk factor for developing psychosocial problems. Social workers need to better understand how this assimilation process unfolds in order to properly target practice interventions. Alternation theorists, or proponents of the bicultural model, believe that individuals can both retain cultural identity and establish a positive relationship with the dominant culture. Alternation theorists believe that there is great value in the individual maintaining her or his culture of origin while acquiring the second culture (de Anda, 1984). Thus, biculturalism, or having the ability to competently navigate within two different cultures, is the optimal end point for the process of acculturation or second culture acquisition (LaFromboise et al., 1993). There is research evidence showing that biculturalism may serve as a protective factor against psychopathology. Gil, Vega, and Dimas (1994) found bicultural adolescents to have the lowest levels of acculturation stress and were less likely to report low family pride, compared to low- and high-acculturated Latino adolescents. For these bicultural adolescents, the acculturation process did not erode levels of family pride (familism) – a dynamic that usually takes place as adolescents become highly acculturated. Compared to low- and highacculturated families, Miranda, Estrada, and Firpo-Jimenez (2000) reported that bicultural families displayed significantly lower levels of conflict and demonstrated more commitment, help, and support among family members. Considering its potential as a protective factor, social workers need to better understand the dynamics of bicultural identity development. Fully exploring the range of dynamics that characterize both acculturation processes in general and biculturalism in particular is an ongoing challenge. Research in this area has traditionally emphasized quantitative epidemiological studies and has largely ignored qualitative methodologies that can explore the intricate complexity of biculturalism and the acculturation experience (Rogler, Cortes, and Malgadi, 1991). Biculturalism is a fascinating concept for qualitative inquiry because it is involved with complex issues in identity development. The process of becoming bicultural is not well researched and would lend itself to this type of inquiry. The positive effects of biculturalism focus on the multiple cognitive and affective processes that help the individual withstand the negative impact of acculturation stress. It is ironic that qualitative research methods have not been commonly used in this area of inquiry because the concept is dynamic, nonlinear, and multidimensional.

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The purpose of this paper is to describe processes associated with bicultural identity development in immigrant Latino adolescents. Three major questions guide data collection and analysis. How do immigrant Latino adolescents adapt to life in the United States? What is the process these individuals went through to develop or not develop bicultural identity? And how do environmental influences affect the development of bicultural identity?

METHODS In-depth, standardized, open-ended interviews were conducted with four adolescents and three parents. Active consent to participate was obtained from both parents and adolescents before the interviews took place. All of the participants came to live in the United States within the last five years. Further, the adolescent had to be between 12 and 18 years old.

SAMPLE The sample characteristics are shown in Table 1. Out of the four adolescents, two were Colombian and two were Mexican. The two Colombians were unrelated females. The two Mexicans were males and were brothers. There were also two Colombian parents who participated (one parent of each of the adolescent girls‘ parents) – one father and one mother. Finally, one Mexican mother of the male brothers also was interviewed. Table 1. Sample Characteristics Participants

Ethnicity

Years in U.S.

Gender

Age

Family #1 Parent Adolescent

Occupation in Native Country

Colombian Colombian

4 3

Male Female

36 15

Cab Owner and Driver

Family #2 Parent Adolescent

Colombian Colombian

2 2

Female Female

41 13

Family #3 Parent

Mexican

Female

49

Adolescent

Mexican

Male

16

Adolescent

Mexican

1 yr. 9 mo. 1 yr. 9 mo. 1 yr. 9 mo.

Male

14

Occupation in U.S. Does not work outside the home Does Laundry in Nursing Home

Assistant Administrator at University Admissions Office Did not work Prepares outside the salads in home school cafeteria

Acculturation Level*

Low** Bicultural

Low High

Low Low Low

*This is the interviewer‘s subjective rating of the participant‘s acculturation level. **Stepmother is bicultural, a Korean-American health care provider who speaks Spanish.

El Centro Latino, a community service agency for immigrant families, referred families for this project. The three participating families were chosen for several reasons. All of the

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adolescents had spent their childhoods in Columbia or Mexico before coming to the United States. They were different in the following ways: They represented two countries, families‘ motives for immigrating differed – for example, one Colombian family fled political upheaval while the other Colombian family left after the destruction of their home due to an earthquake. The Mexican parents moved their family so that they could offer a better education and the English language to their sons. Ability to communicate in English varied. However, all the adolescents had participated in an English as a Second Language (ESL) curriculum during their first entry year in the school system. They attended different schools within the same school district. Range in ages spanned from 13 to 16, and there were two females and two males. All of these families had middle class status in their countries of origin, but lowered socioeconomic status in the U.S. They were once homeowners and were now tenants in large apartment complexes (all families resided in 2-bedroom apartments). Family structure was similar. They were two-parent families with siblings, and at least one extended family member resided in the home. The four adolescents spent childhood in their countries of origin, arriving to the U.S. during adolescence. There was some variation in the number of years they had spent in the U.S (less than 2 years to 4 years). The adolescents were found to be at different stages within the acculturation process. These differences in acculturation level would lead to important contrasts in the data analyses. Sampling Strategy. This study used maximum variation sampling. Participants were purposefully picked to show variation on their acculturation processes and development of bicultural identities. It also used criterion sampling procedures because adolescents had to have come to the U.S. within the past five years. This sampling strategy used had strengths and weaknesses. Adolescents were at different stages of the acculturation process and had developed different levels of bicultural identity. This led to interesting contrasts for the qualitative analyses. At the same time, this was a small study that collected extensive interview data on three families. Considering the small sample size, the findings are not generalizable to larger groups. Qualitative research findings are typically generalized to theory rather than to populations. Thus, the current findings should be used to increase our understanding of issues related to Latino adolescent bicultural identity development and should not be used as any indication of how Latino families or Latino adolescents as a group behave. Although the differences among interview participants provided useful qualitative contrasts, this was a convenience sample that was not random or representative.

DATA COLLECTION PROCEDURES A structured in-depth interviewing guide was designed for this study. This interviewing guide contained questions on ethnic affiliation in both cultures (Mexican or Colombian and American), adjustment to life in the U.S., and attitudes towards biculturalism. It also included questions concerning school experiences, discrimination, and relationships with family members, Latino friends, and American friends. The questions were developed to examine both the individual‘s acculturation processes for becoming bicultural and to consider environmental influences (family, school), that might support or inhibit bicultural identity development. The first four questions (―In what ways are you Mexican?‖ ―In what ways are you American?‖ ―In what ways are you not Mexican?‖ ―In what ways are you not

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American?‖) were specifically designed to explore identifications and behaviors in each cultural system independently without mentioning the word biculturalism. After the interviewer used these questions to address cultural activities separately, she asked participants what they called living in two cultural systems. She subsequently adopted their term in asking later questions about biculturalism. For example, if the adolescents responded ―Mexico-Americana,‖ she asked him what it is like to live as a ―Mexico-Americana.‖ The interviews took place in the participants‘ homes, where the interviewer could observe effects in context (Patton, 2002). After obtaining informed consent, the interviews were recorded with a digital recorder. Each interview lasted approximately two hours and was conducted in Spanish and/or English, depending upon the participant‘s preference. Strengths and Limitations of this Approach. Standardized, open-ended interviews have several important advantages. The interview protocol is fixed for all participants, making it easily available for replication. Interviews are focused and efficient. This type of interview facilitates analyses because responses are easy to find and compare (Patton, 2002). This approach also has weaknesses. Compared to unstructured interviews, it permits less flexibility and individual variation. It also does not allow interviewers to pursue topics that are not contained in the interview protocol.

Data Analyses Recordings of the interviews were transferred to a computer database and transcribed verbatim into a text file. This 56-page text file was coded using Atlas.ti version 4.1 for Windows. Analyses progressed in three stages. First, the text was coded using codes that paralleled the different parts of the interview guide (e.g., school experiences, discrimination, ways in which you are American, etc.) Second, an extensive process of network mapping was performed. Codes were clustered into families. Families of codes were imported into a large network map with three categories, ―Adolescent Bicultural Identity Development‖, ―Latino Influences‖ and ―American Influences.‖ Each of these broad categories was then given a separate network map showing specific codes relevant to that category. A series of increasingly detailed network maps was then generated within each category. Coded information was examined to identify themes. Relationships among codes and categories were hypothesized. Finally, the three-category network map was re-drawn to display relationships within and across the categories. Verification Techniques. Six colleagues performed investigator triangulation in the analysis (Patton, 2002) on the coded qualitative data. Colleagues helped to confirm the appropriateness of coded categories, questioned the theoretical perspectives used for interpretation, and offered suggestions for further refinement in the qualitative analyses. Theory triangulation (Patton, 2002) was also used to strengthen the analysis by applying two theoretical perspectives (assimilation and alternation theories) to the interpretation of the data. Consultations with an expert qualitative researcher, two school counselors in the school district who work with Latino adolescents, and a colleague were made to address specific questions and issues that emerged from the data. We also conducted a member check by phone with two adolescents who participated to clarify statements they had made during the interviews.

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RESULTS Figure 1 displays the three-category network map and will serve as a way to organize the presentation of findings. This three-category scheme of conceptualizing adolescent bicultural identity development was derived inductively after close examination of the interview transcripts. The Latino adolescents thought that they had three worlds to balance. Their Latino world was primarily driven by family influences and dynamics within the home. This world supported bicultural identity development, but was particularly invested in maintaining the adolescent‘s sense of familism and pride in her or his culture of origin. School and American friends dominated the American world. These American influences were strongly assimilationist, pushing the adolescent to become increasingly integrated into American culture. The need to learn the English language (i.e., become bilingual) and anti-Latino discrimination further supported this assimilation push. The third world was characterized by an emerging sense of self for the adolescent. This represented the internal process for integrating these disparate influences and making personal identity decisions. One highly acculturated Colombian female adolescent described it in the following way when asked to interpret a drawing she made. Adolescent: Here‘s my world (pointed to the ‗me‘ circle on drawing paper). I can look down on them (referring to the ‗friends‘ and ‗family‘ circles, separate and below the ‗me‘ circle). Family (pointed to family circle) and friends (pointed to friends circle), and I see the differences. And before I make any decisions, I go to my new world, and that‘s just me, up there (pointed to the ‗me‘ circle). Interviewer: Okay. So, look at this. Family and friends don‘t really connect. Adolescent: (Interrupted) They are not alike at all.

The family world this adolescent referred to represented her Latino influences while all of her friends were American. These Latino and American worlds did not interact well. A young Mexican boy described similar dynamics. Interviewer: Tell me about this idea of living Mexico-America. Describe it. Adolescent: Like, in your house, you live like Mexican. Your father and mother speak Spanish. My uncles speak Spanish. Nothing of English. And outside, like American. Outside is America, where I have to speak English. In my classes, with teachers. Everything outside is in English. Except some of my friends. Interviewer: Where do you spend the majority of your day? Adolescent: At school, the American place. From 8 AM, and I get home at 4. But many of my friends speak Spanish at school. Interviewer: So, do you (pause) feel more like in one culture than in another? Adolescent: Yes, more in American culture. The school is pure American.

Having established the importance of these worlds, the following sections discuss each in more detail. At the end, we will examine bicultural identity development issues.

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LATINO INFLUENCES Culture of Origin Identity. Several factors constitute Latino influences in the lives of adolescents. These include culture of origin, familism, parent protection and support, and Latino friends. Culture of origin identity was the foundation for Latino influence. All of the adolescents were born outside the U.S. and had important memories of customs, lifestyles, places, and people that they had left behind. It was a simple and obvious fact that they were Mexican or Colombian, and this needed little explanation. Several times, each of the parents described this sense of identity as being in their blood. One could not forget that he was Mexican because it was in his blood. Aside from this blood tie, the adolescents expressed feelings of ethnic pride and loyalty. For example, when asked what it was about Mexico he would never let go of, one adolescent responded, ―My blood, Mexican blood, my country‘s flag, and my color (pointed to arm) - all this makes me proud to be Mexican.‖ Memories of their native land, and attachments with family members who were left behind also served to help maintain culture of origin identities. Culture of origin identity appeared stable in all of the adolescents. They were not actively rejecting their culture of origin. At the same time, problems arose because parents saw American customs, behaviors, and attitudes gradually influencing their children. When they felt threatened by this increasing American influence, parents tried to strengthen the Latino influence in their children‘s lives by invoking familism and parent protection strategies. Familism and Parent Protection. Familism was strongly emphasized among these families. All of the families had immigrated to increase the chances that their children would have a successful future. They believed that the long-term achievement of the family lineage was dependent upon the success of the children today. One parent‘s goal was to have his adolescent daughter graduate from an American university, holding a diploma in one hand and his hand in her other hand. While parents were willing to make the sacrifices associated with immigration to help their children, they also felt lonely and isolated because they had left many of their extended family behind. This isolation from their extended family may have prompted them to be increasingly focused on invoking familism as a way to protect their adolescents from the dangers they perceived to be in their U.S. environment. Parents perceived their children to be in a dangerous environment. They thought that American adolescents were given too much freedom by parents, and that recreation time was spent away from the family instead of with the family. One parent said, ―I worry that my son will pick up the customs of the Americans here. You know…(said in a whisper, leaning towards interviewer) using drugs, becoming too independent. That is what most worries me.‖ In response to this perceived threat, parents invoked protective familism-oriented parenting strategies that restricted what their children were allowed to do. For example, the Mexican adolescents had a strict curfew of 9 PM on weekdays and weekends. Another adolescent could only go out once on the weekend with her friends. Adolescents argued over the restrictions, noting that their American friends had more freedom. During the interview, one mother and daughter brought up a long-standing disagreement about sleepovers. A portion of this interaction illustrates the two points of view. Interviewer: Now, have you (to adolescent) had sleepovers at these girls‘ houses? Adolescent: Mami, Mami, answer the question. Mami? Parent: No.

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Martica Bacallao and Paul R. Smokowski Adolescent: She won‘t let me sleepover at someone else‘s house. Parent: I will not let my daughter go to a house that I don‘t know. I don‘t know these parents. One has to be there, vigilant. I have to be involved in everything that my children do. If I send her out, I don‘t know what is happening to her.

Parents wanted to be introduced to their adolescent‘s friends‘ parents in order to form a close supervision network. When visiting or having sleepovers, American friends often did not talk to, or even greet, these Latino parents. This might have been due to the language barrier or to lack of courtesy. In either case, this violated the Latino parents‘ values of familism and respect (respecto), making Latino parents perceive American friends as a particularly bad influence on their children. This prompted parents to become more protective and restrictive of their children‘s social lives outside of school. Parent Academic Support. All of the parents wanted their children to do well, especially in school. At the same time, there was an important chasm between the immigrant parent and the school system. The Latino parents did not understand the U.S. school system and were generally too intimidated to go into their child‘s school. The language barrier was a serious setback in this area. One Colombian adolescent was held back a year in school. This shocked and devastated her family members who believed that she was progressing in her classes and nothing was wrong. She told this story. Adolescent: Before my dad didn‘t know anything about the system (school), he didn‘t set any goals. He didn‘t really know (said with a softer volume and lowered pitch of voice). The (Latino) parents can‘t really help us. If they did know about the school system, they‘d set goals. Latino kids don‘t really care to study because their parents aren‘t there for them. Interviewer: What you do mean ‗aren‘t there for them‘? Adolescent: They‘re not there telling them what to do, setting goals for them in school like the American parents. It‘s not that they (Latino parents) don‘t care. It‘s that they don‘t know. They don‘t know (voice lowered). They don‘t have parents to push them, help them, and they achieve less. It‘s pretty sad.

Her father agreed. Parent: I didn‘t know how the school (system) functions here. It‘s very different in Colombia. And nobody, nobody at the school explained it to us, the parents. Less one knows if one doesn‘t speak English, which is my case. So, that has changed. I am getting to understand what the school tries to do, and not do. But before Ling (bicultural KoreanAmerican stepmother) was with us, I felt lost trying to understand the school. And I would ask Olivia, but she didn‘t really understand. I would ask her what the teachers say, and they were telling her she was doing well, but in reality, she was not. They‘d tell her not to worry, that she would pass high school, but with the grades she was getting, she would not be able to continue her studies in the university. We were worried. But they would tell her not to worry. I felt confused. But all that has changed, thanks to Ling (Korean-American wife of 1½ years).

Parent academic support was hampered by language difficulties, lack of understanding school expectations, and values that unquestioningly respect the authority of teachers. At the same time, parents felt a sense of frustration with an American system that they did not understand and may have sought more control over what they did understand – the family system.

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Latino friends played a small role in this drama. Three of the four adolescents felt more comfortable with Latino friends because they understood the difficulties and dynamics of the immigration experience. One adolescent said that she could express herself better in Spanish and enjoyed the familiar, comfortable feeling she had when she was with Latino friends. However, her father discouraged her from spending too much time with these friends because they did not study and were considered a poor academic influence. He wanted his daughter to compete academically with Americans. This female adolescent, who was the most bicultural, enjoyed reminiscing with Latino friends, and debating which country was better. At the same time, she did not want to behave like her Latino friends did at school (i.e., some were truant, flunking classes) and tried to distance herself from the ―bad reputation‖ they had earned for not studying. Another adolescent found that his Latino friends were less troublesome than the ones he had in Mexico. They tried to influence him to break his curfew; However, they did not steal things. Interestingly, the most highly assimilated adolescent did not have Latino friends. She was Colombian, and did not like the Mexican students in school. This lack of Latino friends led her to spend more of her time with American friends. Out of all of the adolescents, she had the most conflict with her parents.

AMERICAN INFLUENCES The American influence in the adolescents‘ lives centered on school experiences and American friends. Both of these factors strongly impacted the adolescents‘ bicultural identity development by emphasizing American ways from an assimilationist point of view. Both of these factors also had ties to racist or discriminatory experiences that the adolescents endured. American friends were central to the adolescents‘ adjustment processes. On the positive side, American friends provided academic competition that was useful in providing the adolescents with motivation to study hard. Adolescents said that American friends talked about school, whereas, Latino friends never talked about school. The language barrier was a significant obstacle to making new, American friends. Adolescent: For instance, when I first came here, I couldn‘t speak to anybody. I felt so alone. I would sit by myself because I couldn‘t talk. Well, not by myself, but I felt completely, completely alone. It was very difficult for me. And nobody talked to me. Interviewer: Because of the language? Adolescent: Uhm-hum (agreed). I remember how I tried to tell someone that my family and I went to the beach. But instead of saying beach, I said a bad word, and she started laughing at me. And I didn‘t know (started laughing a little). I said to her, ―What did I say?‖ and she didn‘t say anything.

In another example, a Mexican adolescent used his new American friends to help him learn English faster. This quickened his adjustment process. According to all of the adolescents, American friends did not interact well with their Latino family and friends. This disconnection compartmentalized the adolescents‘ worlds of family and friends. Balancing the two worlds played out in different ways. The bicultural Colombian adolescent in family #1 maintained a high sense of familism, believing that

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American friends were for academic competition but not true social support. In contrast, the highly acculturated Colombian adolescent in family #2 craved more time with American friends and had frequent arguments with her parents. Here is an example of an interaction between this mother and daughter. Adolescent: My mother wants me to do things the Colombian way, always. Parent: Your friends have put the American culture right here (raised hands together, fingers closed, to front of face, placing them about 8 inches away from face) in front of you. This is all you see. But I‘m like standing back to the side, watching all this. Seeing you look only in this front direction. (Turned to interviewer) She says her friends (American friends) make their own decisions. She tells me that her friends don‘t talk to their mothers. Don‘t tell them what they‘re thinking about, how their day went, about their friends. I want her to keep talking to me about these things. But she‘s talking less to me, more to her friends.

This tension between the Latino influence in the family and the American influence from friends was the root of intense struggles between parents and their children. Latino parents thought American adolescents had too much freedom and were a source of danger for their children, leading them to adopt restrictive parent protection strategies. Latino adolescents saw that their American friends had more freedom and thought they had more fun. This made them resent the restrictive parent protection strategies and yearn for more freedom. School was another area of significant concern. Everyone agreed that the U.S education was best, and through U.S. education, children have a "future". At the same time, schools were strong agents of assimilation, making even the low acculturated Mexican adolescents feel more American during school hours. Adolescent: Yes. The school is pure American. Interviewer: What exactly is ―pure‖ American? Adolescent: The way they run the school. How things are done, like, like the classes. How the classes are. The teachers, how they teach, what they teach. The language everybody speaks. How the other (American) students are. Interviewer: Just to make sure I understand this, when you‘re at school, you feel more American. Adolescent: Yes. Speaking in English, being with Americans. Yes.

As introduced in the Latino influences section, parents had a difficult time understanding the American school system and how it was different from the ones in their country of origin. The language barrier was a serious impediment to parent involvement in school. Latino parents instructed their children to listen to their teachers because the parent‘s ability to help was limited. This dependency on teachers, rather than parents, became problematic when tension occurred between adolescents and teachers. Below is an example that illustrates how this happened for the bicultural Colombian adolescent. Adolescent: My ESL teacher last year, she wouldn‘t let me get out of ESL. She would say, You need my help. You can‘t get out of ESL because you need my help, and if you get out, I won‘t help you anymore. You need to stay in ESL.‘ I think that‘s really discriminating against me. Being in her class didn‘t let me know things or people at school really well. For example, there‘s a problem with many of my teachers, whether they‘re ESL or not. Just because I‘m a Latina, they think I need a special thing, like if I say, ‗oh, I didn‘t finish this

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homework‘ they say (in an exaggerated slower, louder voice), ‗oh, that‘s okay. You can do this whenever you want.‘ It‘s like because I‘m from Colombia, I need more time to do things. I get this extra favor. For example, if some American person said that to a teacher, the teacher would say (in a stern voice), ‗You had a lot of time to do that. Get it done by the end of the day.‘ I think teachers have to be fair with all the people. (Pause) They feel pity! (appeared to have made an insightful discovery) They feel sorry for us and they, like, try to give us extra time to do things, or not even do them. And I don‘t like that. We are not stupid. And for example, they have really low expectations of us (tone of voice expressed anger) Like if I‘m making a C, and I go to the teacher, the teacher says, ‗Oh, Olivia! You‘re grade is really good.‘ I say, ‗What‘s my grade?‘ And she says a C. I think, what? A ‗C‘? That‘s not really a good grade. A ‗B‘ is a good grade. But the teacher says, ‗you are doing just fine‘. And I say WHAAAT? And if that same teacher says a ‗C‘ to an American person, they say, you have to work harder at it. They expect a better grade from them, a B or an A. They expect from us to get at least a D or a C, to pass the class. Well, I guess it‘s our fault that we Latinos have that reputation. But I get mad because I‘m not like that. I work hard.

The other adolescents corroborated this dynamic where teachers had lower expectations for Latino students, and regularly gave them extra time (or the answers) for assignments. Interestingly, the bicultural female above considered this to be discrimination. The highly acculturated Colombian female, on the other hand, found it to be helpful. For this adolescent, school was a place to socialize with her American friends. Parents agreed that this situation was problematic. Initially, they trusted the messages their adolescents reported from their teachers. At the same time, adolescents understood that their parents were vulnerable and may have tried to protect them from what was going on. Schools could also be an important place where a mentor can emerge to greatly influence Latino students. The same bicultural adolescent who found teacher actions to be racist said that her principal (who previously taught her English) was a critical mentor. He made himself available to advise her, offered her extra resources, checked her report cards, encouraged her participation in an extra-curricular activity, and signed forms for her to enter an Honors‘ class in Spanish literature.

ADOLESCENT BICULTURAL IDENTITY DEVELOPMENT Biculturalism is the ability to navigate between two different cultures. This ability should evolve through a series of stages, moving from initial cultural contact to having a fully developed bicultural identity. During these stages, family members, school personnel, and Latino and American friends strongly influence the development of bicultural identity. These adolescents were placed in a difficult situation where they had to adjust to a system that was completely foreign to them while balancing disparate messages from important people in their lives. Even though school and friends outside the home were pressing the adolescent to assimilate, parents consistently reminded their children that they could never change the Latin/Mexican blood that runs through their veins; What was internal to them was unchangeable. The adolescents were in different phases of the bicultural identity development process. It is useful to place their descriptions of what it is like to be bicultural next to one another. First, the low acculturated Mexican adolescent said:

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Martica Bacallao and Paul R. Smokowski With Americans, I just speak English. With Mexicans, I just speak Spanish. But I feel Mexican. I am Mexican, even though I‘m living here. I am very, I am very, how do you say? I like to have fun. That‘s what I enjoy, talking and sharing stories, telling jokes with people. But not really with the Americans. They are serious. They don‘t stand around talking for much time. They say what they need to say, and leave. I like being with people, but not really with the Americans.

In contrast, the highly acculturated Colombian female was moving away from her culture of origin influences, and embracing American ways of doing things. For example, she grew excited when we discussed differences in attitudes toward dating. Adolescent: In Colombia, you bring the guy to your house. They talk to your parents. Here, (voice pitch goes up) they don‘t. They‘re kinda more free (shrugged shoulders)? In that way, it‘s, it‘s like, like, like, the boy comes to the house for the parents. Here, no (held index finger up). If the boy comes to the house, it‘s for the girl (pointed to herself with index finger that was held up). Like, they do homework together, listen to music, like they chill together. They don‘t have to talk to the parents (emphasized the word ‗have‘).

Finally, the bicultural Colombian female was the most conscious of the ways she used to go between the two cultural systems. Adolescent: It depends on where I‘m at. In my house, I consider myself fully Latina. I‘m with the family, and they are Latino. When I‘m with my friends, I‘m Latina because they‘re Latinos. When I‘m with Americans, I change totally to American. And when I‘m with both, I guess I‘m bicultural (smiled).

The adolescents‘ experiences of bicultural identity were split, depending upon what the situation demanded. This showed how their sense of identity was fluid. Parents and adolescents agreed that there were important benefits in being bicultural. Parent: The idea of living in two cultures is a good thing for this country because the Hispanic needs to adjust to the ways of the American. We live in a country that has different customs than ours, and if one does not adjust to these customs, one is forever sad and longing to be back in one‘s country. It holds one back from advancing in this rich country. So many opportunities for work, education, buying a house. To have the two cultures is to open oneself to all the opportunities in this country. To have only my Colombian culture, is to limit myself in these opportunities. This is much, much easier for the children to do than for their parents. [My daughter] can go anywhere she wants and doesn‘t have to depend on anyone to interpret. She is (paused), she is free (emphasized the word ‗free‘) in this country, in that sense. If you can‘t speak the language of the country, you are not free, really. One becomes more vulnerable. Olivia is free of all these constraints. She knows the freedoms of this country, and she can use them.

There were noteworthy challenges to the development of bicultural identity. Conflicts sometimes arose for the adolescent who knew customs and values from two cultures that were difficult to integrate. Adolescents understood the values from both cultures and needed to form personal opinions when the cultural ideologies clashed.

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Adolescent: It‘s difficult being bicultural when you have to like, when you have to like, you have different opinions in each culture. You have to defend different points of view. Like knowing things from both cultures, it puts me against some things that each culture does because I know how things are done in the other culture. In Colombia, a child is supposed to work. Being in this country now, I‘m against that. My Colombian people there are okay with that, that children can work to help the family. I ask my friends over there about their work. To me, as an American, I am against that. But as a Colombian, I can understand that many of the children have to help out at the house, with their families because they‘re poor.

To summarize, Latino families strongly encourage biculturalism, placing the primary support for alternation theory in the adolescent‘s home. Because American influences outside the home, especially school and American friends, emphasize assimilation, Latino parents may counteract this influence by reinforcing familism and practicing restrictive parenting protection strategies. Latino parents tried to protect their children from the dangers they perceived in the American environment. They associated these perceived dangers with American friends, drug use, and increased independence. Adolescents are left trying to mediate between these three worlds; their Latino world, their American world, and their internal world where they make personal decisions. It is a challenging balance and an ongoing process.

DISCUSSION Implications for Theory Bicultural identity development appears to be influenced by factors which support both assimilation and alternation theories. Rather than looking at these theories in isolation, researchers should consider how different perspectives might impact individuals at the same time. This study found support for both assimilation and alternation theories, however the main implication is that these theories are not independent, but rather have multiple applications in the Latino adolescents‘ ecological system. It is less important to prove one of these theories correct than it is to understand how individuals and systems representing these theories interact to make adolescent bicultural identity development complex. Implications for Social Work Intervention School social workers can help Latino adolescents adjust by lowering the intensity of the assimilation pressures in the school environment. Dual-language programs, rather than English-only approaches, would soften the adjustment process. Support groups for Latino students could provide a forum for them to discuss important issues and address concerns related to school achievement. Integrating parents in these groups would be useful, decreasing parent intimidation and helping parents understand the school system in order to increase their capacities to support and direct their child‘s educational efforts. Interventions should also target problems within the Latino family system. Familyoriented programs could work with family members to try to find common ground, thus lowering the intensity of parent-adolescent conflict. Acculturation processes and messages from American friends exacerbated normative parent-adolescent disagreements (e.g., over sleepovers, curfews, dating). These intra-familial culture conflicts were an intervention target

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for structural family therapists who developed bicultural skills training interventions (Szapocznik et al., 1984), but these efforts were not widely disseminated. Social work practitioners would benefit from exploring and extending this approach.

DIRECTIONS FOR FUTURE RESEARCH More research is needed on adolescent bicultural identity development. Because biculturalism has been shown to be a protective factor in the acculturation process, we need to understand the adolescent‘s process for becoming bicultural so that we can fashion appropriate interventions and social policies. Researchers should examine how adolescents make decisions to pursue bicultural identity, how internal and environmental factors promote or inhibit this identity development, and why some adolescents are able to maintain biculturalism while others are not. The current study provided a beginning glimpse into these issues, but they must be explored in closer detail.

REFERENCES Berry, J.W. (1998). Acculturation stress. In P. Balls Organista, K.M. Chun, and G. Marin (Eds.). Readings in ethnic psychology (pp.117-122). New York, NY: Routledge. Berry, J.W. (2001). A psychology of immigration. Journal of Social Issues, 57(3), 615-631. Castro, F.G., Coe, K., Gutierres, S., and Saenz, D. (1996). Designing health promotion programs for Latinos. In P.M. Kato and T. Mann (Eds.). Handbook of diversity issues in health psychology (pp. 319-346). New York, NY: Plenum. De Anda (1984). Bicultural socialization: Factors affecting the minority experience. Social Work (March-April), 101-107. Gil, A. G., Vega, W. A., and Dimas, J. M. (1994). Acculturative stress and personal adjustment among Hispanic adolescent boys. Journal of Community Psychology, 22(1), 43-54. Gil, A.G., Wagner, E.F., and Vega, W.A. (2000). Acculturation, familism and alcohol use among Latino adolescent males: Longitudinal relations. Journal of Community Psychology, 28(4), 443-458. LaFromboise, T., Coleman, H.L., and Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114(3), 395-412. Lorenzo-Hernandez, J. (1998). How social categorization may inform the study of Hispanic immigration. Hispanic Journal of Behavioral Sciences, 20(1), 39-60. Miranda, A., Estrada, D., and Firpo-Jimenez, M. (2000). Differences in family cohesion, adaptability, and environment among Latino families in dissimilar stages of acculturation. The Family Journal: Counseling and Therapy for Couples and Families, 8(4), 341-350. Organista, P.B., Organista, K.C., and Kurasaki, K. (2003). The relationship between acculturation and ethnic minority mental health. In K.M. Chun, P.B. Organista, and G. Marin (Eds.). Acculturation: Advances in theory, measurement, and applied research. Washington D.C.: American Psychological Association.

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Patton, M.Q. (2002) Qualitative research and evaluation methods: 3rd Ed. Thousand Oaks, CA: Sage. Portes, A., and Rumbaut, R.G. (1990). Immigrant America: A portrait. Berkley, CA: University of California Press. Redfield, R., Linton, R., and Herskovits, M. (1936). Memorandum for the study of acculturation. American Anthropologist, 38, 149-152. Rogler, L.H., Cortes, R.S., and Malgadi, R.G. (1991). Acculturation and mental health status among Hispanics. American Psychologist, 46, 585-597. Szapocznik, J., Santisteban, D., Kurtines, W., Perez-Vidal, A., and Hervis, O. (1984). Bicultural Effectiveness Training: A treatment intervention for enhancing intercultural adjust-ment in Cuban American families. Hispanic Journal of Behavioral Sciences, 6(4), 317-344. Trimble, J.E. (2003). Introduction: Social change and acculturation. In K.M. Chun, P.B. Organista, and G. Marin (Eds.). Acculturation: Advances in theory, measurement, and applied research. Washington, DC: American Psychological Association. U.S. Census Bureau. (2000). Census 2000 Redistricting Data (P.L. 94-171) Summary File. Retrieved February 4, 2003, from http://www.census.gov. U.S. Census Bureau. (2001a). United States Census Bureau interactive census database. Retrieved February 12, 2003, from http://www.census.gov. U.S. Census Bureau. (2001b). The Hispanic Population in the United States. Retrieved February 12, 2003, from http://www.census.gov.

In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 6

ACCULTURATION, SOCIOCULTURAL ADAPTATION AND SELF-ESTEEM OF IMMIGRANT YOUTH IN PORTUGAL Félix Neto1 and Joana Neto Universidade do Porto, Portugal

ABSTRACT The main research questions of the study were: (1) Do immigrant adolescents‘ selfesteem differ from national youth‘s self-esteem? (2) In what way and to what extent are immigrant youth‘s acculturation orientations and perceived discrimination related to their self-esteem? Answering these questions is seen as important to the exploration of needs and possibilities for improving immigrant youth‘s acculturation experiences and their adaptation. The study sample consisted of 299 immigrant adolescents from three ethnocultural groups (Guineans, Mozambicans, and Sao Tomese) and 320 native Portuguese adolescents. The majority of adolescents with immigrant background was born in Portugal or had immigrated before the age of 7 years (69%). The mean duration of residence in Portugal for both the foreign born and host born participants was 11.5 years (SD = 4.98). Adolescents from immigrant families reported similar levels of self-esteem to that of their native Portuguese counterparts. Predictive factors - socio-demographic, acculturation, and sociocultural variables - were significantly linked to youths‘ selfesteem. Major predictors of self-esteem were integration, behavioral prob-lems, ethnic orientation, and school adaptation.

Keywords: Acculturation, adaptation, adolescents, migration, self-esteem.

1

Correspondence relating to this paper should be addressed to Félix Neto, Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Rua Dr. Manuel Pereira da Silva, 4200-392 Porto, Portugal e-mail ([email protected]). This work was supported by the Portuguese Science and Technology Foundation, Grant Nº PTDC/PSI/69887/2006.

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In response to rapidly changing demographics, many psychologists are focusing their efforts to better understand the impact of culture and acculturation on adaptation (Ward, Bochner, and Furnham, 2001). Acculturation is a term which has been defined as culture change that results from continuous, first hand contact between two distinct cultural groups (Redfield, Linton, and Herskovits, 1936). While originally proposed as a group-level phenomenon it is now also widely recognized as an individual phenomenon and it is termed psychological acculturation (Graves, 1967). At this second level, acculturation refers to changes in behaviors, attitudes, values, and identities of individuals whose reference groups are experiencing acculturation. While psychological acculturation refers to the changes resulting from intercultural encounters at the individual level, the term adaptation is used to describe the personal long-term outcomes of these processes. Adaptation has been commonly referred to as the level of ―fit‖ between the acculturating individual and the mainstream cultural context (Berry, 1997). This study examines the effect of intercultural contact and sociocultural adaptation on the self-esteem of immigrant youth living in Portugal. In this paper immigrant youth is an inclusive term that refers to both immigrant children and to children of immigrants. It thus incorporates both first generation (born in the country of origin) and second generation youth (born in the receiving society or arriving there before age 7). The term ethnic culture refers to the culture of the society of origin of the immigrants and of their descendants and the term national culture refers to the culture of the society of settlement (Berry et al., 2006). However the difference between ―ethnic‖ and ―national‖ is a relative one. What is ―ethnic‖ in the country of immigration used to be ―national‖ in the context of the country of origin. In the context of migration, immigrants‘ national identities often turn into ethnic ones. For the purposes of this study, self-esteem will be used as an indicator of positive psychological adaptation. Self-esteem has been widely defined as feelings of personal worth. Rosenberg and Kaplan (1982) used the notion of self-esteem to refer to the evaluative dimension of self-concept. Coopersmith (1967) defined it as ―the evaluation which the individual makes and customarily maintains with regard to himself: it expresses an attitude of approval or disapproval, and indicates the extent to which the individual believes himself, to be capable, significant, successful, and worthy‖ (p. 4). A global feeling of self-worth is only one of many indices of psychological adaptation (Berry et al., 2006). However, it is widely recognized as a central aspect of psychological functioning and well-being (Wylie, 1979). The main research questions of the study were: (1) Do immigrant adolescents‘ selfesteem differ from national youth‘s self-esteem? (2) In what way and to what extent are immigrant youth‘s acculturation orientations and perceived discrimination related to their self-esteem? Answering these questions is seen as important to the exploration of needs and possibilities for improving immigrant youth‘s acculturation experiences and their adaptation.

THE CULTURAL CONTEXT OF PORTUGAL Portugal is located in the southwestern part of Europe in the Iberian Peninsula. Portugal has also two small archipelagos of volcanic origin: the Azores and the Madeira. Her own smallness, long Atlantic coast, intense Christianity, proximity to the north of Africa, commercial ambition and adventurous spirit have pushed the Portuguese, from

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long ago, into a vocation of sailors and new land discoveries. These were the primary reasons why such this country had expanded her influence and culture throughout other continents, namely to Africa, India, East and Southeast Asia, and South America, particularly between the 15th and 18th centuries. Later, this tradition of leaving Portugal was continued in the form of a substantial emigration flow to other countries. Currently, Portugal is reversing her traditional role of an emigration country and is fast becoming an immigration country (Neto, 2009). A variety of ethnic groups compose the immigrant population in Portugal. Some immigrants are officially registered as foreign residents, others are clandestine arrivals. The official number of legally registered foreigners in 2006 was 409, 185, or 4.1% of the population resident in Portugal and 8% of the working population. The growth of the immigrant communities has basically been from the 1990s onwards, when there were only approximately 100, 000 immigrants. These numbers reflect a 400% increase in the past 16 years. In 2006, Cape-Verdean immigrants (16.0%) were the most numerous, with Brazilians (16.0%) occupying the second and the Ukrainians (9.3%) the third place (Table 1). The immigrants from PALP (Portuguese-Speaking African Countries) represented 34.1% of the total legally registered foreigners, which corresponds to almost double the number of European Union residents. Table 1. Foreigners with legal residence in Portugal in 2006 Nationality

2006

%

Cape Verde

65,485

16.0

Brazil

65,463

16.0

Uckraine

37,851

9.3

Angola

33,215

8.1

Guinea Bissau

24,513

6.0

Moldova

12,673

3.1

São Tomé e Príncipe

10,761

2.6

Romania

10,299

2.5

China

9,695

2.4

Mozambique

5,854

1.4

Russian Federation

4,945

1.2

Partial Total

280,754

68.6

European Union

79,774

19.5

Others

48,657

11.9

National Total 409,185 Source: Foreigners and Borders Office (SEF).

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The majority of foreign workers were mostly employed in the following main areas: agriculture, manufacturing, industry, building and civil engineering, and services. Immigrants of European Union origin were employed mainly in the professional and service sectors; most Brazilians were employed in the service sector; whereas the majority of Africans were employed in the industrial and construction sectors. Portugal has a reputation of being tolerant of cultural diversity and positive attitudes prevail (Neto, 2009). This may be due to Portugal‘s long history of contact with other cultures. Marriage between Portuguese and native peoples was more frequent in Portuguese colonies than in other European colonies (Bastide, 1971). In a previous study, the perception of personal discrimination from personal acts of discrimination had a relatively low occurrence among adolescents from immigrant background in Portugal (Neto, 2006). In fact, a unique aspect of immigration in Portugal is that the majority of immigrants comes from Portuguese-speaking countries, or from countries in which Portuguese is the formal lingua franca. These are mainly former colonies where Portugal had influenced the local culture, religion, the judicial system and the educational structures, including the educational curriculum. Thus, it may be much easier for these immigrants to adapt to the changes that came with the settlement in Portugal than it was for immigrants who had to deal with a larger cultural distance, such as Chinese and Romanians (e.g., Galchenko and Van de Vijver, 2007). In a sense the immigrant population in Portugal is more homogeneous than the immigrant populations in many other Western countries, moreover, due to the remnants of colonial history in their countries of origin one may suppose that the acculturation conductive to a swift integration in the Portuguese society started long before the actual move to Portugal.

BACKGROUND The purpose of this investigation was two-fold. The first objective was to examine whether an immigrant background had an effect on self-esteem. For Phinney and Alipuria (1996), one basic question about bicultural individuals is whether they are confused outsiders or special individuals with a broader understanding. The "marginal man" conceptualization (Park, 1950; Stonequist, 1961) is guiding our research. Park's (1950) view was that, with migration and the loosening of bonds to his original culture, the marginal man - a person at the edge of two cultures - becomes "the individual with the keener intelligence, the wider horizon, the more detached and rational viewpoint" (Park, 1950, pp. 375-376). In contrast, Stonequist (1961) viewed the marginal man as a person caught between two cultures, never fitting in. Until recently, the dominant western view of the multiethnic person was consistent with that of Stonequist (1961). Multiethnic people have been portrayed as troubled and anxious outsiders who lacked a clear identity. However, recent research have indicated that multiethnic individuals were at no psychological disadvantage in comparison to monoethnic individuals. For example, researchers have consistently found no differences between selfesteem of multiethnic and monoethnic groups (Phinney and Alipuria, 1996). Concerning immigration to the United States, Fuligni (2004) reported that a number of studies have begun to paint a surprising portrait of the children from immigrant families. Immigrant children were found to exhibit positive adjustment compared to American-born children. Two studies

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have shown that young Portuguese living in France did not differ on loneliness and satisfaction with life from young Portuguese who had never migrated and were living in Portugal (Neto, 1995, 1999). Similar results were found among Portuguese migrants living in Switzerland (Neto and Barros, 2007). In the present study, we will present research comparing self-esteem of adolescents from immigrant background living in Portugal and young Portuguese living in the same country without migratory experience. Demographic factors such as ethnicity, gender, age, place of birth, and duration of residence are seen as key factors in understanding the migration experience (Ward, Bochner, and Furnham, 2001). However research on demographic factors has yielded conflicting results regarding the nature of the relationship with adaptation (Castro, 2003). For example, although it is often reported that migrant women showed a greater risk of psychological symptomatology (Beiser et al., 1988), the research on gender differences in stress has produced mixed results (Ward et al., 2001). Gender has a variable influence on self-esteem. For example, Phinney, Cantu, and Kurtz (1997) found that gender was predictive of selfesteem among Latino and White adolescents, but not among African American adolescents. Research pertaining to age and adaptation are also somewhat ambiguous. Some studies have reported that younger persons coped better with transitions while others have concluded that older people have fewer problems (Church, 1982). However, studies concluded that early adolescence is marked by a reduction in global self-esteem, which reaches its lowest value among 12-13 years old (Harter, 1990; Rosenberg, 1985). Longitudinal studies suggest a gradual but considerable increase in self-esteem between ages 12 and 18 (O‘Malley and Backman, 1983). The adaptation of adolescents with immigrant background is a complex and multifaceted phenomenon (Pernice and Brook, 1996). However, various reviews of the literature (e.g., Aronowitz, 1984; Berry, 1997; Rogler, Cortes, and Malgady, 1991; Ward et al., 2001) have identified some intercultural contact factors that arguably are important in the well-being outcomes. Six of these intercultural factors are examined in this study: acculturation attitudes, family values, language proficiency, identity, social interaction, and perceived discrimination. For answering the second question, exploring the relation between acculturation and adaptation, we used Berry‘s classification of acculturation preferences (Berry, 1997): integration, marginalization, assimilation and separation. Integration refers to a combination of a strong link with the ethnic culture and a strong link with the culture of the society of settlement (the national culture). Marginalization refers to a weak link with both the ethnic and the national cultures, separation is a preference of the ethnic culture combined with a depreciation of the national culture, and assimilation is a preference for the national culture combined with a loss of links with the ethnic culture. Individuals often adopt some degree of each of these attitudes, indicating that the process of cross-cultural adjustment involves selective permeability of their new experience (De Vos, 1980). The association between acculturation attitudes and psychological functioning in adolescent populations has been examined in a number of studies. For example, Berry (1997) reported that individuals who are marginalized experience the most stress and mental health problems, while integration was the healthiest mode of acculturation. Changes in values are part of the acculturation process. An aspect of cultural values that parents may transmit to their children pertains to family relationships, and in particular, values regarding relationships. Family obligations refer to values found in cultures stressing interdependence, which are typical of many immigrant groups. Parents are expected to be the

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authorities, and children should be respectful and obedient to their parents. Children should share in household chores and live at home until they marry. During acculturation, individuals are confronted not only with different attitudinal options but also with new lifestyles. Language, identity, social interaction and discrimination have been generally considered to be central to intercultural contact. Proficiency in both the ethnic minority language and the majority language appear to be useful as indicators of the acculturation process (Phinney, 1998). Another important domain is the extent to which changes in identity are related to changes that occur in the process of acculturation. Two aspects which have been found to be very important to adolescents of immigrant background are ethnic identity and majority identity (Phinney, 1990). Another important indicator of intercultural contact is peer interactions with their own and other ethnocultural groups. One aspect of the context is the ethnic discrimination and prejudice that immigrants experience. The concept of discrimination is expected to be familiar for adolescents since the concept of discrimination has been widely used in the media and is part of the curriculum in many schools who were concerned with intercultural education (Sousa, Neto, and Mullet, 2005). Recent empirical research is revealing that ethnic discrimination and prejudice play a major role in the adaptation of immigrants as such experiences diminish the physical and emotional health outcomes of immigrants (Liebkind, and Jasinskala-Lahti, 2000). Adaptation, varying from well-adapted to maladapted, is the long term outcome of psychological acculturation (Berry, 1997). Acculturation researchers have used a multitude of variables as relevant adaptation, but these variables can be systematically grouped under two major types: psychological outcomes and sociocultural outcomes (Ward et al., 2001). Psychological adaptation refers to psychological well-being or good mental health and satisfaction in a new cultural context, whereas sociocultural adaptation relates to learning new social skills to interact with the new culture, dealing with daily problems of living, and effective carrying out of tasks. These two forms of adaptation are interrelated but predicted by different variables (Ward et al., 2001). Whereas psychological adaptation is closer related to personality, the availability of social support, and to ethnic identity, sociocultural adaptation is more related to the intensity and quality of relationships with members of majority group. In this study, we will take into account two kinds of sociocultural adaptation, school adaptation and behavioral problems, and one kind of psychological adaptation, self-esteem. Specifically, based on a literature review, the following hypotheses on adaptation of adolescents from immigrant families were tested: Hypothesis 1. We hypothesized that the self-esteem levels of immigrant adolescents living in Portugal will be similar to those of native Portuguese adolescents. Hypothesis 2. We hypothesized that variables within each one of the three sets taken into account (sociodemographic factors, intercultural contact, and sociocultural adaptation) will be predictors of self-esteem. Hypothesis 3. We hypothesized that intercultural contact and sociocultural predictors will account for a larger proportion of the explained variance in self-esteem scores than would demographic predictors.

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METHOD Participants Participants were 299 immigrant adolescents (57% girls and 43% boys) enrolled in basic and secondary public schools in the Lisbon area. The mean age of the participants was 15.8 years (SD = 1.89). The participating ethnic groups included Guineans (n = 119), Mozambicans (n = 103), and Sao Tomese (n = 77). The majority of adolescents with immigrant background were born in Portugal or had immigrated before the age of 7 years (69%). The mean duration of residence in Portugal for both the foreign born and host born participants was 11.5 years (SD = 4.98). Almost all of the sample (90.2%) came from low SES families, with 12% of the sample having both parents unemployed. The majority (68.7%) lived in communities where the population was ethnically balanced or predominantly from another group. For purposes of comparison, 320 native Portuguese adolescents (158 girls; M age = 14.80 years, SD = 1.30) were recruited for the study. The proportion of immigrants and natives by gender was not significantly different (χ2[1] = 3.55, df=1, p > .05). The mean age of immigrants and natives were significantly different, F (1, 618) = 55.44, p < .001, η2 = .08. The average number of years of schooling was 8.63 (SD = 1.66) among immigrants and 8.78 (SD = .95) among natives, showing no significant differences F [1, 618] = 1.85, p > .05).

Measures Measures used in this study were assembled by an international group of scholars for use in the study of adaptation of immigrants and ethnocultural youth across cultures (Berry et al., 2006). Measures were either developed for the project, or taken directly or with modification from existing scales, as described below. In designing the Portuguese version of the items, the authors followed the guidelines proposed in the literature on cross-cultural methodology (Brislin, 2000): independent/blind/back translation, educated translation, and small scale pretests. We present a short description of each of the scales only. A more extensive presentation is given elsewhere (Berry et al., 2006). Except for the demographic questions, all the items were answered on a five-point scale. Demographics: Participants had to report on their gender, age, place of birth (whether Portuguese or foreign-born), age of arrival in Portugal, their self-defined ethnicity as well as that of their parents. Participants also reported on their parents‘ current occupation, separately for mothers and fathers. Acculturation attitudes: this was a 24-item scale, based on the model of Berry (Berry, 1997). It assessed four acculturation attitudes (assimilation, integration, separation and marginalization) in each of six domains: marriage, cultural traditions, language, social activities, friends and music. An example of an item examining each of the sub-scale items was: ―I feel (ethnic group) should adapt to mainstream Portuguese society and not maintain their own traditions‖ (Assimilation); ―I would rather marry a (ethnic) than marry a Portuguese‖ (Separation); ―It is important for me to know both Portuguese and (ethnic) language‖ (Integration); and ―I don‘t want to attend either (ethnic) or (Portugeuse) social

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activities (Marginalization). The response options ranged from ―strongly disagree‖ (1) to ―strongly agree‖ (5). The internal consistencies of assimilation, integration, separation and marginalization were .75, .62, .70, and .72, respectively. Family obligations: This scale, based on one developed by Georgas, Berry, Shaw, Chrisakopoulou, and Mylonas (1996). Ten items assess attitudes toward parental authority (henceforth family obligations), indicating adherence to hierarchical family structures based on age and gender. An example is : ―Children should obey their parents.― The response options ranged from ―strongly disagree‖ (1) to ―strongly agree‖ (5). The internal consistency of family obligations was .80. Language proficiency: four items assessed the adolescents‘ self-evaluated proficiency in speaking, reading, writing and understanding the Portuguese language (national language proficiency) and the ethnic language (ethnic language proficiency). A sample question is: ―How well do you speak [ethnic language]?‖ The Cronbach‘s alpha was .91 and .87, respectively. Response options ranged from ―not al all‖ (1) to ―very well‖ (5). Cultural identity: Cultural identity was measured with a scale originally developed by Phinney (1992). The scale assesses ethnic identity with 8 items by inquiring about ethnic affirmation (e.g., one‘s sense of belonging, positive feelings about being group member) (Cronbach alpha. .89). A sample item is: ―I feel that I am part of [ethnic] culture.‖ The other scale (4 items) measured national affirmation and the importance of one‘s national identity (Cronbach alpha. .85). A sample item is ―I am happy that I am Portuguese.‖ Response options ranged from ―strongly disagree‖ (1) to ―strongly agree‖ (5). Ingroup and outgroup social interaction: ingroup peer interaction (4 items) assessed the frequency of interaction with peers from ones ethnic group. A sample questions is: ―How often do you spend free time with peers from your own ethnocultural group?‖ (Cronbach alpha. .85). Outgroup social interaction was reported on a similar scale with 4 items assessing the frequency of interaction with peers from the national group (Cronbach alpha. .84). Responses options ranged from ―almost never‖ (1) to ―almost always‖ (5). Perceived discrimination: This scale consisted of nine items (Neto, 2006). Five of the items assessed direct experience of discrimination - negative or unfair treatment from others (e.g., I have been teased or insulted because of my ethnic background), and the remaining 4 items assessed the sources of the negative treatment (e.g., teachers, pupils etc.). Participants responded on a scale ranging from 1 (never) to 5 (very often).The internal consistency for this scale was .88. School adaptation was measured using 7 items (adapted from Anderson, 1982; Moos, 1989). A sample item of the scale for school adjustment is: ―I feel uneasy about going to school in the morning.‖ Response options ranged from ―strongly disagree‖ (1) to ―strongly agree‖ (5). The internal consistency for this scale was .75. Behavioral problems were measured using 10 items, adapted from Bendixen and Olweus (1999). A sample item of the scale for behaviour problems is: ―Cursed at a teacher.‖ Response options ranged from ―never‖ (1) to ―many times during the past 12 months.‖ The internal consistency for this scale was .89. Self-esteem was measured using Rosenberg‘s (1965) 10-items self-esteem inventory. A sample items is ―On the whole I am satisfied with myself.‖ Cronbach alpha was .76. The variables were measured with scales most of which had satisfactory to good reliability. We examined whether the scales measured the same psychological constructs in all cultural groups using a procedure described by Van de Vijver and Leung (1997). All scales

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were unidimensional and we found very strong support for the structural equivalence of the measures.

PROCEDURE Because of the concentration of immigrants and ethnic minorities in urban areas in Portugal, recruitment of participants took place in Lisbon area. The questionnaire was selfexplanatory, but a standard instruction was given at the start of the session in which students were informed that participation was voluntary, that responses were confidential and they would be used solely for research purposes. Approximately 1 hour was required to complete the instrument.

RESULTS Preliminary Analyses In Table 2 we can observe the descriptive statistics of the scales used. Overall, the immigrant adolescent self-esteem was well above the theoretical midpoint of the sale (i.e., 3.0), suggesting a satisfactory level of self-esteem. Table2. Self-report Scales Used in the Study: Descriptive Statistics and Reliabilities in the Immigrant Youth Sample Scale Acculturation: Integration Acculturation: Marginalization Acculturation: Separation Acculturation: Assimilation Family obligations Ethnic language proficiency National langauge proficiency Ethnic identity National identity Ethnic peers contacts National peers contacts Perceived discrimination School adjustment Behavioral problems Self-esteem

# items 6 6 6 6 10 4 4 8 4 4 4 9 7 10 10

Mean 3.73 1.82 2.31 2.35 3.75 2.30 4.47 3.84 3.08 3.21 3.62 2.29 3.59 1.43 3.73

SD .75 .72 .75 .81 .76 1.15 .73 1.00 1.43 1.21 1.04 .86 .82 .64 .69

Cronbach‘s α .62 .72 .70 .75 .80 .87 .91 .89 .85 .84 .85 .88 .75 .89 .76

We decided to use the perceived discrimination variable as a separate variable, representing acculturation experiences. The other acculturation variables were factor analyzed

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(PCA with varimax rotation) in four separate FA‘s, with the intention to construct theoretically relevant factor scores. The outcomes are presented in Table 3. The ethnic orientation factor refers to various aspects of relationships or identification with an immigrant adolescents‘ own ethnic culture; higher scores mean a stronger orientation toward one‘s own group. The national orientation factor refers to various aspects of relationships or identification with the national culture; higher scores mean a stronger orientation toward the national society. The integration factor combines attitudes toward both the ethnic and the national cultures; higher scores indicate positive attitudes to both cultures (more integration and less marginalization). The fourth factor involves ethnic behaviors; higher factor scores indicate more contacts with ethnic peers and a higher proficiency in the ethnic language, whereas lower scores indicate a stronger orientation toward friends of the national group and a higher proficiency in the national language. Table 3. The Factor Analyzed Variables and the Resulting Factors

Factor

Input variables

Ethnic orientation

Ethnic identity Family obligations Separation National identity Assimilation Integration Marginalization Ethnic language proficiency National language proficiency Ethnic peers contacts National peers contacts

National orientation Integration Ethnic behaviors

Immigrant youth Eigenvalue % explained variance 1.20 39.98 1.28

63.85

1.30

64.93

1.84

46.08

Do Immigrant Adolescents’ Self-esteem Differ from National Youth’s Self-esteem? In order to answer the first question we conducted two ANCOVAs by ethnocultural group (immigrant vs national group) with age covariated, in which the self-esteem variable was included as dependent variable. The effect of ethnocultural group on self-esteem was not significant, F(1,615) = .96, p = .33. Thus both immigrant and native groups showed similar levels of self-esteem, supporting our first hypothesis. Examining among immigrant groups, a one-way ANOVA was performed to examine whether self-esteem scores differed among them. This analysis showed no significant effects of ethnicity on self-esteem, F(2, 295) = .21, p > .05.

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In What Way and to What Extent are Immigrant Youth’s Acculturation Orientations Perceived Discrimination and Sociocultural Adaptation Related to Their Self-esteem? The correlations between self-esteem and ethnic orientation (r = .28, p<.001), integration (r = .38, p<.001), ethnic behaviors (r = .12, p<.05), and school adaptation (r = .8, p<.01) were significant and positive, whereas the correlations between self-esteem and national orientation (r = -.14, p<.05), and behavioral problems (r = -.18, p<.01) were significant and negative. Perceived discrimination was not significantly associated with self-esteem. The correlation matrix of the individual predictor variables showed that no correlation was greater than 0.50, suggesting that the predictor variables could be used without the danger of multicollinearity. As shown in Tables 3, we conducted hierarchical multiple regression analyses entering gender, age, duration of sojourn, generation, and neighborhood in the first step, because we wanted to explore the relationship between acculturation and self-esteem taking a possible relationship between adolescents‘ demographic characteristics and both acculturation and self-esteem into account. Both the acculturation orientations and acculturation experiences (i. e., perceived discrimination) were entered on the second step. The sociocultural adaptation variables, school adaptation and behavioral problems were entered on the third step. Table 4. Multiple Regression Analysis of Socio-Demographic, Acculturation and Sociocultural Adjustment Predictors on Self-esteem Scores R R2 Beta t Socio-demographic predictors (Stepwise) 1. Age 13 02 13 2.08* Socio-demographic and Acculturation predictors (Stepwise) 1.Integration .36 .13 .36 6.12*** 2 .Ethnic orientation .40 .16 .17 2.73** 3.Perceived discrimination .43 .18 -.16 -2.70** Socio-Demographic, Acculturation, and Sociocultural Adjustment Predictors (Stepwise) 1 Integration .36 .13 .36 5.94*** 2 Behavioral problems .41 .17 -.19 -3.19** 3. Ethnic orientation 4 School adaptation .44 .20 .19 3.08** .47

.22

.15

2.48*

*p<0.05; ** p<0.01; p<0.001. The beta and t values are for the step at which the variables entered.

The first set of demographic variables predicted only 2% of the variance in self-esteem scores, and the significant predictor was age. Self-esteem increased with age. By adding acculturation variables, integration, ethnic orientation, and perceived discrimination emerged as significant predictors of self-esteem scores. As adolescents reported greater integration and ethnic orientation, the more likely they were to experience greater self-esteem. The higher

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perceived discrimination was, the lower the score on self-esteem. These variables predicted 18% of the variance in self-esteem scores. When the two sociocultural adjustment variables were included in the final model, both were significant. In addition, integration and ethnic orientation also remained as significant predictors. Overall, the variables predicted 22% of the variance in self-esteem scores. These findings support the second and third hypotheses.

DISCUSSION Specifically, this study focused on the self-esteem of immigrant adolescents in Portugal, a group that has not been studied much by immigration researchers. In the introduction we formulated two research questions: (1) Do immigrant adolescents‘ selfesteem differ from national youth self-esteem? (2) In what way and to what extent are immigrant youth‘s acculturation orientations, perceived discrimination and sociocultural adaptation related to their self-esteem? This study provides insight regarding issues related to the psychological adaptation of ethnically differentiated immigrants from former Portuguese colonies. Consistent with the results of several studies (e.g., Fuligni, 2004; Neto, 1995, 1999; Phinney and Alipuria, 1996), we found that multiethnic young people were not at a psychological disadvantage because of their mixed background. As adolescents from immigrant background revealed similar levels of self-esteem to those of natives, our first hypothesis was supported. The notion that geographic mobility of parents is a primary cause of adaptation problems in their children appears to be incorrect. The adolescents from immigrant families could cope with suffering adversity and the challenges related to immigration and acculturation in a resilient way and maintain adjustment. These findings appear to be in line with Berry‘s (1997) conclusion that the majority of immigrants adapt very well to their new societies, despite difficulties in meeting the demands of cultural changes and of living in two cultures. This study points to the multiple origins of self-esteem, since we found significant predictors of adaptation within the three sets of variables, namely socio-demographic, intercultural contact, and sociocultural adaptation variables. However, intercultural contact and sociocultural adaptation predictors accounted for a larger proportion of the explained variance in self-esteem than the demographic predictors, supporting our second and third hypotheses. Among socio-demographic factors only age emerged as significant predictor of selfesteem. Self-esteem increased with age. This finding seems to be in agreement with previous reports indicating an increase in self-esteem throughout adolescence among American adolescents (Harter, 1990; O‘Malley and Backman, 1983; Rosenberg, 1985). Demographic variables were then largely unrelated to self-esteem, accounting for only a modest level of the explained variance. However, the inclusion of the demographic variables allowed for their effect to be controlled in regressions. Among the sociodemographic, acculturation, and sociocultural adaptation predictors, integration emerged as the strongest predictor of self-esteem. Integration provides adolescents with two social support systems and represents the absence of intergroup conflict (Berry, 1997). In agreement with research on intergroup contact a dual identity assures individuals

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optimal distinctiveness as subgroup members and the superordinate social identity (Brewer, 1996). Besides integration, ethnic orientation emerged also as predictor of self-esteem. This finding is consistent with the assumption that a positive sense of ethnic orientation is related to feelings of self-regard. For example, the affective and evaluative components of ethnic identity were found to be significant predictors of self-esteem among Vietnamese immigrants in Australia (Nesdale, Roomey, and Smith, 1997). Ward and Rana-Deuba (1999) showed that the preference for maintaining the heritage culture predicted greater psychological adjustment among international workers in Nepal. Two kinds of sociocultural adaptation, behavioral problems and school adaptation, emerged also as predictors of self-esteem. The more behavioral problems the adolescents reported, the lower was their self-esteem; the higher school adaptation the immigrant youth reported, the higher was their self-esteem. These findings are in agreement with several studies showing that psychological adaptation and sociocultural adaptation are related (Ward and Kennedy, 1999). The results of the present study should be interpreted with caution, given the inability to prescribe cause-and-effect relationships between variables. In addition, it should be noted that the measures used in the present study were also self-reported, leaving open the possibility that participants provided socially desirable responses. Another shortcoming concerns the fact that any generalization of these results to settings culturally different from the present study should be made with caution. The role of acculturation factors may be different in other cultural contexts. Given these limitations, future research could corroborate the present findings by following participants longitudinally. These limitations notwithstanding, the present results have important practical implications for successful adjustment of immigrant youth.

REFERENCES Anderson, C. (1982). The saech for school climate: A review of the research. Review of Educational Research, 53, 368-420. Bastide, R. (1971). Anthropologie appliqué. Paris: Payot. Beiser, M., Wood, M., Barwick, C., Berry, J. W., deCosta, G., Milne, W., et al. (1988). After the door has been opened: Mental health issues affecting immigrants and refugees in Canada. Ottawa: Ministries of Multiculturalism and Citizenship, and Health and Welfare. Bendixen, M., and Olweus, D. (1999). Measurement of antisocial behaviour in early adolescence and adolescence: Psychometric properties and substantive findings. Criminal Behaviour and Mental Health, 9, 323-354. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46, 5-34. Berry, J. W., Phinney, J. S., Sam, D. L., and Vedder, P. (2006). Immigrant youth in cultural transition: Acculturation identity and adaptation across national contexts. Mahwah, NJ.: Erlbaum. Brewer, M. B. (2000). When contact is not emough: Social identity and intergroup cooperation. International Journal of Intercultural Relations, 20, 291-303.

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Brislin, R. W. (2000). Some methodological concerns in intercultural and cross-cultural research. In R. W. Brislin (Ed.), Understanding culture’s influence on behaviour (2nd ed., pp. 349-411). Fort Worth, TX: Harcourt. Church, A. T. (1982). Sojourners adjustment. Psychological Bulletin, 91, 540-572. Coopersmith, S. (1967). The antecedents of self-esteem. San Francisco: W. H. Freeman. De Vos, A. G. (1980). Ethnic adaptation and minority status. Journal of Cross-Cultural Psychology, 11, 101-124. Fuligni, A. (2004). The adaptation and acculturation of children from immigrant families. In U. P. Gielen and J. Roopnarine (Eds.), Childhood and adolescence: Cross-cultural perspectives and applications (pp. 297-318). Westport, CT: Praeger. Galchenko, I., and Van de Vijver, F. J. R. (2007). The role of perceived distance in the acculturation of exchange students in Russia. International Journal of Intercultural Relations, 31, 181-197. Georgas, J., Berry, J. W., Shaw, A., Christakopoulou, S., and Mylonas, S. (1996). Acculturation of Greek family values. Journal of Cross-Cultural Psychology, 27, 329338. Graves, T. (1967). Psychological acculturation in a tri-ethnic community. South-Western Journal of Anthropology, 23, 337-350. Harter, S. (1990). Processes underlying adolescent self-concept formation. In R. Montemayer, G. P. Adams, and T. P. Gullota (Eds.), From childhood to adolescence, pp. 205-239. Tousand and Oaks, CA: Sage. Liebkind, K., and Jasinskaja-Lahati, I. (2000). Acculturation and psychological well-being among immigrant adolescents in Finland: A comparative study of adolescents from different cultural backgrounds. Journal of Adolescent Research, 15, 446-469. Moos, R. (1989). Evaluating educational environment. San Francisco: Jossey-Bass. Nesdale, D., Rooney, R., and Smith, L. (1997). Migrants ethnic identity and psychological distress. Journal of Cross-Cultural Psychology, 28, 569-588. Neto, F. (1995). Predictors of satisfaction with life among second generation migrants. Social Indicators Research, 35, 93-116. Neto, F. (1999). Loneliness among second generation migrants. In J.-C. Lasry, J. Adair, and K. Dion (Eds.), Latest contributions to cross-cultural psychology (pp. 104-117). Lisse: Swets and Zeitlinger. Neto, F. (2006). Psycho-social predictors of perceived discrimination among adolescents of immigrant background: A Portuguese study. Journal of Ethnic and Migration Studies, 32, 89-109. Neto, F. (2009). Portuguese young peoples‘ attitudes towards immigration: A comparison between 1999 and 2006. In A. Gari and K. Mylonas, Quod erat demonstrandum: From Herodotus’ ethnographic journeys to cross-cultural research (pp. 255-264) Athens: Pedio Books Publishing. Neto, F., and Barros, J. (2007). Satisfaction with life among adolescents from Portuguese immigrant families in Switzerland. Swiss Journal of Psychology, 66, 215-223. O‘Malley, P, and Backman, J. (1983). Self-esteem, change and stability between ages 13 and 23. Development Psychology, 19, 257-268. Park, R. E. (1950). Race and culture. Glencoe, IL: Free Press.

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Pernice, R., and Brook, J. (1996). Refugees‘ and immigrants‘ mental health: Association of demographic and post-immigration factors. The Journal of Social Psychology, 136, 511 519. Phinney, J. (1990). Ethnic identity in adolescents and adults: Review of research. Psychological Bulletin, 108, 3, 499-514. Phinney, J. (1992). The multigroup ethnic identity measure: A new scale fro use with diverse groups. Journal of Adolescent Research, 7(2), 156-176. Phinney, J. (1998). Ethnic identity and acculturation. Paper presented at the conference o acculturation, University of San Francisco, December 1998. Phinney, J., and Alipuria, L. (1996). At the interface of cultures: Multiethnic/ multiracial high school and college students. The Journal of Social Psychology, 136, 139-158. Phinney, J., Cantu, C. L., and Kurtz, D. A. (1997). Ethnic and American identity as predictors of self-esteem among African American, Latino and White adolescents. Journal of Youth and Adolescence, 26, 165-185. Redfield, R., Linton, R., and Herskovits, M. (1936). Memorandum on the study of acculturation. American Psychologist, 38, 1149-152. Rogler, L. H., Cortes, D. E., and Malgady, R. G. (1991). Acculturation and mental health status among Hispanics: Convergence and new directions for research. American Psychologist, 46, 585 - 597. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Rosenberg, M. (1985). Self-concept and psychological well-being in adolescence. In R. L. Leahy (Ed.), The development of the self, pp. 334-367. New York: Academic Press. Rosenberg, M., and Kaplan, H. B. (1982). Social psychology of the self-concept. ArlingtonHeights, IL: Harlan Davidson. Sousa, M.R., Neto, F., and Mullet, E. (2005). Can music change ethnic attitudes among children? Psychology of Music, 33, 304-316. Stonequist, E. V. (1961). The marginal man: A study in personality and culture conflict. New York: Russell and Russell. Van de Vijver, F. J. R., and Leung, K. (1997). Methods and data analysis for cross-cultural research. Newbury Park, CA: Sage. Ward, C., and Kennedy, A. (1999). The measurement of sociocultural adaptation. International Journal of Intercultural Relations, 23, 659-677. Ward, C., and Rana-Deuba, A. (1999). Acculturation and adaptation revisited. Journal of Cross-Cultural Psychology, 30, 422-442. Ward, C., Bochner, S., and Furnham, A. (2001). The psychology of culture shock (2nd ed.). Hove, UK: Routledge. Wylie, R. (1979). The self-concept. Lincoln: University of Nebraska Press.

In: Acculturation Editor: Tara M. Johnson

ISBN 978-1-61122-525-9 © 2011 Nova Science Publishers, Inc.

Chapter 7

DOES ACCULTURATION EQUAL A+? CORRELATES OF COLLEGE-GOING EXPECTATIONS AMONGST HISPANIC AND ASIAN IMMIGRANT YOUTH Elizabeth Trejos-Castillo* and Jobi Martinez≠ Texas Tech University, Lubbock, TX, USA

ABSTRACT One of the most important foundations of a country‘s economic growth and future rests on education. The American society is not an exception to that reality. In fact, given the rapid demographical and societal changes it is paramount to further understand the educational trajectories of the immigrant groups representing the fastest growing minorities: Hispanics and Asians—approx. 56% of all immigrants are Hispanic or Asian descendent children under 18 years old—. Despite an increased awareness about the impact of the immigration process on today‘s societies, acculturation effects on collegegoing expectations among immigrant youth remains an underdeveloped area of research. On one hand, this is due to the complexity of the assimilation patterns to the host culture plus variations occurring across immigrant groups (Portes & Zhou; 1993). On the other hand, current scholarship on the effects of acculturation on educational expectations among immigrant youth is not only inconclusive but has failed to examine additional correlates such as individual, family, and social factors (Kao & Tienda, 1995; Feliciano & Rumbaut, 2005). The current study examines multiple correlates of college-going expectations among N= 4,566 immigrant youth drawn from the National Longitudinal Study of Adolescent Health (Add Health, Wave I & II). The study subsamples include: n=779 foreign-born and n=2,394 American-born Hispanic and n=524 foreign-born and n=869 American-born Asian immigrant youth. Parental support (e.g., felt supported by parents), social support * Corresponding Author: E. Trejos-Castillo, Ph.D. Assistant Professor of Human Development and Family Studies at Texas Tech University. Department of Human Development and Family Studies. Texas Tech University, MS 41230, Lubbock, TX 79409-1162 USA. E-mail: [email protected] ≠ J. Martinez, M.S. Director of the Cross Cultural Academic Advancement Center. Division of Institutional Diversity, Equity, and Community Engagement, Texas Tech University, MS 45065, Lubbock, TX 79409-5065 USA. E-mail: [email protected]

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Elizabeth Trejos-Castillo and Jobi Martinez (e.g., felt supported by teachers, other adults), depression (e.g. felt cannot do things right), school connectedness (e.g., felt close to people at school), school problems (e.g., experienced problems getting along with other students) and acculturation (e.g., English vs. other language use) were examined as predictors of college-going expectations across groups. Consistent with previous scholarship, results provided evidence that depression, social support, school connectedness, and school problems were significantly associated with college-going expectations across samples; however, parental support was not found to be significant in the current study (Reynolds & Baird, 2010; Rumbaut, 2003). Though acculturation was significantly associated with college-going expectations across samples, moderation by acculturation in the association of college-going expectations and individual and contextual factors was not significant. Theoretical and practical implications of the study results are further discussed.

ACKNOWLEDGMENT This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 ([email protected]). No direct support was received from grant P01-HD31921 for this analysis.

INTRODUCTION During the last four decades, the demographic composition of the American society has been markedly impacted by the influx of foreign-born immigrants. As reported by the U.S. Census Bureau (2010) by July 1st 2009, the total U.S. population was 307,006,550 million— in 2008 14% of the total U.S. population was foreign-born (38.1 million). The latest American Community Survey (ACS) reports that Mexico (11.7 million) followed by China (1.9 million), the Philippines (1.7 million), India (1.5 million), El Salvador, Vietnam, and Korea (approx. 1 million) were the top countries of birth by 2009 (Census Bureau, 2009). In addition, the National Center for Education Statistics (2009) reported that in 2008, 69% of all Asian and 44% of all Hispanic U.S. populations were foreign-born. To date, Hispanics and Asian immigrant populations represent the fastest growing minorities—approx. 56% of all immigrants are Hispanic or Asian descendent children under 18 years old—. These significant demographic changes have impacted the nation at many levels among which, the expansion of post-secondary education (PSE) has become a salient concern for the American public. The dynamics of college enrollment have grown considerably since the 70s with approximately 90% of high school senior reporting that they plan to attend college (The Education Trust-West, 2002). National statistics show that about 68% of all minority high school students were foreign-born in 2007, whereas about 75% of high school graduates enroll in some type of postsecondary education (Carnevale & Fry, 2001; NCES, 2009). From

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2007 to 2008, there was an increase of 144,000 freshmen students indicating the highest college enrollment in 40 years despite of the economic recession; the number of ethnic and racial minorities was 32% in 2008 (NCES, 2009). The rapid increase of college minority students has been attributed mainly to the enrollment of Latin American-Hispanic and Asian immigrant students which account for 7% and 11% of all college students in 2009, respectively (NCES, 2009). A recent publication released by the Census Bureau in fall 2009 based on the Annual Social and Economic (ASEC) survey reports that across ethnic and racial groups, native-born youth have a higher high school educational attainment rate (88%) compared to foreign-born (67%); however, at the college level, educational attainment among native and foreign-born college students is about the same (27%). As reported by the National Center for Education Statistics (2009) across all 25 years or older U.S. college graduates in 2009 about 53% of all Asians earned a college degree compared to only 13% of all Hispanics. In addition, Asians‘ educational achievement is higher among foreign-born students than their native-born counterparts whereas the pattern is inverted for Hispanics—native-born Hispanics report a higher educational attainment than foreign-born Hispanics (Census Bureau, 2003; NCES, 2009). Since foreign-born Hispanics comprise about half of the current entire U.S. Hispanic population, the low educational achievement rates reported by foreign-born represent a key factor impacting the educational performance of the total Hispanic population as reported by the latest national census (Census Bureau-ASEC, 2009). Despite the importance of education attainment of immigrant populations in the U.S. economic and social development, at the individual and personal levels the dynamics of how acculturation impacts college-going expectations in immigrant college students remains an underdeveloped area of research. On one hand, this is due to the complexity of the assimilation patterns to the host culture plus variations occurring across immigrant groups (Gans, 1992; Portes & Zhou; 1993). On the other hand, current scholarship on the effects of acculturation on educational expectations among immigrant students is not only inconclusive but has failed to examine additional correlates such as individual, family, and social factors (Kao & Tienda, 1995; Feliciano & Rumbaut, 2005).

THEORETICAL UNDERPINNINGS Multiple theoretical models have been used to explain variations in educational trajectories across generations of immigrant students as well as across ethnic and racial groups. Perhaps one of the most known frameworks is the classical model of assimilation— assimilation is generally understood as the process of fully integrating into the host culture (Brown & Bean, 2006). Assimilation theorists believe that assimilation follows a linear – continuous progression, and thus, differences between the culture of origin and the new culture (e.g., descending economic mobility, lack of education) narrow down with the emergence of new generations over time (Chun, Organista, & Marin, 2003; Rumberger Larson, 1998; Suárez-Orozco & Suárez-Orozco, 2001). Thus, the successful economic and social adaptation of immigrant groups into the dominant culture is mainly due to the ability to gradually adopt the values and behaviors from the host culture while leaving behind one‘s cultural identity (Brown & Bean, 2006).

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Though the assimilation model has been widely adopted, one of the main shortcomings of the assimilation model is that it cannot be longer supported given the rapidly changing demographics and multicultural characteristics of the American society. In the case of educational attainment, for instance, studies on the integration of immigrant children into the American educational system has yielded mixed results underscoring the importance of examining the particular needs and characteristics of the immigrant individuals across generations (Sassler, 2006). Thus, even though assimilation challenges experienced by immigrant families and children may be similar across groups, cultural variations and behavior patterns as well as the stress experience while adapting to a host culture may influence each group differently (Brown & Bean, 2006; Glick & White, 2004). During the last decade, a growing body of scholars has advocated for the so called ―revisionist theories‖ of immigrant assimilation providing evidence that developmental outcomes among immigrant individuals are not substantially greater than those of Caucasians or individuals from other racial and ethnic backgrounds (Harker-Tillman, Guo, & Mullan Harris, 2004; Kwak, 2003). The reconceptualization of the classical model of assimilation leads to multiple theoretical propositions. Among the most popular models, alternation theory describes assimilation as a multidirectional complex process involving the interaction of two or more unique and independent cultural groups that may lead to cultural and structural changes across all groups. Thus, the alternation model posits that individuals can preserve their cultural identity while at the same time they are able to adopt the dominant culture; this process is generally described as acculturation (Berry, 1998; Chun et al., 2003). Similarly to the societal structural and cultural changes, immigrant families and children experience adaptation and change. Alternation theorists argue that individuals integrate not only cultural beliefs and values, but they also go through complex cognitive, emotional, and behavioral adjustments during the acculturation process (Berry, 2001). Among all those adjustments, academic problems have been consistently found to be associated with levels of acculturation though the direction of that association and the dynamics of how acculturation interacts with academic achievement remain inconclusive across studies (Rumberger & Larson, 1998). In part, the lack of consistent findings in the literature on acculturation and academic achievement might be due to methodological problems in the study of this complex process which, as Rumbaut (1997) discusses, ―[it] has not been uniformly defined in the literature or operationalized in research studies. Although th[is] may appear to be simple and straightforward issue, [it] becomes complex and elusive on closer inspection‖ (p.1183). For the most part, studies on college-going expectations on immigrant populations have failed to examine individual and contextual correlates (Kao & Tienda, 1995; Feliciano & Rumbaut, 2005). From a more inclusive perspective, the ecological model developed by Bronfenbrenner (1979) allows for a closer evaluation of the role that multiple factors such as individual characteristics, family, and school play on development. Thus, the process of adjustment and acculturation to a host culture is understood from the ecological perspective as a dynamic interaction between proximal and distal factors that shape the experiences of immigrant families and their children (Coatsworth et al., 2002). Informed by the ecological model, current study aimed to overcome previous studies limitations by examining multiple correlates of college-going expectations among immigrant students, namely parental support, social support, depression, school connectedness, school problems, and acculturation .

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CORRELATES OF COLLEGE-GOING EXPECTATIONS Generally, educational expectations are described as a self-assessment of an individual‘s educational future (Mickelson, 1989); thus, college-going expectations reflect the individual‘s eagerness to pursue a higher education degree to secure a professional career. Scholars have suggested that low educational expectations in immigrant minorities in U.S. are mostly related to language proficiency issues (Van Hook, 2002), poverty (Hernandez et al., 2007; Rumberger et al. 1990), perception of multiple structural barriers to attained post-secondary education (Davies & Maldonado, 2008; Valencia & Black, 2002), low parental educational expectations (Chiswick & DebBurman, 2003; Portes & Rumbaut, 2001), limited funding opportunities (Bohon, Macpherson, & Atiles, 2005), adaptation to and reception from the dominant culture (Suarez-Orozco et al., 2008; White & Glick, 2000). With regard to college-going expectations, it is important to note that high-school experiences and school context play a very important if not determinant role in pursuing postsecondary education. Previous studies have provided evidence of the importance of school connectedness and positive engagement to support educational attainment as well as meeting students‘ socio-emotional needs (Eccles & Roeser, 2003; Ruiz-de-Velasco & Fix, 2001). Students reporting feeling closer to peers, teachers, and staff in high school contexts also report less disruptive behaviors, positive attitude towards schools‘ rules, and feel more committed towards academic goals (Marks, 2000; Wentzel, 1998). Particularly among immigrant students, English language proficiency has been linked to positive context adjustment as well as a sense of belongingness and connectedness (Fredricks, Blumenfeld, & Paris, 2004; Orfield & Lee, 2006; Portes & Rumbaut, 2001; Suarez-Orozco et al., 2008). English proficiency has also been found to be a strong predictor of high acculturation among immigrant youth along with other key factors such as length of residence, family, and social support, which in turn, positively impact academic achievement (Berry, 2003; Choi & Thomas, 2009; Perreira, Harris, & Lee, 2006; Portes & Rumbaut, 2006). At the individual level, the stress experienced during immigration and acculturation is also a significant factor that may influence educational expectations directly or indirectly via other factors such as context and family characteristics. In general, scholarship on psychological factors has consistently identified depression as a predictor of educational expectations and outcomes; however, results remain inconclusive largely due to mixed findings regarding cultural backgrounds, generational effects, levels of acculturation, and other factors inherent to the specific population under study (Choi, 1997; Noh & Kasper, 2003; Takeuchi, Hong, Gile, & Alegria, 2007; Yeh, 2003). Similarly, though robust evidence has found that educational expectations represent a key factor in college attendance, some studies suggests that the way college-going expectations are formed and maintained vary across minority groups along with other factors such as socio-economic status, gender, cultural background, etc (Driscoll, 1999; Kao & Tienda, 1998; Portes & Wilson, 1976; Qian & Blair, 1999). For instance, national data suggest that Asian immigrant students are more likely to pursue postsecondary studies or college education than Hispanic immigrant descendants. Differences in educational attainment across both groups have been found to be associated with variations in parental employment, socioeconomic background, immigration patterns, grade level at school entrance, and family obligations among others (Kaufman, Chavez, & Lauren, 1998; Vernez & Abrahamse, 1996).

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In summary, multiple underlying forces determine the development of college-going expectations among immigrant youth and thus, a more comprehensive examination of that complex process is warranted. The current study extend the extant literature on college-going expectations and acculturation among Hispanics and Asian immigrant college students in three ways: a) examining the unique contributions of acculturation as well as individual and contextual correlates on college-going expectations, b) comparing across first and secondgeneration Hispanic and Asian college students to tease apart potential generational differences or similarities, and c) examining the potential moderation effects of acculturation on college-going expectations across generational and ethnic/racial groups.

METHOD Sample The current study uses a sample of N=4,566 immigrant youth drawn from The National Longitudinal Study of Adolescent Health (Add Health, Wave I & II). Participants were selected using the following criteria: self-identified Hispanic and Asian origin, country of birth (Hispanic/Latino or Asian country and/or U.S.A), and age (11-18 years old, 6th to 12th graders). The study subsamples include: n=779 first and n=2,394 second generation Hispanic and n=524 first and n=869 second generation Asian immigrant youth. Data collection procedures were established by the institutional review board of the University of North Carolina at Chapel Hill (see Harris, Halpern, Entzel, Tabor, Bearman, et al., 2008); as recommended by Chantala and Tabor (1999), appropriate sample weights were applied for data analyses. Measures Demographics. Demographic information on age, sex, family structure, socio-economic status, ethnicity/race, country of origin, parents‘ country of origin, and length of residence in U.S. was provided by the participants. Generational status was determined by combining the participants and parents‘ country of birth; four groups were created: foreign-born Hispanics and Asians (first generation), and American-born Hispanics and Asians (second generation). Acculturation. Though the Add Health data set does not include a specific measure of acculturation status, language use (e.g., English vs. other language) has been tested by previous Add Health studies interested in acculturation effects in immigrant youth (e.g., Crosnoe, López-González, & Muller; 2004; Guilamo-Ramos, Jaccard, Pena, & Goldberg, 2005). As described by Guilamo-Ramos and colleagues, language use is ―conceptually, a rough indicator of the amount of exposure to U.S culture: adolescents residing for longer periods of time have probably have more exposure to the U.S. majority culture, on average‖ (p. 89). In addition, previous studies have extensively documented the use of language use and proficiency when examining acculturation in general (Popkin & Udry, 1998). Acculturation status was measured using a single item namely language used at home (Guilamo-Ramos et al., 2005; Gordon-Larsen et al., 2003). The item measured language spoken at home (e.g., ―What language do you use most with your family and close relatives?‖ Answers were rated as 1= English, 2 = Spanish, 3= other language. This item was recoded (1=1, 2 & 3= 2) and dichotomized into 1=high acculturation and 2=low acculturation based

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on evidence provided by previous studies documenting that use of English language indicates high acculturation whereas use of native language indicates low acculturation. College-Going Expectations were measured using 3 items (e.g. how likely is that you will go to college); responses were given using a 5 point Likert-scale (1=less likely to 5=most likely). Cronbach‘s alpha reliability estimates were: α =.80 and α =.75 for first generation Hispanics and Asians, and α =.81 and α =.76 for second generation Hispanics and Asians, respectively. Depression was measured using 9 items (e.g. felt cannot do things right) answered on 4 point Likert-scale (0= never or rarely to 3=most of the time or all the time). Cronbach‘s alpha reliability estimates were: α =.93 and α =.90 for first generation Hispanics and Asians, and α =.88 and α =.89 for second generation Hispanics and Asians, respectively. Parental Support was assessed using five items; constructs for mothers and fathers were collapsed together (e.g., Mullan-Harris, 1999; Ream & Savin-Williams, 2005). Two of the items (e.g., how close do you feel to your mother/father were measured using a 5 point Likert-scale (1= not at all to 5=very much). The last three items (e.g., most of the time, your mother/father is warm and loving to you) were measured by a 5 point Likert-scale (1= strongly agree to 5= strongly disagree). Items were recoded so that a high score (5) reflects high support whereas a low score (1) reflects low support. Cronbach‘s alpha reliability estimates were as follows: α =.81 and α =.85 for first generation Hispanics and Asians respectively, and α =.85 for both second generation Hispanics and Asians. Social Support was measured using 8 items (e.g., felt supported by teachers, other adults); responses were given on a 5 point Likert-type scale (1= not at all to 5= very much). Cronbach‘s alpha reliability estimates were: α =.98 for both first generation Hispanics and Asians, and α =.96 for both second generation Hispanics and Asians. School Connectedness was measured using 4 items (e.g., felt close to people at school) answered on a 5 point Likert-scale (1= strongly agree to 5= strongly disagree). Cronbach‘s alpha reliability estimates were: α =.73 and α =.72 for first generation Hispanics and Asians respectively, and α =.75 and α =.76 for second generation Hispanics and Asians, respectively. School Problems were measured using 4 items (e.g., how often have you experienced problems getting along with other students) answered on a 5 point Likert-scale (0= never to 5= most of the time). Cronbach‘s alpha reliability estimates were: α =.73 for both first generation Hispanics and Asians, and α =.70 for both second generation Hispanics and Asians.

PLAN OF ANALYSIS First, descriptive statistics, reliability estimates, and correlations were computed for main constructs and demographic variables. Preliminary analyses tested for multi-level/nesting effects prior to the main analyses (Chantala & Tabor, 1999). Two sets of hierarchical regressions were computed to test the unique effects of individual and contextual variables plus acculturation on college-going expectations by first by sample, and second, by including interaction terms to test the potential moderation effect by acculturation level (i.e., collegegoing expectations X acculturation) in the total sample. Demographic variables and length of residence were entered as controls in a first model step followed by depression in a second

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step, parental support and social support in a third step, school connectedness and school problems in a fourth step, and acculturation in a final step.

RESULTS Demographic variables were examined using frequencies by generational status and by sample and were compared across groups using a χ² test whereas mean ages were compared using an ANOVA. The results show no significant differences in age or number of sampled males and females across groups of Hispanic and Asian immigrant youth. Significant differences were found for family structure, maternal education, and annual family income across samples. Across generational groups, about 64% and 68% of foreign-born and American-born Asians reported living with both biological parents respectively compared to 48% and 52% reported by foreign-born and American-born Hispanic youth. Higher maternal educational level was reported by foreign-born and American-born Asians for high school diploma or GED (48% and 46%), and college or graduate schooling (27% and 28%), whereas percentages of some maternal college education were very similar across Hispanic and Asian foreign and American-born samples. Similarly, higher annual family income was reported by foreign-born and American-born Asians compared to their Hispanic counterparts (see detail information in Table 1). The main study constructs were significantly correlated and in the expected direction across samples; the findings are presented in Table 2. Based on the observed differences in preliminary analyses across samples all demographic variables were included in subsequent analyses as controls. In addition, results for school clustering showed very modest effects across the main study constructs and only explained between 1% and 3% of the variance. These findings were consistent with previous studies that have reported no few important school nesting effects for the Hispanic subsample of the Add Health data set (e.g., Crosnoe, López-González, & Muller, 2004; Guilamo-Ramos, Jaccard, Peña, & Goldberg, 2005). Results of the first set of hierarchical regressions conducted by sample showed that demographic variables explained a modest 3% of the variance of college-going expectations when introduced in the analysis across samples. Depression explained an additional 1% to 1.5% of the variance across samples and it was statistically significant for foreign-born Hispanics (β= -.16, p < .000), American-born Hispanics (β= -.06, p < .000) and foreign-born Asians (β= -.17, p < .000), but not for American-born Asians (β= -.01, p < .344). Parental and social support also explained an additional 1% of variance of college-going expectations across samples. However, parental support did not reach statistical significance across samples whereas social support was statistically significant only for foreign-born (β=.13, p < .000) and American-born (β= .05, p < .000) Hispanic youth. School variables did not explain any additional variance across samples. School problems were statistically significant for foreign-born Hispanics (β= -.16, p < .000), American-born Hispanics (β= -.04, p < .041), foreign-born Asians (β= -.08, p < .023), and American-born Asians (β= -.04, p < .006). On the other hand, school connectedness was statistically significant for American-born Hispanics (β=.03, p < .000) and American- born Asians (β=.02, p < .036), but not for foreign-born Hispanics (β= .06, p < .080) or foreign-born Asians (β= .05, p < .142). Acculturation explained a modest 1% of additional variance when entered in

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the model and it was statistically significant across all samples: foreign-born Hispanics (β= .18, p < .000), American-born Hispanics (β= -.03, p < .000), foreign-born Asians (β= -.28, p < .000), and American-born Asians (β= -.02, p < .000). Table 1. Means and Frequencies of Demographic Variables by Sample. Total Sample N= 4,566 Age (mean, SD) Sex Male Female Family Structure Biological parents Biological mother only Step families Other Maternal Education Less than high school High school diploma or GED More than high school (some college) College or post-graduate schooling Annual Family Income $15,000 or less $16,000 to $34,000 $35,000 to $59,000 $60,000 or more

Foreign-born American-born Foreign-born American-born Hispanics Hispanics Asians Asians n= 779 n=2,394 n=524 n=869 16.8 (1.35) 16.3 (1.53) 16.8 (1.47) 16.3 (1.54) 394 (50.6%) 385 (49.4%)

1,200 (50.1%) 1,194 (49.9%)

249 (47.5%) 275 (52.5%)

474 (54.5%) 395 (45.5%)

371(47.6%) 305 (39.2%) 82 (10.5%) 21 (2.7%)

1,250 (52.2%) 848 (35.4%) 207 (8.6%) 89 (3.7%)

334 (63.7%) 132 (25.2%) 36 (6.9%) 22 (4.2%)

593 (68.2%) 192 (22.1%) 41 (4.7%) 43 (4.9%)

362 (46.5%)

863 (36%)

52 (9.9%)

68 (7.8%)

260 (33.4%)

876 (36.6%)

251 (47.9%)

395 (45.5%)

94 (12.1%)

454 (19%)

76 (14.5%)

161 (18.5%)

54 (6.9%)

196 (8.2%)

143 (27.3%)

245 (28.2%)

219 (26.1%) 181 (23.2%) 58 (7.4%) 26 (3.3%)

411 (17.2%) 583 (24.4%) 456 (19.0%) 256 (10.7%)

34 (6.5%) 71 (13.5%) 94 (17.9%) 65 (12.4%)

35 (4%) 105 (12.1%) 177 (20.4%) 221 (25.4%)

t: 37.99 χ²: 2.60 46.08***

277.22***

238.37***

Note: *p < 0.05, **p < 0.01, ***p < 0.001. Participants were given the option to answer ―does not know/does not apply‖; these figures are not included in the table and make up the difference between the sum of all categories and 100%.

Table 2. Correlations among Main Study Constructs in the Total Sample. Total Sample N= 4,566 1.Depression 2. Parental Support 3. Social Support 4. School Trouble 5. School Connectedness 6. College-going Expectations 7. Acculturation

1 -

2 -.07** -

Notes: *p < 0.05, **p < 0.01, ***p < 0.001.

3 -.30** .14** -

4 .25** -.18** -.06** -

5 -.25** .15** .02** -.32** -

6 7 -.16** -.05** .06** .04 .05** .04** -.23** .12** .21** .01 -

.02 -

Results of the second set of hierarchical regressions with interaction terms conducted in the total sample did not yield any significant moderation effects by acculturation on study constructs.

Table 3. Hierarchical Regression Analyses for Individual and Contextual Correlates by Collegegoing Expectations among samples. Total Sample N= 4,566 Model 1 2

3 4

Depression Parental Support Social Support School Trouble School Connectedness Acculturation

Foreign-born Hispanics n = 779 b SE β p -.20 .05 -.16 .000

American-born Hispanics n = 2,394 b SE β p -.10 .02 -.06 .000

Foreign-born Asians n = 524 b SE β -.20 .04 -.17

p .000

.01

.04

.01

.873

.02

.01

.02

.259

.03

.03

.04

.291

.01 -.22

.03 .05

.13 -.16

.000 .000

.01 -.03

.02 .02

.05 -.04

.000 .041

.01 -.07

.03 .03

.02 -.08

.685 .023

.09

.05

.06

.080

.04

.01

.03

.019

.05

.03

.05

.142

.03

.03

.18

.000

.37

.06

.03

.000

.04

.02

.28

.000

American-born Asians n=869 b SE β -.02 .02 -.01 .01 .02 .04

p .344 .350

.02 -.04 .03

.02 .06 .01

.01 -.04 .02

.219 .006 .036

.04

.06

.02

.000

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177

More specifically, none of the interaction terms explained any additional variance and did not reach statistical significance when entered in the model: depression X acculturation (β= .03, p < .589), parental support X acculturation (β= .01, p < .997), social support X acculturation (β= .03, p < .458), school problems X acculturation (β= .02, p < .799), school connectedness X acculturation (β= .07, p < .082). These results provide evidence of the lack of moderation effect by acculturation level on the relationship among individual and contextual factors and college-going expectations across study samples (see details in Table 3).

DISCUSSION Official data shows that approximately 1 in 5 children in the United States are born to immigrants, where Hispanic and Asian descendent children under 18 years old comprise about 56% of all immigrant populations (Census Bureau, 2004, 2009). Despite the significant impact of U.S. changing demographics, the particular needs and characteristics of immigrant populations continue to be overlooked. The current study sought to provide some insights on the trends of college-going expectations among Hispanic and Asian immigrant youth. More specifically, we aimed to broaden the scarce literature available on individual and contextual correlates in college-going expectation across generational groups of foreign and Americanborn Hispanic and Asian youth. Secondly, we aimed to further examine whether acculturation moderated the relationship between college-going expectations and individual and contextual correlates. Results from the associations of college-going expectations and depression show that depression is significantly associated with lower expectations across foreign and Americanborn Hispanic and foreign-born Asians, but not for American-born Asians. The results also provide evidence that the association of depression and lower expectations is stronger for foreign-born Hispanic and Asian youth compared to their American-born counterparts. This finding is consistent with previous studies reporting elevated depressive symptoms among foreign-born immigrants compared to their American-born counterparts. As suggested by those studies, depression might be related to acculturative stress and cultural adjustment process (Choi, 1997; Crockett, Iturbide, Torres-Stone, McGinley, Raffaelli et al, 2007; Noh & Kasper, 2003; Takeuchi, Hong, Gile, & Alegria, 2007; Yeh, 2003). Our findings for the association between parental support and college-going expectations were not statistically significant across samples. Though there is a robust body of literature supporting a strong link between parental support and college-going expectations among youth in general, other studies have found that the dynamics of parental support in immigrant families may follow a different path. For example, Tym and colleagues argue that many immigrant students are the first individuals in their families to go to college and thus, parents and other family members might not be able to support immigrant youth as they transition into college (Tym, McMillion, Barone, & Webster, 2004). Other scholars have also suggested that immigrant youth experience multiple difficulties in their paths toward college such as discrimination, lack of knowledge about college context and institutional expectations which might create conflicts between family and college environment; thus, immigrant youth might interpret those disagreements as lack of parental support (Hsiao, 1992; Thayer, 2000). In

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addition, it is important to note that the lack of a significant association between parental support and college-going expectations might be related to the measuring instrument used as the items included might have not captured parental efforts or behaviors related to pursuing post-secondary education. In the case of social support and college-going expectations, our results are consistent with other studies that have found significant associations among those constructs for foreign and American-born Hispanics but not for foreign and American-born Asian youth (Crockett et al., 2007; Zea, Jarama, & Bianchi, 1995). As argued by those studies, sources of social support might come from a variety of sources and might be represented differently across ethnic/racial groups. For example, reaching out to family and friends for support in times of stress and struggle is a well documented practice for Hispanics (Crean, 2004; Marín & Marín, 1991). In the case of Asians, though they have close links with family and friends, they are less likely to seek direct advice for personal issues or emotional support from their social networks (Kim, Sherman, & Taylor, 2008). Statistical significance or lack thereof for social support across samples might be also due to the inclusion of youth from multiple Hispanic and Asian descendant groups. Across all samples, school problems were statistically significantly associated with college-going expectations suggesting that school environment and experiences is a strong predictor for pursuing postsecondary education among immigrant youth as documented by other studies. For example, evidence has been provided that students‘ perceptions of discrimination in school environment might have an indirect effect on school connectedness and postsecondary studies among ethnic/racial youth (Marks, 2000; Ryan & Patrick, 2001; Stone & Han, 2005). School connectedness was significantly associated with college-going expectations for American-born but not for foreign-born Hispanics and Asian youth in the current study. Previous scholarship has provided evidence of weaker institutional attachment and school connectedness among foreign-born immigrant youth possibly related to acculturative stress, lower English proficiency, as well as multiple cultural and social adjustments (Brown & Evans, 2005; Creasey, Jarvis, & Gadke, 2009; Melendez & Blanco-Melendez, 2010; Vericker, Pergamit, Macomber, & Kuehn, 2009). Another potential explanation for this finding might be related to the function that peers serve in developing a sense of school belongingness among youth. As documented by Vaquera and Kao (2008) in a study conducted with multi-ethnic youth, adolescents who report higher levels of reciprocated friendships also report higher levels of school connectedness; in that study, Asian Americans reported higher levels of reciprocated friendships when compared to other ethnic groups. Though reciprocated friendships were not tested in the current study, it can be speculated that perhaps reciprocated friendships could be an important factor in explaining the lack of school connectedness found among foreign-born youth. This, of course, is beyond the scope of the current study and thus, it would definitely require further exploration. One of our main goals was to tease apart the unique contribution of acculturation level in explaining college-going expectations among foreign and American-born Hispanic and Asian youth. In general, the results show that acculturation has a main effect on college-going expectations across all study samples. These findings support previous studies documenting variations in post-secondary education expectations across immigrant youth related to acculturation level (Leong & Chou, 1994; McWhirter et al., 1998; Nepper-Fiebig, Braid, Ross, Tom, & Prinzo, 2010; Ramos & Sanchez, 1995; Tang, Fouad, & Smith, 1999).

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However, our findings show that the association of acculturation level with college-going expectations is stronger for foreign-born Hispanic and Asian youth than for their Americanborn counterparts. It is important to further discuss here that acculturation was measured in the current study using a single item that assessed English language use vs. native language use. Thus, it is possible that English proficiency might be perceived as a stronger predictor of college-going expectations for foreign-born youth who report lower English use compared to American-born youth for whom English might be their first language. Indeed, the use of English language use and proficiency as a proxy for acculturation has been widely documented (Guilamo-Ramos et al., 2005; Nguyen, Messé, & Stollack, 1999; Popkin & Udry, 1998). The lack of a significant interaction effect by acculturation on college-going expectations and individual and contextual factors across samples represent a key finding in the current study. This suggests that the process of acculturation in isolation cannot fully explain generational differences in individual and contextual factors and college-going expectations across ethnic/racial youth. This finding highlights the importance of studying immigrant assimilation from a broader perspective on common developmental processes across ethnic/racial and immigrant groups as opposed to the traditional deficit assimilation view (Dmitrieva et al., 2004; Kagitçibasi; 2005). Although the present study provides significant insights, limitations are also important to be acknowledged. Two important limitations are the use of self-reported data and the crosssectional nature of the data used in the current study. Self-reported data may not be the best representation of actual behaviors as participants might inflate their responses to conform to social expectations or obtain social approval particularly when sensitive topics are discussed (King & Brunner, 2000). In addition, the use of cross-sectional data to test the relationships among study constructs is not most desirable approach as causal inferences cannot be drawn and thus, findings should be interpreted cautiously. Finally, it is important to acknowledge well documented differences within groups of immigrant youth not only across generations but also across ethnic/racial backgrounds and thus, the study findings may not generalize to all Hispanic or Asian immigrant youth. In summary, the findings from the current study underscore the importance of examining educational processes in immigrant youth using an ecological framework that encompasses individual and contextual factors to further our knowledge on the development of collegegoing expectations.

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In: Acculturation Editor: Tara M. Johnson

ISBN: 978-1-61122-525-9 ©2011 Nova Science Publishers, Inc.

Chapter 8

IMPACT OF ACCULTURATION ON PHYSICAL ACTIVITY AND DIETARY BEHAVIORS IN LATINOS Cody J. Robinson1, Joseph Martinez1, Andrea Cherrington1, Brooke Barbara2, Brad Boye3 and Dorothy W. Pekmezi1 1

University of Alabama at Birmingham, AL, USA 2 Brown University, RI, USA 3 Northern Illinois University, IL, USA

The United States population is growing, and its racial and ethnic composition is changing. According to the U.S. Census Bureau, the Latino population is projected to increase rapidly from 1995 to 2025, accounting for 44 percent of the growth in the nation's population (Campbell, 1996). Latinos already accounted for almost half (1.4 million) of the national population growth (2.9 million) between July 1, 2005 and July 1, 2006. While much of this growth can be attributed to high birth rates among Latinos in the U.S., immigration constitutes a significant proportion (Bernstein, 2007). For Latinos, introduction to U.S. culture occurs with varying degrees of acculturation, defined as ―the bidirectional process in which individuals adopt new values, beliefs, and norms as an adaption into a new, mainstream culture while still retaining some aspects of their traditional culture.‖ (Ayala, Baquero, and Klinger, 2008). The influence of acculturation on specific behaviors has been a subject of investigation for decades.

ACCULTURATION AND HEALTH BEHAVIORS In recent decades, acculturation has become recognized as a major explanatory variable in the study of the health behaviors of ethnic minorities (Zane and Mak, 2003). For example, numerous studies have been performed on the physical activity trends of Latinos in order to better understand whether or not acculturation to the United States has a positive or negative effect on physical activity behaviors. The multifaceted, complex nature of acculturation often

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makes it difficult to formulate a distinct correlation between the construct itself and health behavior habits of Latinos. As a result, existing research includes a wide range of the various aspects of acculturation such as language choice and preference, birthplace of Latino immigrants, degree of acculturation, and years of residence in the U.S. Depending on which aspects of acculturation are examined (e.g., age, gender, country of origin, socioeconomic status, and education; Lara, Gamboa, Kahramanian, Morales, and Bautista, 2005) results may vary. The lack of model specificity helps to explain seemingly discrepant findings and may lead to invalid generalizations to immigrant populations (Arcia, Skinner, Bailey, and Correa, 2001). There are also issues associated with relying strictly upon unidirectional approaches to assessing acculturation. For example, language use is often the only variable assessed when measuring acculturation levels. If Spanish is the primary language used when speaking with family and friends, the level of acculturation is considered low, whereas acculturation is assumed to be higher if the primary language is English (Dave, et al., 2009). Such unidirectional approaches only measure the movement away from traditional culture and adoption of newer cultural practices (Perez-Escamilla, 2009). It does not encompass the possibility of individuals becoming multicultural by retaining traditional cultural behaviors and functioning in both the Latino and mainstream societies. In order to establish a multidirectional measurement of acculturation, factors other than language (e.g., beliefs and values, structural assimilation) must also be examined. Then, this data can be used to classify individuals on a spectrum including the following categories: 1) assimilated – complete loss of original culture and adoption of new ―mainstream‖ culture; 2) integrated or bicultural – full integration into ―mainstream‖ culture with retention of original culture; 3) separated – retention of original culture with no attempt to adopt ―mainstream‖ culture; or 4) marginalized – loss of original culture with no attempt to adopt ―mainstream‖ ideas and not fitting into either culture (Perez-Escamilla, 2009). Keeping these measurement issues in mind, we will focus on how the phenomenon of acculturation affects both the physical activity and dietary behaviors of the U.S. Latino population.

ACCULTURATION AND PHYSICAL ACTIVITY Prince and colleagues defines physical activity as ―any bodily movement produced by the skeletal muscle that results in energy expenditure (EE)" and physical inactivity as ―associated with an increased risk for many chronic diseases including: coronary artery disease, stroke, hypertension, colon cancer, breast cancer, Type 2 diabetes, and osteoporosis, as well as premature death‖ (Prince, Adamo, Hamel, Hardt, Gorber, and Tremblay, 2008). The impact of acculturation on physical activity behaviors depends greatly on various indicators (e.g. language, birthplace, years of residence, age, etc.), but the differing measurements used to assess physical activity levels themselves obstruct conclusive results. One obstruction involves the questionable accuracy of self-report measures (e.g. questionnaire, diary) versus direct measurement (e.g. using an accelerometer, doubly labeled water) in assessing physical activity. A disadvantage of self-report (subjective) measures of physical activity, although typically used as an inexpensive way for gaining insight into the physical activity levels of populations, is that these measurements have the capacity to over- or underestimate true

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physical activity energy expenditure and are vulnerable to response bias (e.g. social desirability, inaccurate memory) (Prince, Adamo, Hamel, Hardt, Gorber, and Tremblay, 2008).

Language Among the most common measures of acculturation is that of language preference and language ability. Language preference and English language proficiency have commonly been used as measures of immigrant acculturation. English language proficiency has previously been associated with health-related behaviors, disease prevalence, and receipt of health care services among Latinos. There is evidence that in many cases Spanish-speaking Latinos are more likely to report not meeting the recommended guidelines for physical activity. For example, a study performed by Crespo and colleagues indicated that Spanishspeaking Mexican-Americans have a higher prevalence of physical inactivity during leisuretime than those who spoke mostly English (Crespo et al., 2001). Considering that aerobic classes, exercise guidelines, and physical activity information sources (pamphlets, websites, etc) in the U.S. are mostly printed in English, Latinos who speak only Spanish may be limited in their ability to participate and have difficulty locating comparable Spanish-language health services and promotions in their local communities. However, when occupational activity was examined by DuBard and colleagues, 63% of Spanish-speaking Latinos described either heavy labor or "mostly walking" as part of their job, compared with 42% of English-speaking Latinos (DuBard et al., 2008).

Birthplace In addition to differences by language preference, physical activity patterns and levels of usual daily activity among Latinos may differ by their country or region of origin (Ham, Yore, Kruger, Heath, and Moeti, 2009). Neighbors and colleagues examined the impact of acculturation on physical activity levels of Latinos from the following countries of origin: U.S., Mexico, Puerto Rico, Cuba, Dominican Republic, and Central/South America. Although all the Latino subgroups had lower levels of leisure-time physical activity than did non-Hispanic White participants, significant differences in leisure-time physical activity prevalence were found among the subgroups. For example, Cuban and Dominican participants were the least active, whereas Mexican-American participants were the most active. Women were less active than men. However, men and women born in Mexico (and thus likely less acculturated) had a higher prevalence of physical inactivity than U.S.-born Mexican-American men and women. These findings indicate that interventions must address the particular needs of subgroups that may be overlooked as surveillance focuses on groups broadly defined at a national level (Neighbors, Marquez, and Marcus, 2008).

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Years of Residence Extending beyond birthplace, acculturation among Latinos is also impacted by the years of residence within the United States. Much of the literature supports that as the years of residence increase so does the level of acculturation. However, the question of how many years of residence are necessary for one to be considered highly acculturated (e.g.5 years, 7 years, >10 years) remains. Crespo and colleagues reported that Latinos who are less acculturated (living in the U.S. for <5 years) were more likely to be inactive during leisuretime than more acculturated (living in U.S. for >5 years) Mexican-Americans (Crespo et al., 2001). This research suggests that there is a positive correlation between years of residence in U.S. and physical activity.

Generational Status Generational status is often a key indicator of acculturation levels in Latinos. According to the Institute of Medicine, generation coding is depicted by the following definitions: 1) First Generation—an immigrant to the U.S. not preceded by parents or other family members; 2) Second Generation—U.S.-born child of a first-generation immigrant; and 3) Third Generation—U.S.-born child of a second- generation immigrant. In a study conducted by Taverno and colleague, sedentary lifestyle was most prevalent among first-generation, nonEnglish speakers, followed by second- and third-generation, non-English speakers. Secondand third-generation immigrants are typically more acculturated and may have a higher prevalence of physical activity than first-generation immigrants. (Taverno, Rollins, and Francis, 2010).

Age Closely related to generational status is the acculturation variable of age. According to Ham and colleagues, the prevalence of participation in leisure-time physical activity appears to decline with age in Latinos (Ham et al., 2009). Commonly, adults are more likely to be first- or second-generation immigrants and thus less acculturated than their children (secondand third-generation immigrants). Studies have shown higher levels of participation in leisure-time activity among more acculturated Latino children, compared to less acculturated Latino children (Singh, Yu, Siahpush, and Kogan, 2010; Unger, Reynolds, Shakib, SpruijtMetz, Sun, and Johnson, 2004). However, other data has indicated that less acculturated children are more likely to walk to school than more acculturated children. (Martinez et al., 2008). Thus, the impact of acculturation upon physical activity in Latino children likely varies by type of activity and will require future studies with thorough physical activity assessments to tease out.

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Gender Gender is another variable of acculturation that is important to review, considering that the social experiences of men and women vary, particularly in the Latino community (Arcia et al., 2001). A study by Ham and colleagues indicated that, while rates of participation in leisure-time physical activity and household physical activity were similar between genders, Mexican-American men reported higher rates of participation in occupational physical activity than Mexican-American women (Ham et al., 2009). Degree of acculturation has also been positively correlated with physical activity levels in both genders. Barcenas and colleagues found that 50% of the highly acculturated men engaged in high levels of physical activity compared with only 42% of those with a low degree of acculturation; in women, these numbers were 27% vs. 18%, respectively (Barcenas et al., 2007).

DISCUSSION ON ACCULTURATION AND PHYSICAL ACTIVITY Overall, acculturation appears to have a positive impact on the physical activity behaviors of Latinos, primarily in leisure-time activity. More often than not, research evidence indicates a parallel relationship between one‘s degree of acculturation and physical activity levels found in this community. Other activity types such as occupational activity (more prevalent in Latino men) and household activity (often relating to Latino women) have been reviewed, however more research needs to be produced before significant conclusions can be made. These findings may be surprising to some, considering that similar research examining other health behaviors of Latinos in the United States often portray a negative outcome with increased acculturation. One such area is that of acculturation and diet.

ACCULTURATION AND EATING BEHAVIORS Ongoing research indicates that Latinos in the Unites States engage in less healthful dietary practices when compared to other racial or ethnic groups (Ayala, Baquero, and Klinger, 2008). This trend of poor dietary practices is seen in all Latino age groups with children eating less fruits and vegetables (Dave, Evans, Saunders, Watkins, and Pfeiffer, 2009) and adolescents acquiring an increase in negative dietary behaviors as they progress in grade level (Diaz, Marshak, Montgomery, Rea, and Backman, 2009). Such changes in diet have likely played a role in the increased incidence of obesity and diabetes among Latino adults and can lead to poorer health outcomes despite the increased access to healthcare that acculturation into American society brings (Mainous, Diaz, and Geesey, 2008). A less overt effect of acculturation among Latinos is an increased risk of diet-related illnesses (e.g., cancer, obesity, hypertension, diabetes, etc.) due to changes in nutrient consumption upon immigration to the United States (Reyes-Ortiz et al., 2009). A recent literature review by Ayala and colleagues identified relationships between acculturation variables (previously discussed in terms of their relationship with physical activity) and eating behaviors among Latinos. Findings will be discussed in the following section, integrated with findings from subsequent studies.

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Generational Status Research has also lined acculturative variables such as place of birth with dietary behaviors. For example, Mexican-born adult men and women are more likely to meet dietary recommendations for total fat, fiber, vitamins, and other minerals when compared to U.S.born Mexican-Americans. Also, Mexican-born adults consume more fruits, vegetables, juices, and grains while taking in less salty snacks, desserts, and added fats (Ayala, et al., 2008). Recently emigrated mothers describe food quality and availability more conducive to a healthful diet in their home countries with more fresh produce available as opposed to more processed foods here in the U.S. (Sussner, Lindsay, Greaney, and Peterson, 2008). Despite trying to maintain the traditional meals and foods, these mothers described changing eating habits themselves due to having less time to eat the traditional three meals per day and resorting to snacks and fast food, all of which they themselves viewed as unhealthy practices (Sussner, et al., 2008). These trends show that the more Latinos become acculturated into American society, the less healthful the dietary practices become.

Age Children of immigrant parents do not necessarily adopt the same dietary practices as their less acculturated parents. In fact, Latino children consume less fruits and vegetables than children from other ethnic and racial backgrounds, regardless of acculturation level (Dave, et al., 2009). Consumption of lower-costing, high energy foods places Latino children at a higher risk for childhood obesity and future morbidities and complications such as diabetes (Rosas et al., 2009). Similar trends are found in Latino adolescents, with negative associations between greater acculturation and intention to eat healthy foods, willingness to give up liked foods, and having support and encouragement to eat more healthy foods (Diaz, et al., 2009). In terms of parental influence on eating behaviors in Latino children/adolescents, lessacculturated mothers often struggle to maintain traditional Latin meals while their children prefer American foods, particularly fast foods (Sussner, et al., 2008). In contrast, while some research reflects negative impacts of acculturation on dietary behaviors in Latinos, qualitative data suggests that this process sometimes results in a positive transition in the beliefs about food and child feeding for Latino mothers. They described shifting away from the traditional large feedings, which was equated with good parenting and traditional norms, to feeding their children smaller portions, despite negative feedback from older relatives (Sussner, et al., 2008).

Regional Differences in the U.S. When discussing acculturation, regional differences within the U.S. are just as important as country and regional differences based on country of origin. The systematic review performed by Ayala and colleagues noted that 71% of studies regarding acculturation and diet were performed in the Southwest region of the United States which is also the region with the highest density of Latinos ("Hispanics in the United States," 2006). Thus, the results of those studies cannot be completely generalized to other regions of the U.S. where the Latino

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population is still growing (Ayala, et al., 2008). Also, research about acculturation and diet must include where the people lived in their home countries, as someone who grew up in a rural area in Latin America may experience a greater change in dietary practices and other lifestyle behaviors upon immigration to a more urban area in the U.S, than someone who grew up in a more urbanized country or city (Perez-Escamilla, 2009).

Food Insecurity Food insecurity is described as the limited access or availability of adequate, nutritional, and safe foods or the ability to acquire those foods in a socially acceptable manner (Dave, et al., 2009). In a 2007 survey of all U.S. households, 11.1% of households reported being food insecure compared to 20.1% of Latino households. Research has shown that fatty and sweet foods are less expensive than fruits and vegetables which can lead to reliance on these cheaper foods among the food insecure families (Rosas, et al., 2009). In a nutritional survey among 4-16 year olds, higher acculturation levels, based on parental language preference, were associated with higher food insecurity (Perez-Escamilla, 2009). In contrast, Dave and colleagues found a negative correlation between acculturation and food insecurity, with regard to fruit and vegetable intake, in Latino children. Although most studies show the negative correlation between acculturation and food insecurity, conflicting results do exist and exemplify the need to better understand how acculturation affects dietary practices (Perez-Escamilla, 2009).

Discussion of Acculturation and Dietary Habits Several studies discussed in this section indicated that an increase in acculturation among Latinos more often than not produces a negative effect on healthful eating habits. Latinos with lower degrees of acculturation are more likely to meet dietary recommendations and consume balanced diets than those with higher degrees of acculturation. However, in some cases, food insecurity, or the lack of access to nutrient dense foods, can result in consumption of calorie dense and processed foods that are abundant throughout the United States, thereby moderating somewhat the effects of acculturation. Also, the protective effects of lower acculturation on dietary practices within Latino households may deteriorate more rapidly if the children and adolescents become accustomed to an Americanized diet (high calorie, low nutrient dense foods) and begin refusing the more healthful traditional food (fresh fruits and vegetables). This may cause mothers to feel as if they are forced to conform to their children‘s preferences simply to put food in the children‘s mouths.

ACCULTURATION AND OBESITY In discussing physical activity and eating behaviors, one cannot overlook the excess burden of obesity in the Latino community. Throughout the literature, there appears an association between generational status and body mass index (BMI) among Latinos. Defined,

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body mass index is simply a comparison between one‘s height and weight (kg/m2). Taverno and colleagues found that the rates of obesity were highest among first and second-generation non-English speakers and that more than one quarter of third-generation, non-English speakers were overweight. Also, almost one half of Latino children aged 6–11 years were discovered to be overweight (Taverno et al., 2010). Moreover, birthplace and length of U.S. residency have been associated with obesity among various immigrant groups. One study indicated that Mexican immigrants who had lived ≥15 years in the U.S. had more than a 4 times higher risk of obesity than those residing in the U.S. for <5 years (Barcenas et al., 2007). With that being said, it is evident that obesity is prevalent among the Latino community, yet the conflicting literature presents that it is inconclusive on the specific impacts that acculturation has on this topic.

CONCLUSION Throughout this chapter, multiple articles were reviewed in an attempt to find trends between acculturation and the health behaviors of Latinos. The evidence appears to suggest that acculturation has a negative impact on dietary behaviors for Latinos in the U.S., while potentially positively impacting physical activity levels. For example, as the years of residence increase for Latinos, revealing signs of increased acculturation, Latinos appear to improve their overall physical activity levels, while poorer eating habits are developed in the process of acclimating to the American diet. Also, when using language preference and ability to measure acculturation, English-speaking Latinos are more likely to meet recommended physical activity guidelines than Spanish-speaking Latinos. On the flip side, English-speaking Latinos are often report poor eating habits, likely due to their progressive levels of acculturation (Crespo et al., 2001). Nevertheless, current research is limited, particularly by issues related to measurement and more investigation in the area of acculturation is needed before distinct conclusions can be drawn. Such efforts represent a public health priority, as this rapidly growing population is disproportionately burdened by chronic diseases related to the discussed health behaviors. For instance, according to recent data from the National Center for Health Statistics, obesity rates among Mexican-Americans 20 years and older are as high as 30.4% for males and 42.6% for females. Similarly, rates of physician-diagnosed diabetes (12.4%) are almost double the rates for Non-Hispanic Whites (National Center for Health Statistics, 2010). Once more studies have been conducted to elucidate the impact of acculturation upon dietary and physical activity behaviors in Latinos, this data can then be used to inform the development of future health promotion programs specifically targeting the needs of this underserved population and thereby help address existing health disparities. In terms of future directions for promoting healthy diet and physical activity behaviors in Latinos, researchers should consider capitalizing on the many strengths of this group. For example, the importance of family is a common theme within the Latino community and mothers have a strong influence on establishing social norms for dietary practices. Latino families normally consist of close interaction among its members, with husbands and fathers fulfilling occupational demands while wives and mothers maintain the household. In many cases, Latino homes include multiple generations within one residence. Therefore,

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considering that various levels of acculturation can be found within a single home (e.g., different generations, ages, and years of residence in the U.S.), family-based diet and exercise interventions may be a particularly appropriate and effective approach for this target population. In addition, dietary practices in countries of origin are often quite healthy, thus health care providers may wish to encourage a return to traditional dishes (Dave, et al., 2009). At large, the challenge lies in finding efficient interventions for the evolving nature of acculturation.

REFERENCES Abraido-Lanza, A.F., Chao, M.T., and Florez, K.R. (2005). Do healthy behaviors decline with greater acculturation?: Implications for the Latino mortality paradox. Soc Sci and Med, 61, 1243-1255. Arcia, E., Skinner, M., Bailey, D., and Correa, V. (2001). Models of acculturation and health behaviors among Latino immigrants to the US. Soc Sci and Med, 53, 41-53. Ayala, G.X., Baquero, B., and Klinger, S. (2008). A systematic review of the relationship between acculturation and diet among Latinos in the United States: Implications for future research. J Am Diet Assoc, 108(8), 13301344. Barcenas, C.H., Wilkinson, A.V., Strom, S.S., Cao, Y., Saunders, K.C., Mahabir, S., Hernandez-Valero, M.A., Forman, M.R., Spitz, M.R., and Bondy, M.L. (2007). Birthplace, years of residence in the United States, and obesity among Mexican-American Adults. Obesity, 15(4), 1043-1052. Bernstein, R. (2006). Minority Population Tops 100 Million. US Census Press Releases. May 17, 2007. Campbell, P.R. (1996). Population Projections for States by Age, Sex, Race, and Hispanic Origin: 1995 to 2025.U.S. Bureau of the Census, Population Division, PPL-47. Castro, F.G., Marsiglia, F.F., Kulis, S., and Kellison, J.G. (2010). Lifetime segmented assimilation trajectories and health outcomes in Latino and other community residents. Am J Public Health, 100(4), 669-676. Crespo, C.J., Smit, E., Carter-Pokras, O., and Anderson, R. (2001). Acculturation and leisuretime physical inactivity in Mexican-American adults: Results from NHANES III, 19881994. Am J Public Health, 91(8), 1254-1257. Dave, J. M., Evans, A. E., Saunders, R. P., Watkins, K. W., and Pfeiffer, K. A. (2009). Associations among food insecurity, acculturation, demographic factors, and fruit and vegetable intake at home in Hispanic children. J Am Diet Assoc, 109(4), 697-701. Diaz, H., Marshak, H. H., Montgomery, S., Rea, B., and Backman, D. (2009). Acculturation and gender: influence on healthy dietary outcomes for Latino adolescents in California. J Nutr Educ Behav, 41(5), 319-326. DuBard, C.A., and Gizlice, Z. (2008). Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health, 98(11), 2021-28. Elder, J.P., Arredondo, E.M., Campbell, N., Baquero, B., Duerksen, S., Ayala, G., Crespo, N.C., Slymen, D., and

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McKenzi, T. (2010). Individual, family, and community environmental correlates of obesity in Latino elementary school children. J Sch Health, 80(1), 20-30. Ham, S.A., Yore, M.M., Kruger, J., Heath, G.W., and Moeti, R. (2007). Physical activity patterns among Latinos in he Unites States: Putting the pieces together. Preventing Chronic Disease, 4(4), 1-13. Heron, M. (2010). Deaths: Leading Causes for 2006. Nat Vital Stat Reports, 58(14), 15. Owens, A. M. (2006). Hispanics in the United States. Retrieved 5/24/2010, from U.S. Census Bureau http://www.census.gov/population/www /socdemo/hispanic/files/Internet_His panic_in_US_2006.pdf Lara, M., Gamboa, C., Kahramanian, M.I., Morales, L.S., and Bautista, D.E.H. (2005). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annu Rev Public Health, 26, 367-97. Martinez, S.M., Ayala, G.X., Arredondo, E.M., Finch, B., and Elder, J. (2008). Active transportation and acculturation among Latino children in San Diego County. Prev Med, 47, 313-318 Mainous, A. G., 3rd, Diaz, V. A., and Geesey, M. E. (2008). Acculturation and healthy lifestyle among Latinos with diabetes. Ann Fam Med, 6(2), 131-137. National Center for Health Statistics. Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD. 2010. Neighbors, C.J., Marquez, D.X., and Marcus, B.H. (2008). Leisure-time physical activity disparities among Hispanic subgroups in the United States. Am J Public Health, 98, 1460-1464. Perez-Escamilla, R., and Putnik, P. (2007). The role of acculturation in nutrition, lifestyle, and incidence of type2 diabetes among Latinos. J Nutr, 860-870. Perez-Escamilla, R. (2009). Dietary quality among Latinos: is acculturation making us sick? J Am Diet Assoc, 109(6), 988-991. Prince, S.A., Adamo, K.B., Hamel, M.E., Hardt, J., Gorber, S.C., and Tremblay, M. (2008). A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 5:56, 1-24. Reyes-Ortiz, C. A., Ju, H., Inniss, A., Eschbach, K., Kuo, Y. F., and Goodwin, J. S. (2009). Acculturation and serum nutrients thought to be involved with cancer prevention among Mexican-American men in the United States. Cancer Control, 16(2), 169-175. Rosas, L. G., Harley, K., Fernald, L. C., Guendelman, S., Mejia, F., Neufeld, L. M., et al. (2009). Dietary associations of household food insecurity among children of Mexican descent: results of a binational study. J Am Diet Assoc, 109(12), 2001-2009. Sing, G.K., Yu, S.M., Siahpush, M., and Kogan, M.D. (2008). High levels of physical inactivity and sedentary behaviors among US immigrant children and adolescents. Arch Pediatr Adolesc Med, 162(8), 756-763. State-specific prevalence of obesity among adults--United States, 2007. (2008). MMWR Morb Mortal Wkly Rep, 57(28), 765-768. Sussner, K. M., Lindsay, A. C., Greaney, M. L., and Peterson, K. E. (2008). The influence of immigrant status and acculturation on the development of overweight in Latino families: a qualitative study. J Immigr Minor Health, 10(6), 497-505. Taverno, S.E., Rollins, B.Y., and Francis, L.A. (2010). Generation, language, body mass index, and activity patterns in Hispanic children. Am J Prev Med, 38(2), 145-153.

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Unger, J.B., Reynolds, K., Shakib, S., Spruijt-Metz, D., Sun, P., and Johnson, C.A., (2004). Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents. J Commu. Health,29 (6), 467. Zambrana, R.E., and Carter-Pokras, O. (2010). Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos. Am J Public Health, 100(1), 18-23. Zane, N., and Mak, W. (2003). Acculturation: Advances in theory, measurement, and applied research. Chun, K.M., Organista, P.B., and Marín, G. (Ed.). Washington, DC: American Psychology Association.

In: Acculturation Editor: Tara M. Johnson

ISBN: 978-1-61122-525-9 ©2011 Nova Science Publishers, Inc.

Chapter 9

ACCULTURATION AND PSYCHOLOGICAL CHARACTERISTICS OF BOSNIAN INTERNALLY DISPLACED AND REFUGEE ADOLESCENTS FROM SREBRENICA REGION AFTER THE WAR 1992-1995 IN BOSNIA AND HERZEGOVINA *

Mevludin Hasanović¹, Osman Sinanović² and Slobodan Pavlović¹ ¹ Departments of Psychiatry, ² Neurology, University Clinical Center, School of Medicine University of Tuzla, Tuzla, Bosnia and Herzegovina

ABSTRACT Aim To estimate the frequency, type and severity of psychological trauma among Bosnian refugee and internally displaced adolescents after the 1992-1995 war in Bosnia and Herzegovina. Methods The sample of 225 pupils (112 females and 113 males) aged of 15.1±2.1 years were evaluated for assessment of war traumatic events, acculturation, neuroticism, school behavioral problems; and presence of post-traumatic stress disorder (PTSD). The sample was divided into group of participants from eastern Bosnian region (Srebrenica and Podrinje) (n=143) who had been exposed to the war catastrophes in their original region, and survived Srebrenica catastrophe 1995 and a group of participants from north-east Bosnian region (Semberija and Posavina), who were exposed to the war catastrophes in *

A version of this chapter was also published in Adolescent Behavior Research Studies, edited by Rene S. Grenell, published by Nova Science Publishers, Inc. It was submitted for appropriate modifications in an effort to encourage wider dissemination of research.

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Mevludin Hasanović, Osman Sinanović and Slobodan Pavlović the first beginning of war, in April 1992 and became refugees during the whole war and after it (n=82). Results In both groups, refugee and internally displaced adolescents had been exposed to severe war trauma and had reported high level of trauma more than three years after the war. Among participants from Srebrenica region we found 52 of 143 (36.4%) participants lost father what is significantly more than participants from Semberija region 7 of 82 (8.5%) (Chi-square=20.860, df=1, P<0.001), significantly more children from Srebrenica 94 of 143 (65.7%), stayed in homeland and survived additional trauma exposure to war catastrophes as refugees in so called ―free territory‖, after survived war experiences in 1992, while from Semberija region only 22 of 82 (26.8%) experienced whole war period out of original places (Chi-square=31.583, df=1, P<0.001). The level of trauma severity (mean±standard deviation = 4.3±0.9 on a scale from 0-5), and stress level 2.0±1.2 were higher among adolescents and internally displaced from Srebrenica than among those from Semberija (4.1±1.1 and 1.7±1.1, respectively) but not significantly (p=0.150; P=0.072, respectively, t-test). The level severity of re-experience cluster symptoms, (mean±standard deviation = 2.5±1.4 on a scale from 0-5) were significantly higher among adolescents from Srebrenica than among those from Semberija region (1.9±1.2, ttest=3.255, P=0.001). The prevalence of PTSD statistically significantly differed between Srebrenica group (67.8%) and Semberija group of respondents (52.4%) (Chisquare=5.253, df=1, P=0.022). Participants from Srebrenica had significantly more acculturation problems for: Missed friends during exile/displacement, Wanted to return to native place/homeland, Listened to news from native place/homeland and Had alimentary problems after being exiled/displaced (p<0.05), and there were no statistically significant differences for the rest of listed acculturation problems between groups. According the Tscore of Achenbach check list, (mean±standard deviation on the scale from 0-100), from Srebrenica reported significantly more severe anxious depressed behavior (58.8±10.7) than their peers from Semberija (54.9±8.9) (t-test=7.782, P=0.006); they reported significantly more severe withdrawn depressed behavior too (57.6±11.2; 53.4±9.5 respectively) (t-test=8.226, P=0.005), also they reported significantly more severe internalizing problems (57.3±9.0; 54.1±7.5 respectively) (t-test=7.309, P=0.007). Participants from Srebrenica had more severe thought problems (54.5±8.0; 51.6±6.0 respectively) (t-test=8.082, P=0.005), as well as significantly more expressed attention problems (53.0±4.5; 51.8±3.5 respectively) (t-test=4.583, P=0.033). The prevalence of anxious-depressed behavior in clinical range among Srebrenica participants 24 of 143 (16.8%) were significantly higher than among their peers from Semberija 8 of 82 (9.8%) (Chi square=9.611, P=0.008), also the prevalence of thought problems were significantly more expressed among Srebrenica adolescents 13 of 143 (9.1%) related to 5 of 82 (6.1%) (Chi-square=7.143, P=0.028). Adolescents from Srebrenica reported significantly lower activeness, 66 of 143 (46.2%) which is under average activeness, related to 21 of 82 (25.6%) among children from Semberija (Chi-square=10.408, P=0.005). Sociability among children from Srebrenica with over average sociability 80 of 143 (55.4%) were significantly less than among children from Semberija 59 of 82 (72.0%) (Chi-square=6.836, P=0.033). Adolescents from Srebrenica were significantly more introverted 31 of 143 (21.7%) than their peers 11 of 82 (13.4%), but less extroverted 25 of 243 (17.5%) related to 29 of 82 (35.4%) (Chi-square=9.692, P=0.008). The severity of trauma experiences and stress level highly correlated with severity of neuroticism (Pearson r=0.394, P<0.001; r=0.551, P<0.001 respectively), but negatively highly correlated with sociability (r=-0.170, P=0.011; r=-0.3, P<0.001). Stress level severity highly correlated with level of activeness (r=0.145, P=0.030).

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Conclusions Bosnia-Herzegovina refugee and internally displaced adolescents, 3.5 years after war, suffer from PTSD very frequently. Adolescents from Srebrenica region suffered significantly more from PTSD, acculturation problems, anxious/depressed behavior problems, and thought problems. Also they were significantly less active, less sociable, and less extroverted, in other words they were significantly more introverted. Professionals and institutions involved in education and mental health care of adolescents should develop programs to address this after war outcomes among young population.

Keywords: Bosnia and Herzegovina, Srebrenica, adolescents, refugees, exile, acculturation, neuroticism, introversion, and PTSD.

INTRODUCTION The state of Bosnia, located in the Balkans, first appeared in the 10th century. The rich history of Bosnia-Herzegovina (BH) demonstrates the uniqueness of a country where four religions: Roman Catholicism, Christian Orthodoxy, Islam and Judaism; have left an indelible mark on development of a civilization [1]. The latter part of the twentieth century has seen an increased concern for the implications of war for civilian populations, and more attention has been given to psychosocial impacts of uprooting and displacement [2]. Large parts of the population were exposed to extreme threats and intense feelings of helplessness. These long-term traumatic and stressful experiences leave an imprint upon people‘s inner lives and take a long time to heal [3]. Wars in Yugoslavia began in summer 1991 after Slovenia and Croatia declared their independence. The situation in Bosnia was the most complicated of all the former Yugoslav republics. According to the 1991 census, Bosniaks-Muslims represented 43 percent of the population, followed by Serbs at 32 percent and Croats at 17 percent. As the federation unraveled, the republic's inhabitants began to polarize along ethnic lines [1]. From 1992 to 1995, the people of Bosnia and Herzegovina (BH) experienced one of the most horrible wars seen in Europe at the end of the 20th century [3]. The fall of the Bosniak-populated, eastern Bosnian enclave of Srebrenica on July 11, 1995, became a significant event that fundamentally changed conflict dynamics and enhanced the prospect for peace. The fall of Srebrenica was the darkest moment in international involvement in Bosnia [1]. In July 1995 about 15 000 people attempted to walk from the enclave of Srebrenica to free territory in Bosnia. Two-thirds were captured or killed. Many of the remainder experienced hallucinations on the march, leading them to believe they were the victims of chemical weapons. After the literature on the likeliest CW agent, 3-quinuclidinyl benzilate (BZ), and on stress as a cause of hallucinations were reviewed, CW exposure could not be ruled out. It was concluded that the hallucinations can be ascribed to the consequence of multiple stresses: artillery attacks, exhaustion due to lack of sleep, starvation, thirst and the effects of drinking unpurified water [4]. Despite Srebrenica was United Nations (UN) safe zone, the murder of 7 000-8 000 Bosniak men was not prevented . Some were killed after surrendering, believing the UN would protect them. Others were hunted down while attempting to escape into Bosnian government-held territory. Some committed suicide, unable to endure the harrowing trek to safe ground [1].

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After the Dayton Peace Accord in November 1995 was signed in Paris the following month, war quitted. The war in Bosnia lasted approximately 3 and 1/2 years, and although military casualties were high for all sides [5], an estimated 100 000 to 250 000 people were killed and 200 000 were wounded [1], by far the greatest impact of the fighting was on civilians. It is estimated that >1.3 million Bosnians were displaced within the country, more than 800 000 became refugees to other nations, and up to one quarter of 1 million were killed [5], 90% of whom were civilian [6]. The use of violence against civilians in times of war has been one of this century's most alarming military developments, creating increasing numbers of displaced persons and refugees in the wake of regional and tribal conflict. Usually from among the poorest of their communities and largely women and children, little is known about the intensity and prevalence of their experiences or about the influence of those experiences on distress symptoms [5]. Many refugees exiled to different European countries, where they faced different acculturation processes [3]. 'Loss of place', acute and chronic trauma, family disruption and problems of family reunification have become issues of concern. The war in Bosnia was characterized by massive displacement, disruption and loss of life, relatives and property. Health and psychosocial well-being were affected in a number of ways. The findings show that there may be more serious longer-term psychological problems in people who are forced to leave their country during wartime [7]. The critical element that makes an event traumatic is the subjective assessment by victims of how threatened and helpless they feel [8]. Little is known about the impact of modern warfare on children. Together with adults, many children witnessed and/or were exposed almost to all of the war-related experiences [3,5]. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation [5]. Traumatic experience has overall far reaching consequences on personality. In particular, it has significant impact on teenagers that are just approaching the phase of solving their identity problems. Traumatic experience has overall far reaching consequences on personality. In particular, it has significant impact on teenagers that are just approaching the phase of solving their identity problems [9]. The group having the most difficult time with postwar adjustment is young adults who were children, ages five to 12 years old, during the war. Their condition is the result of growing up in an environment without a sense of safety and security (e.g., they could not play outdoors, often confined to living in interior rooms) [1]. The whole social web was destroyed and there was no natural social support system in place. Traumatic events experienced by thousands of people during this conflict may have a lasting effect on the mental health of the country [10]. After the end of war in Bosnia in 1995, a certain number of refugee families were repatriated. They were often repatriated against their whishes to return to a completely changed, unsafe and devastated environment. During this process, children were exposed to another stress of dislocation and process of acculturation [3]. Several hundred thousand people remain internally displaced persons (IDP) in BosniaHerzegovina living in camps and settlements. Displaced peoples have specific burdens over belonging, housing, occupation, welfare, security and loss of communities. The decision whether to return to their homes is complex, with local and international political pressures adding to their uncertainties and insecurities. In addition there is the impact of the war, the experiences of violence, the remembering and issues of reconciliation, and a variety of mostly unevaluated psychosocial programs aimed at helping with these. All this has a profound

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impact on their health and well-being [11], and has led to long-term emotional scars and mental health problems in the children and adolescents population [3]. Exposure to warrelated violence and social isolation was highly predictive of PTSD symptoms; depressive symptomatology was accounted for primarily by the exile-related stressors [12]. A failure to resolve moderate to severe traumatic reactions may result in long-term consequences on the ability of adolescents to engage in productive behaviors and function adequately socially, academically, professionally, and personally [13]. Certain war experiences were also associated with greater symptomatology [7]. For adolescents who lost their fathers, the combination of dangerous environment during a war and their own personal experiences outside of their homeland could expose them to a large number of traumatic stressors that could subsequently lead to severe PTSD and many different behavioral dysfunctions [3]. PTSD and behavioral dysfunctions in general could affect adolescent‘s abilities to achieve their life goals in the future [14,15], because of an overwhelming loss of perceived power and self-esteem. Displaced persons no longer felt they were able to play a useful role; they had lost a sense of worth. Widespread depression and feelings of fatigue and listlessness may have prevented adolescents from taking steps to improve their situation. Many of internally displaced people had a high startle capacity and they were constantly nervous. Most adverse psychosocial responses increased with age and this poses serious problems. The major challenges with respect to repatriation and reconstruction is pointed out. The importance of family reunification and the facilitating of decision-making by affected people themselves were highlighted [2]. In this study, we analyzed acculturation and psychological characteristics of Bosnian refugee and internally displaced adolescents who survived Bosnia war and Srebrenica enclave catastrophe. All of them survived very difficult humanitarian catastrophes being besieged without normal life properties together with war dangerousness that they were exposed to together with their families. After separation from men, these adolescents were transported by crowded trucks and buses together with their mothers, very old men and other children to airport Dubrave close to Tuzla town. Among more than 15 000 humiliated of coming displaced persons from Srebrenica enclave, field emergency services accepted various pathology of these exhausted persons. Among children there were dominated respiratory disease case and uncared skin infections [16]. During our research, a part of them were in the process of repatriation to home country after certain period of life in exile (1995-1998), and another part of investigated group stayed during and after the war in Bosnia and Herzegovina as internally displaced persons, without possibility to return to their place of origin despite war quitted. We compared them with their peers from another geographical position named Semberija plain, who survived different catastrophic war conditions in the its‘ first beginning; who partly were exiled (1992-1998) and partly were internally displaced, but did not survive Srebrenica catastrophe. We assessed the severity of trauma experiences, stress level, level of neuroticism, sociability, activeness and introversion-extroversion. Also we assessed maladjustment problem of acculturation in the exile country of foreign culture and language, and maladjustment problems that appeared during the process of repatriation; then severity and prevalence of social/behavioral disorders reported by school teachers. We also explored the influence of age, gender, loss of father on the acculturation and repatriation maladjustment and on the development of posttraumatic stress disorder and school behavior problems.

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METHODS Data collection took place in June 1999 in the classrooms of adolescents‘ schools, with the written permission of the Tuzla Canton Ministry for Culture, Sport and Education. The study received ethics approval from the Human Research Ethics Board of the Tuzla University Clinical Center and from the Tuzla Canton Ministry for Culture, Sport and Education. During data collection, only the first author was together with examinees, without school authorities.

Subjects The targeted populations were elementary and secondary school pupils of early and middle adolescence, who were refugees during and after the BH war. Participants were chosen from available refugee pupils in one public elementary school and seven secondary schools, who agreed to participate voluntarily; with their parents who gave verbal permission, after they had been informed and asked for participation in this research. We selected a single elementary school, because the number of refugee pupils in the Tuzla municipality was greatest in this school. The selection of secondary schools depended on the availability of displaced and repatriated pupils, who were dispersed in all public secondary schools in the city of Tuzla. We tested 274 adolescents, but only the questionnaires were valid for 225 (81.2%) subjects. The sample was divided into group of participants from eastern Bosnian hillside region along river Drina (Srebrenica and Podrinje) (n=143) (65 female 45.5%) who had been exposed to the war catastrophes in their original region, and survived Srebrenica catastrophe in July 1995 and a group of participants from north-east Bosnian plain side region (Semberija and Posavina), who were exposed to the war catastrophes in the first beginning of war, in April 1992; and became refugees during the whole war and after it (n=82) (47 female 57.3%) (Chi-square=2.93, P=0.087). Among Srebrenica adolescents there were 73 (51.1%) elementary school pupils and 70 (48.9%) secondary school pupils of 143, and in Semberija-Podrinje group 45 (54.9%) and 37 (45.1%) of 82 respectively. (Chi-square=0.306, df=1, P=0.580). Regarding refugee status of participant the groups were divided into two subgroups: internally displaced persons (IDP) consisted from school pupils who spent over four years displaced in one or more different places in Bosnia and Herzegovina and repatriated persons, school pupils who spent over four years exiled in one or more different foreign countries during the war in Bosnia and Herzegovina. In the Srebrenica group there were significantly more IDP 94 (65.7%) of 143, compared with Semberija 22 (26.8%) of 82 participants. On the other side the frequency of repatriated subjects in Srebrenica group was significantly less 49 (34.3%) of 143, compared with Semberija group with 60 (73.2%) of 82 participants (Chisquare=31.583, df=1, P<0.001). The IDP and repatriated participants were without ability to return into their original homes, from where they had been displaced/exiled. Selection criteria were: a) participants had to be originally from two BH geographical regions (Srebrenica, eastern part of BH and Semberija, north-eastern part of BH) with different history of the recent war, b) adolescents had to experience war conditions in the beginning of the BH war, when they were forced to

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leave their homes under life threatening conditions, c) adolescents were prevented to return to their homes, from where they had to leave because of life threatening reasons, and still could not return. The average age (mean±standard deviation) of all participants was 15.1±2.1 years, with no difference between the Srebrenica group (15.3±2.1) and Semberija group (14.9±2.1)(t-test=1.455; P=0.147). The mean age of examined participants when they experienced forcedly leaving their homes was 8.5±2.4 years, (8.5±2.2 for Srebrenica and 8.5±2.7 for Semberija group)(t-test=0.071; P=0.943). Participants who left Bosnia and Herzegovina, spent an average period of exile of 5.2±1.2 years, groups did not differ significantly.

Outcome Measures The questionnaire on basic personal and socio-demographic information was designed specifically for this study, and included questions on basic data (age, gender, level of parents‘ education, employment status of parents, self-evaluation of the psychosocial family status, habits). To evaluate traumatic events, severity of trauma and presence of PTSD, as well as the expressiveness of PTSD symptoms, the modified culturally validated measures for posttraumatic stress disorder (PTSD): the Harvard Trauma Questionnaire (HTQ), Bosnia and Herzegovina Version [17,18] was used. We also asked the respondents to evaluate how they felt when they remember upsetting trauma experiences, either experienced or witnessed. For every identified traumatic event, the respondent‘s were asked: ―How do you feel, when you remember of that?‖ rated on a 0-5 scale: 0 – no feeling; 1- bit upset; 2- somewhat upset; 3moderately upset; 4 – seriously upset and 5 – extremely seriously upset [3]. Another part of self-rating questionnaire contained the 16-item scale for measuring the PTSD symptoms and presence of PTSD. The items corresponded to the DSM IV symptoms for PTSD assessment and yielded a total score and three-symptom cluster subscales scores [18]. The frequency of each DSM-IV PTSD symptom (stress level) assessed on the 0-5 rated scale by determining it‘s‘ appearance over the last month: 0 – not at all, 1 - almost never, 2 – sometime, 3 – moderately, 4 – often and 5 – almost every day. The acculturation and repatriation characteristics were determined according to DSM-IV instructions for systematic description of cultural influence [19], and a self-administered questionnaire was used for socio-demographics data. To evaluate neuroticism and extroversion of adolescents we used HANES-scale ―The Hamburg scale of neuroticism and extroversion for children and adolescents.‖ The scale was purposed for determination of children and adolescents‘ characteristics aged from 8-16 years. It is consisted of two subscales for neuroticism and two subscales for extraversionintroversion (activity and sociability) measured on a 1-9 scale, together with BIAS scale. The authors of this scale were Burrgle and Baumgartel (1972). For the region of former Yugoslavia it was adapted in the Center for psycho-diagnostical means, Ljubljana. The authors of adaptation and publication were Bele-Potočnik et al. [20]. Data about school behavior disturbances were collected from the teachers using The Child Behavior Checklist of Achenbach, CBCL-TRF [19], based on teachers‘ observation in the classroom. The checklist consisted of 121 close-ended questions, thematically divided into the following sections: 1) anxious/depressed – 13 items, 2) withdrawn/depressed – 8 items, 3) somatic complains – 11 items, 4) social problems -11 items, 5) thought problems –

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15 items, 6) attention problems – 10 items, 7) rule-breaking behavior – 17 items, 8) aggressive behavior – 18 items and 9) other problems – 17 items: bowel movements (BM) out of toilet, brags, cruel to animals, doesn‘t eat well, bites nails, overeating, overweight, other physical problems, shows off, sleeps more, talks too much, thumb sucking, wets self (day), wets the bed, whining, whishes to be opposite sex, and other problems. Based on the CBCLTRF cut-off T-score 69.5 and respecting the symptom sections criteria, the observed prevalence rate of clinical range of behavioral problems among participants, noted by teachers in schools, were computed [21].

Statistics Collected data were statistically analyzed using the Statistical Package for Social Sciences, version 10.0 (SPSS, Chicago, IL, USA). Statistical tests included t-test, chi-square test (crosstabulation), Pearson‘s r coefficient of correlation and Spearman‘s ρ coefficient of correlation.

RESULTS Socio-Demographic Data and Exposure to Traumatic Events Refugee adolescents from Srebrenica region lived significantly more often in collective settlements and they experienced significantly more often separation from parent/s, father loss and loss of immediate and/or extended family member/s (table 1). There were no significant differences between adolescent refugees from Srebrenica and Semberija regarding of life in non-adequate residence, non-adequate and non-safe neighborhood, poor financial means, extreme poverty and lack of social support (table 1). Table 1. Socio-demographic data for 225 Bosnian adolescents from Srebrenica region (n=143) and Semberija region (n=82) who were internally displaced and repatriated after refuge Socio-demographic characteristics Non-adequate residence Collective settlements Non-adequate and non-safe neighborhood Separation from parent/s Poor financial means Extreme poverty No social support Father loss Loss of immediate or extended family member (s)

Srebrenica Semberija n=143 n=82 No. (%) of adolescents 85 (59.4) 41 (50.0) 81(56.6) 26 (31.7) 61 (42.7) 26 (31.7)

Total n=225 126 (56.0) 107 (47.6) 87 (38.7)

1.88 15.78 2.64

0.170 <0.001 0.105

65 (45.5) 94 (65.7) 15 (10.5) 100 (69.9) 52 (36.4) 65 (45.5)

89 (39.5) 144 (64.0) 25 (11.1) 162 (72.0) 59 (26.2) 81 (36.0)

5.713 0.51 0.15 2.88 20.86 15.22

0.017 0.474 0.695 0.237 <0.001 <0.001

24 (29.3) 50 (61.0) 10 (12.2) 62 (75.6) 7 ( 8.5) 16 (19.5)

* Significant of difference between groups (crosstabulation)(Chi-square test).

Chi-square

P*

Table 2. Severity of feeling when recalling trauma experiences (mean±standard deviation) in 225 adolescents from Bosnia and Herzegovina who were from Srebrenica region (n=143) and Semberija region (n=82)

Trauma Experienced: unwillingly leaving home separation from family and friends forced expelling from home living in collective refugee settlements severe fear shelling very close to me killing of close relatives enemies maltreating my father refugee problems firing at our house running away, hiding and crawling in front the life threatening danger mother‘s crying killing people severe sadness killing of my father devastation and firing of houses, ruins life in a small room in foreign country missed of my father staying in the concentrating camp together with my family wounding of my father Witnessed: dead bodies enemy soldiers killing people watching people being slaughtered on TV wounding and wounded people beating and torturing of men and women everything listed

Feeling severity* Srebrenica No. (%)

Mean*/SD†

Semberija No. (%)

Mean±SD

t-test

P‡

119 (83.2) 115 (80.4) 112 (78.3) 81 (56.6) 72 (50.4) 71 (49.7) 65 (45.5) 62 (43.4) 55 (29.9) 47 (32.9) 46 (32.2)

4.1±1.3 4.7±0.9 4.2±1.2 4.4±0.9 4.8±0.5 3.8±1.5 4.7±0.6 4.7±0.8 4.6±0.8 3.8±1.4 4.5±1.2

68 (82.9) 65 (79.3) 60 (73.1) 28 (34.2) 34 (41.5) 20 (24.5) 16 (19.5) 24 (29.3) 28 (34.2) 18 (22.0) 16 (19.5)

4.0±0.1 4.3±1.2 4.3±1.2 4.6±1.0 4.4±1.0 3.8±1.2 4.4±0.7 4.5±0.9 4.5±1.2 3.4±1.7 4.3±1.1

0.519 2.160 -0.727 -0.971 2.697 -0.111 1.215 0.546 0.372 0.964 0.433

0.605 0.032 0.468 0.334 0.008 0.912 0.228 0.586 0.711 0.339 0.667

40 (28.0) 52 (36.4) 28 (19.6) 41 (28.7) 24 (16.8) 22 (15.4) 19 (13.3) 11 (7.7)

4.7±06 4.8±0.7 4.4±0.9 4.9±0.2 4.3±1.2 4.2±1.3 4.8±0.7 4.8±0.6

20 (24.5) 18 (22.0) 29 (35.4) 8 (9.8) 12 (14.6) 36 (43.9) 1 (1.2) 3 (3.7)

4.7±06 4.6±0.9 4.2±1.1 4.5±0.7 4.2±1.2 4.0±1.3 5.0±0.0 5.0±0.0

0.513 0.975 0.847 2.714 0.302 0.566 -0.288 -0.507

0.610 0.333 0.400 0.011 0.765 0.573 0.777 0.621

9 (6.3)

4.9±0.3

6 (7.3)

4.2±1.2

1,778

0.099

79 (55.2) 75 (52.5) 60 (42.0) 58 (40.6) 54 (37.8) 142 (99.3)

4.4±1.0 4.6±0.7 4.4±1.0 4.6±0.6 4.6±0.8 4.3±0.9

43 (52.4) 58 (91.4) 35 (42.7) 28 (34.1) 20 (24.4) 81 (98.8)

4.2±1.2 4.6±0.6 4.4±0.9 4.5±0.8 4.8±0.4 4.1±1.05

0.970 0.229 -0.079 0.754 -0.965 1.445

0.334 0.819 0.938 0.453 0.338 0.150

* Feeling when remembering the traumatic event, range from 0- no feeling to 5 extremely upset; data presented as a mean score (14) † Standard Deviation ‡ Significant of difference between groups (Student t-test).

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The average severity level of survived traumatic experiences of Srebrenica adolescents was not differ than that of Semberija group (table 2). Srebrenica adolescents reported significantly higher level of experiencing ―Separation from family and friends (p=0.032); severe fear (p=0.008) and killing of my father (p=0.011)‖ compared with Semberija refugee adolescents. For the rest of listed trauma experiences there were no statistically significant differences in the severity level between Srebrenica and Semberija groups (table 2).

The Frequency of Survived Trauma Experiences and Witnessing Srebrenica participants survived significantly more ―running away in front of the life threatening‖, ―shelling very close to me‖, ―killing of close relatives from enemy‖, ―killing of the father from enemy‖, ―maltreating of father from enemy‖, ―killing people from enemy‖ than Semberija ones (table 3). On the other side Semberija participants reported significantly more frequent: ―traveling to exiled country‖, ―life in foreign country without knowledge of speaking language in the exiled country‖, ―life in strange environment in a small room‖, returning to Bosnia-Herzegovina‖ and ―difficulties during acclimatization in B-H after return‖ and ―severe sadness‖ (table 3). Table 3. Frequency of trauma experiences in 225 internally displaced and refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=143) and Semberija region (n=82) Trauma Experienced: unwillingly leaving home separation from family and friends running away in front of life threatening forced expelling from home shelling very close to me firing at our house mother‘s crying killing of close relatives severe fear killing of my father enemies maltreating my father killing people severe sadness traveling to exiled country life in foreign country, no language knowledge life in a strange environment in a small room returning to Bosnia-Herzegovina difficulties during acclimatization in B-H Witnessed: beating and torturing of men and women

No (%) of participants Srebrenica Semberija n=143 n=82

Total N=225

Chi-square

119 (83.2) 110 (76.9)

68 (82.9) 64 (78.1)

187 (83.1) 174 (77.3)

105 (73.4)

49 (59.8)

112 (78.3) 71 (49.6) 47 (32.9) 40 (28.0) 65 (45.5) 72 (50.4) 41 (28.7) 62 (43.4) 52 (36.4) 28 (19.6) 15 (10.5) 26 (18.2)

df

P

0.003 0.038

1 1

0.955 0.846

154 (68.4)

4.5096

1

0.034

60 (73.1) 20 (24.4) 18 (22.0) 20 (24.5) 16 (19.5) 34 (41.5) 8 (9.8) 24 (29.3) 18 (22.0) 29 (35.4) 32 (39.0) 37 (41.1)

172 (78.2) 91 (40.4) 65 (28.9) 60 (26.7) 81 (36.0) 106 (47.1) 49 (21.8) 86 (38.2) 70 (31.1) 57 (25.3) 47 (20.9) 63 (28.0)

1.927 13.806 3.025 0.342 13.056 1.652 10.946 4.381 5.051 6.865 25.678 18.762

1 1 1 1 1 1 1 1 1 1 1 1

0.165 <0.001 0.082 0.559 <0.001 0.119 0.001 0.036 0.025 0.009 <0.001 <0.001

22 (15.4)

36 (43.9)

58 (25.8)

22.152

1

<0.001

15 (10.5) 19 (13.3)

22 (26.8) 25 (30.5)

37 (16.4) 44 (19.6)

10.127 9.802

1 1

0.001 0.002

54 (37.8)

20 (24.4)

74 (31.3)

4.222

1

0.040

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There were no significant differences between Srebrenica and Semberija group regarding experiences of: ―unwillingly leaving home‖, ―separation from family and friends‖, ―forced expelling from home‖, ―firing at home, mother's crying‖, ―severe fear‖ and other listed trauma experiences with lower frequency (P>0.05) (table 3). From the listed trauma witnessing, Srebrenica participants witnessed significantly more ―beating and torturing of men and women‖ (table 3), there were no significant differences regarding other listed witnessing.

Age, Gender, Refugee Status, Father Loss and Trauma Experience There was no correlation of age and trauma experiences severity among Srebrenica adolescents (r=0.117; P=0.162; Pearson‘s correlation); but among Semberija adolescents there was a positive correlation of age and trauma experiences severity (r=0.292; P=0.008; Pearson‘s correlation). Semberija elementary school (younger) refugee adolescents and boys had significantly lower severity of trauma experience mean (±standard deviation) (3.7±1.3; 3.8±1.4) than secondary school (older) ones (4.5±0.8, t=-3.242, P=0.002; 4.3±0.8, t=2.016, P=0.047, respectively; t-test). In Srebrenica group age and gender has no significant influence onto severity of trauma experiences (P=0.057, P=0.604 respectively). In both groups, Srebrenica and Semberija, adolescents who were internally displaced in BH during and after war presented significantly higher severity of trauma experiences (4.4±0.7; 4.5±0.7, respectively) than those who were exiled then returned to home country after war (3.9±1.4, t=-3.117, P=0.002; 3.9±1.2, t=-2.239, P=0.028, respectively; t-test). Srebrenica refugee adolescents who lost father had significantly higher severity of trauma experiences (4.5±0.6) than those who have no experience of father loss (4.1±1.0, t=-2.49, P=0.014, t-test), among Semberija adolescents the loss of father had no influence onto trauma experience severity (P=0.511).

Frequency of PTSD Symptoms - Stress Level The level of PTSD symptoms‘ frequency (stress level) (range 0-5) in the whole sample was (mean±standard deviation) 1.9±1.1. Stress level did not significantly differ between Srebrenica and Semberija group (2.0±1.2, 1.7±1.2, t=1.809, P=0.072; t-test). Scores on the stress level in the whole sample highly correlated with scores on the traumatic experience severity level (r=0.393; P<0.001; Pearson‘s correlation). The stress level highly correlated with the trauma experience severity in Srebrenica group (r=0.491; P<0.001; Pearson‘s correlation) and Semberija group (r=0.242; p=0.030; Pearson‘s correlation). The re-experience cluster in Srebrenica group was significantly more severe than in Semberija group (mean±standard deviation) (2.5±1.3, 1.9±1.2, t-test=3.255, P=0.001) while the severity level of PTSD clusters‘ symptoms: avoidance, hyper arousal and social functioning (DSM IV) did not significantly differ between Srebrenica and Semberija group.

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Age, Gender, Refugee Status, Father Loss and Stress Level In Srebrenica group age did not influence onto trauma experience severity, while in Semberija group trauma experience severity was significantly higher among secondary school pupils (mean±standard deviation) (4.7±0.8) than among elementary school subjects (3.7±1.3) (t-test=-3.242, P=0.02). Older participants in Srebrenica (2.2±1.2) and in Semberija group (2.0±1.0) had significantly higher stress level then younger ones (1.7±1.1, t-test=-2.586, P=0.011; 1.4±1.1, t-test=-2.452, P=0.016, respectively). Gender did not influence on the stress level in both group and on the trauma experience severity in Srebrenica group, but girls (4.3±0.8) in Semberija group presented significantly higher trauma experience then boys (3.8±1.4. t-test=2.016, P=0.047). Trauma experience severity level was significantly higher among IDP from Srebrenica (mean±standard deviation) 4.4±0.7 (range form 0-5) and from Semberija 4.5±0.7 groups then among repatriated participants (3.9±1.1. t-test=-3.117, P=0.002; 3.9±1.2. t-test=-2.239, P=0.028, respectively). Stress level severity did not significantly differ between IDP and repatriated participants from Semberija group, but stress level severity of IDP from Srebrenica 2.2±1.2 was significantly higher then among repatriated subjects (1.5±1.0, t-test=3.59, P<0.001). Loss of father had no influence on the trauma experience and stress level severities among participants in Semberija group, while in Srebrenica group participants who lost father had significantly higher trauma experience severity 4.5±0.6 and stress level severity 2.3±1.1 then the participants who had both parents alive (4.1±1.1, t-test=-2.490, P=0.014; 1.3±1.0. ttest=-2.724, P=0.007, respectively).

Neuroticism, Activity, Sociability, Extroversion The average severity level of neuroticism (range 1-9) did not differ between participants from Srebrenica and Semberija, but participants from Srebrenica were significantly less sociable, less active and more introverted (table 4). In other words, the prevalence of extraordinarily sociability (range: 7-9) among participants from Semberija 59 (72.0%) of 82 presented was significantly more than among Srebrenica 80 (55.9%) of 143 adolescents (Chisquare=6.836, P=0.033). The prevalence of under average activeness (range: 1-3) among Srebrenica participants 66 (46.2%) of 143 was significantly less than among those from Semberija 21 (25.6%) of 82 (Chi-square=10.408, P=0.005); also the prevalence of extraordinarily introversion (range: 1-3) was significantly more 31 (21.7%) and extraordinarily extroversion (range:7-9) was significantly less 25 (17.5%) of 143 Srebrenica subjects than among Semberija ones 11 (13.4%) and 29 (35.4%) of 82, respectively (Chisquare=9.692, P=0.008).

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Table 4. Severity level of Neuroticism, Sociability, Activeness and Extroversion in 225 internally displaced and refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=143) and Semberija region (n=82)

Neuroticism Sociability Activeness Extroversion

Srebrenica n=143 mean±standard deviation 6.6±1.95 6.7±1.9 mean±standard deviation 3.8±1.5 4.96±1.7

Semberija n=82 6.3±2.0 7.2±1.9 4.3±1.5 5.8±1.9

t-test 1.112 -1.952 t-test -2.445 -3.250

P 0.267 0.052 P 0.015 0.001

Age, Gender, Refugee Status, Father Loss and Neuroticism In Srebrenica group age, gender, refugee status and father loss did not influence significantly on neuroticism of participants; meanwhile in Semberija group girls reported more severe neuroticism (6.7±2.0) (mean±standard deviation) than boys (5.7±1.9)(ttest=2.367, P=0.020), older adolescents (7.0±1.9) reported more severe neuroticism than younger (5.8±1.9)(t-test= -2.855, P=0.005), internaly displaced participants (7.0±2.0) were significantly more nervous than repatriated ones (5.9±1.9)(t-test=-3.040, P=0.003), while the loss of father did not influence on neuroticism among these participants.

Age, Gender, Refugee Status, Father Loss and Sociability, Activeness, Extroversion Refugee status and gender did not influence significantly on severity of sociability, activeness and extroversion between Srebrenica and Semberija groups. Srebrenica participants who lost fathers reported significantly lower sociability (6.1±2.1) and more severe introversion (4.4±1.8) than their peers who had both parents (7.0±1.7, t-test=2.9, P=0.004; 5.2±1.6, t-test=2.99, P=0.003, respectively), while father loss did not influence on activeness in this group. Semberija participants who lost fathers (4.4±1.8) were significantly more introverted than those who had both parents (5.9±1.8)(t-test=2.008, P=0.048), while father loss did not influence on sociability and activeness among Semberija group. Age did not influence on sociability, activeness and extroversion among Srebrenica and Semberija refugee adolescents except on activeness among Srebrenica participants where younger (3.5±1.5) reported significantly lower activeness than older ones (4.1±1.3)(t-test=2.29, P=0.027).

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Association of Trauma Experiences, Stress Level, Clusters of DSM-IV PTSD Symptoms and Neuroticism, Sociability, Activeness and Extroversion Frequency of ―unwillingly leaving home‖ highly negatively correlated to sociability of Srebrenica adolescents (Spearmans‘ ρ=-0.197, P=0.018). Separation from friends and relatives highly positively correlated to sociability (ρ=0.249, P=0.003), acclimatization problems after arrived to Tuzla highly positively associated with neuroticism of Srebrenica respondents (ρ=0.177, P=0.035). Experiences of mother‘s crying highly negatively associated with sociability (ρ=-0.220, P=0.008) and extroversion (ρ=-0.697, P=0.047). Maltreating of father from enemy highly positively correlated with neuroticism (ρ=0.211, P=0.011) and negatively correlated with sociability (ρ=-0.203, P=0.015). Experience of severe fear among Srebrenica adolescents highly negatively correlated with sociability (ρ=-0.309, P<0.001) and extroversion (ρ=-0.239, P=0.004). Killing people from enemy highly correlated with neuroticism (ρ=0.254, P=0.002) and negatively correlated with sociability (ρ=-0.351, P<0.001). Running away in front of life threatening dangerous negatively associated with sociability (ρ=-0.209, P=0.012). and extroversion (ρ=-0.171, P=0.040). In Semberija group frequency of ―unwillingly leaving home‖ and ―separation from friends and relatives‖ highly positively associated with neuroticism (ρ=0.218, P=0.049; ρ=0.368, P=0.001, respectively). Acclimatization difficulties after arrived to Tuzla and forced expelling from home highly positively associated with neuroticism of Semberija participants (ρ=0.336, P=0.049; ρ=0.368, P=0.001, respectively). Neuroticism in Srebrenica and Semberija groups highly correlated with severity of trauma experiences, Stress level, PTSD cluster symptoms severity for re-experience, avoidance, hyper arousal and problems in social functioning. In Srebrenica group sociability highly negatively correlated with stress level, re-experiance, avoidance, hyper arousal and social disturbances, while in Semberija group there were no correlation between sociability and trauma symptoms severity. Activeness was highly correlated with stress level, hyper arousal and social disturbances in Srebrenica group and with trauma experience, hyper arousal and social disturbances in Semberija group. Extroversion was not associated with trauma symptoms in both groups (table 5).

Acculturation Problems Refugee adolescents from Srebrenica expressed significantly higher frequency of acculturation problems, such as: ―Missed friends during exile/displacement‖; ―Wanted to return to homeland/native place‖; ―Was sad after arriving in refugee/displaced environment‖; ―Listened to news from homeland/native place‖; ―Had digestion problems after exiled/displaced‖ (table 6).

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Age, Gender, Father Loss, Refugee Status and Acculturation Problems in Srebrenica Group Girls from Srebrenica, 55 (84.6%) of 65 reported significantly more sadness after arrived in refugee/displaced environment than boys 52 (66.7%) of 78 (Chi-square=6.064, P=0.014). Internally displaced participants 78 (83.0%) of 94 and those who lost fathers in Srebrenica group 45 (86.5%) of 52, reported significantly more ―sadness in exile/displacement‖ than repatriated subjects from Srebrenica 29 (59.2%) of 49 and those who had both parents 62 (68.1%) of 91 (Chi-square=9.682, P=0.002; Chi-square=5.952, P=0.015, respectively). Age, gender and father loss did not influence on frequency of ―alimentary problems in refugee environment‖, but internally displaced participants 38 (40.4%) of 94 reported significantly more alimentary problems than repatriated ones 7 (14.3%) of 49 (Chisquare=10.205, P=0.001). Participants who lost father in Srebrenica group 30 (57.7%) of 52 had significantly more „sleeping problems― after exiled/displaced than those who had both parents 35 (38.5%) of 91 (Chi-square=4.936, P=0.026). IDP among Srebrenica subjects 85 (90.4%) of 94 and elementary school students 66 (90.4%) of 73 reported significantly more ―thinking about native place in refugee environment‖ than repatriated ones 36 (73.-4%) of 49 and secondary school students 55 (78.6%) of 70 (Chi-square=7.114, P=0.008; Chi-square=3.848, P=0.050, respectively). Boys from Srebrenica 61 (78.2%) of 78 and younger participants 59 (80.8%) of 73 reported significantly more ―prevented to play outside in place of exile/displacement‖ than girls 41 (63.1%) of 65 and 43 (62.3) of 70 older participants (Chi-square=3.968 p=0.046; Chisquare=6.572 p=0.010, respectively). Srebrenica adolescents who lost fathers 46 (88.5%) of 52 reported significantly more ―missing of friends‖ than those who had both parents 67 (73.6%) (Chi-square=4.393, P=0.036). Adolescent refugees who lost fathers 51 (98.1%) of 52 in Srebrenica group significantly more ―thought about relatives from home country/native place‖ than those who had both parents 80 (87.9%) of 91 (Chi-square=4.448, P=0.035). Internally displaced participants in Srebrenica group 84 (89.4%) of 94 significantly more ―wanted to return to native place‖ than repatriated participants to home country: 32 (65.3%) of 49 (Chi-square=12.169, P<0.001). Internally displaced adolescents 72 (76.6%) of 94 and refugee adolescents who lost fathers 42 (80.8%) of 52 in Srebrenica group significantly more ―listened to news from their native place‖, than repatriated ones 29 (59.2%) of 49 and those who did not lose fathers 59 (64.8%) of 91 (Chi-square=4.707, P=0.030; Chi-square=4. 050, P=0.044, respectively).

Age, Gender, Father Loss, Refugee Status and Acculturation Problems in Semberija Group Age, gender and father loss did not influence on sadness among Semberija refugee adolescents, but internally displaced participants 19 (86.45%) of 22 reported significantly more ―sadness in refugee environment‖ than repatriated ones 27 (45.0%) of 60 (Chisquare=11.183, p=0.001).

Table 5. Association of Trauma experience severity, Stress level, Cluster PTSD symptoms by DSM-IV with Neuroticism, Sociability, Activeness and Extraversion in 225 internally displaced and refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=143) and Semberija region (n=82) (Pearson –r correlation) Severity level of: Trauma experience Stress level Re-experience DSM-IV Avoidance - DSMIV Hyper arousal DSM-IV Social functional disturbance

r P r P r

Neuroticism 0.313 <0.001 0.582 <0.001 0.476

Srebrenica (n=143) Sociability Activeness -0.152 0.035 0.070 0.682 -0.370 0.182 <0.001 <0.030 -0.301 0.103

Extraversion -0.090 0.287 -0.126 0.133 -0.128

Neuroticism 0.523 <0.001 0.488 <0.001 0.483

Semberija (n=82) Sociability Activeness -0.138 0.239 0.217 0.031 -0.138 0.143 0.215 0.200 -0.116 0.059

Extraversion 0.069 0.537 -0.002 0.984 -0.040

P r

<0.001 0.471

<0.001 -0.352

0.221 0.147

0.127 -0.135

<0.001 0.359

0.299 -0.125

0.600 -0.065

0.725 -0.110

P r

<0.001 0.586

<0.001 -0.226

0.080 0.212

0.108 -0.004

0.001 0.587

0.264 -0.154

0.560 0.287

0.324 0.050

P r P

<0.001 0.419 <0.001

0.007 -0.316 <0.001

0.011 0.176 0.036

0.964 -0.127 0.131

<0.001 0.488 <0.001

0.167 -0.022 0.846

0.009 0.243 0.028

0.655 0.149 0.181

Table 6. Frequency of acculturation problems in 225 internally displaced and refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=143) and Semberija region (n=82) Acculturation problems during period of exile/displacement

Thinking about relatives being in refugee environment Thinking about native place after arriving in refugee environment Missed friends during exile/displacement Wanted to return to native place/ homeland Was sad after arriving to refugee environment Listened to news from native place/homeland Was disturbed to accept new environment Had sleeping disturbances after exiled/displaced Was forbidden to play outside in refugee environment Had alimentary problems after being exiled/displaced

Srebrenica Semberija n=143 n=82 No. (%) of adolescents. 131 (91.6) 72 (87.8)

Total n=225

Chi-square

203 (90.2)

0.855

0.355

121 (84.6)

62 (75.6)

183 (91.3)

2.784

0.095

113 (72.0) 115 (80.4) 107 (74.8) 101 (70.6) 81 (56.6) 65 (45.5) 41 (28.7) 45 (31.4)

54 (65.9) 51 (62.2) 46 (56.1) 43 (52.4) 39 (47.6) 30 (36.6) 31 (37.8) 15 (18.3)

167 (74.2) 166 (73.8) 153 (68.0) 144 (64.0) 120 (53.3) 95 (42.2) 72 (32.0) 60 (26.7)

4.723 7.586 8.748 7.485 1.792 1.680 1.998 4.627

0.030 0.006 0.013 0.006 0.408 0.195 0.158 0.031

* Significance of differences between groups (crosstabulation) .

P*

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In Semberija group boys 31 (88.6%) of 35 significantly more ―reflected about native places‖ than girls 31 (66.0%) of 47 (Chi-square=5.563, P=0.018). Participants who lost father in Semberija group 6 (85.7%) of 7, had significantly more „sleeping problems― after exiled/displaced than those who had both parents 24 (32%) of 75, (Chi-square=7.962 P=0.005). In this group 8 (36.4%) of 22 IDP reported significantly more ―alimentary problems after displacement‖ than repatriated ones 7 (11.9%) of 59 (Chi-square=6.374 p=0.012), among same participants those who lost fathers 5 (71.4%) of 7 reported significantly more ―alimentary problems in refugee environments‖ 10 (13.5%) of 74 (Chi-square=14.216, P<0.001). Younger Semberija group participants 34 (75.6) of 45 reported significantly more ―prevented to play outside in place of exile/displacement‖ than older ones 17 (45.9%) of 37 (Chi-square=7.571, P=0.006). Semberija boys 28 (80.0%) of 35 and IDP 19 (86.4%) of 22 reported significantly more ―missing of friends‖ than girls 26 (55.0%) of 47 and repatriated subjects 35 (58.3%) of 60, respectively (Chi-square=5.434, P=0.020; Chi-square=5.625, P=0.018, respectively). Internally displaced participants in Semberija group 19 (86.4%) of 22 significantly more ―wanted to return to native place‖ than repatriated participants to home country 32 (53.3%) of 60 (Chi-square=7.469, P=0.006). Participants who lost their fathers 7 (100%) of 7 significantly more ―wanted to return to native/native place‖ than those who had both parents 44 (58.7%) of 75 (Chi-square=4.652, P=0.031). Internally displaced adolescents in Semberija group 16 (72.7%) of 22 significantly more ―listened to news from native place‖ than repatriated ones 27 (45%) of 60 who ―listened to news from native‖ (Chi-square=4. 962, P=0.026)

Repatriation Problems After return to home country adolescents from Semberija group reported significantly more ―Worse economic situation than before the exile‖, ―Preferring to watch programs from exile country on satellite TV‖ and ―Missing meeting with friends from pre-war period‖ than their peers from Srebrenica group (table 7).

Age, Gender, Father Loss, and Repatriation Problems Girls in Srebrenica group 23 (92%) of 25 reported ―different school system than in exile country‖ significantly more than boys16 (61.5%) of 26 (Chi-square:4.838, p=0.028). In this group adolescents who lost their fathers 4/14 had significantly more ―difficulties with teacher‖ than those with complete families 0/35 (Chi-square:10.889, P=0.001); while adolescents with complete families 25 (71.5%) of 35 had significantly more ―worse economic situation after return‖ than their peers who lost fathers 4 (28.6) of 14 (Chi-square=7.603, P=0.006).

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Table 7. Repatriation problems in 109 refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=49) and Semberija region (n=60) Repatriation problems during period of returning to home country Different school system than in the country of exile Economic situation is worse than before the exile Preferring to watch programs from exile country on satellite TV Sadness after return Missed meeting with friends from pre-war period School study difficulties after returned Lost school friends after return Concentration disturbances in studying after return Sleeping disturbances after return Communication problems with friends, relatives and neighbors Difficulties with teachers Alimentary difficulties

No. (%) of adolescents. Srebrenica Semberija n=49 n=60

Total n=109

Chi-square

P*

39 (79.6)

54 (90.0)

93 (85.3)

0.233

0.127

29 (59.2)

53 (88.3)

82 (75.2)

12.299

<0.001

30 (62.2)

48 (80.0)

78 (71.6)

4.672

0.031

22 (44.9) 14 (28.6)

29 (48.3) 34 (56.7)

51 (46.8) 48 (44.0)

0.128 8.639

0.721 0.003

20 (40.8)

26 (43.3)

46 (42.2)

0.070

0.791

12 (24.5)

17 (28.3)

29 (26.6)

0.204

0.651

8 (16.3)

14 (23.3)

22 (20.2)

0.822

0.365

14 (28.6)

11 (18.3)

25 (22.9)

1.600

0.206

6 (12.3)

3 (5.0)

9 (8.3)

1.869

0.172

4 (8.2) 3 (6.1)

3 (5.0) 3 (5.0)

7 (6.4) 6 (5.5)

0.449 0.065

0.503 0.798

* Significance of differences between groups (crosstabulation)

Girls in Semberija group 32 (97.0%) reported significantly more ―different school system than in exile country‖ and ―missing being with earlier friends‖ 24 (72.7%) of 33 than boys 22 (84.6%) and 10 (37%) of 27, respectively (Chi-square=3.958, P=0.047; Chi-square:7.703, P=0.006, respectively). Older adolescents 19 (76%) of 25 significantly more ―missed being with earlier friends‖ than younger ones 15 (42.9%) of 35 (Chi-square=6.524, P=0.011), while older participants 21 (60%) of 35 were significantly more ―sad after return‖ than younger ones 8 (32%) of 25 (Chi-square:4.578, P=0.032). Also older adolescents 25 (100%) had significantly more ―worse economic situation after return‖ than younger ones 28 (80%) of 35 (Chi-square=5.660, P=0.017).

Association of Acculturation and Repatriation Problems in Srebrenica Group Acculturation and repatriation problems of Srebrenica refugee adolescents who spent certain period in foreign countries and returned to native (n=49) mutually highly correlated. ―School difficulties in home country‖ after return was positively associated with ―sadness in exiled country‖ (ρ=0.199, P=0.038). ―Thinking about home country in exiled country‖ was highly negatively associated with ―lost of school generation‖ (ρ=-0.342, P=0.016) ―preferring

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watching exile county TV program by satellite‖ (ρ=-0.288, P=0.044) and ―sleeping difficulties‖ after return (ρ=-0.254, P=0.050). ―Sleeping difficulties‖ in exiled country negatively correlated with ―worse economic situation than before war‖ after return (ρ=-0.336, P=0.018). Being ―prevented to play outside in exiled country‖ highly positively associated with ―school difficulties in home country‖ (ρ=0.389, P<0.001), but negatively associated with ―sleeping difficulties after return‖ (ρ=-0.335, P=0.009) and with ―worse economic situation than before war‖ (ρ=-0.376, P=0.008). ―Missing friends from home country during exile‖ positively associated with ―school difficulties in home country‖(ρ=0.401, P<0.001). ―Thinking about relatives from home country during exile‖ positively associated with ―meeting of new friends after return‖ (ρ=0.306, P=0.032) and negatively associated with ―sadness after return‖ (ρ=-0.330, P=0.020). ―Wanted to return to home‖ after arrived to exile country highly correlated with ―meeting of new friends after return‖ (ρ=0.298, P=0.037) and with ―school difficulties in home country‖.

Association of Acculturation and Repatriation problems in Semberija Group Among Semberija refugee adolescents (n=60) who returned from exile acculturation and repatriation problems were mutually highly correlated too, even more. ―Sadness in exile‖ negatively correlated with ―watching of exiled country program on satellite TV‖ (ρ=-0.302, P=0.019) and with ―different school system than in exile country‖ (ρ=-0.369, P=0.004). ―Thinking about home country in exile‖ negatively associated with ―sleeping difficulties after return‖ (ρ=-0.254, P=0.050), but positively associated with ―concentration in studying‖ (ρ=0.327, P=0.011), ―meeting with previous friends‖ (ρ=0.426, P=0.001) and ―lost of school peers‖ (ρ=0.331, P=0.010). ―Sleeping disturbances‖ and ―alimentary problems in exile‖ highly negatively correlated with ―watching satellite TV program from exiled country‖ (ρ=0.354, P=0.006; ρ=-0.597, P<0.001, respectively) and with ―different school system than in exile country‖ (ρ=-0.354, P=0.006; ρ=-0.398, P=0.002, respectively). ―Prevented to play outside in exile‖ negatively associated with ―sleeping disturbances after return‖ (ρ=-0.354, P=0.006, both). but positively correlated with ―concentration in studying‖ (ρ=-0.335, P=0.009), but positively associated with ―concentration in studying‖ (ρ=0.458, P<0.001), ―meeting with previous friends‖ (ρ=0.274, P=0.034) and ―lost of school peers‖ (ρ=0.268, P=0.039). ―Missing friends from home land during exile‖ negatively associated with ―watching satellite TV program from exiled country‖ (ρ=-0.423, P=0.001), ―different school system than in exile country‖ (ρ=-0.282, P=0.029) and ―sadness after return ‖ (ρ=-0.265, P=0.041). ―Thinking about relatives in home country‖ decreased ―sleeping problems‖ and ―sadness after return‖ (ρ=-0.448, P<0.001; ρ=-0.307, P=0.017, respectively). ―Wanted to return to home country‖ highly negatively correlated with ―watching of satellite TV programs from exile country‖ and ―different school system than in exile country‖ (ρ=-0.384, P=0.002; ρ=-0.312, P=0.015, respectively). Adolescents who ―listened to news from home country‖ less ―preferred to watch exile country satellite TV programs‖ (ρ=-0.385, P=0.002).

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PTSD In the whole sample, 140 (62%) of 225 participants reported symptoms that meet DSMIV criteria for PTSD; Srebrenica group 97 (67.8%) of 143 reported significantly more PTSD prevalence than Semberija group 43 (52.4%) of 82 participants (Chi-square=5.253, p=0.022). Separation from friends and family highly positively correlated with PTSD prevalence (ρ=0.188, P=0.024) as experience of severe fear (ρ=0.214, P=0.01) in Srebrenica group. Experiences of killing people and maltreatment of my father from enemy highly positively associated with occurrence of PTSD (ρ=0.178, P=0.033; ρ=0.180, P=0.032, respectively) in this group too. Among Srebrenica participants who experienced killing close relatives from enemy PTSD occurrence 49 (76.6%)of 64, was significantly higher than among their peers 48 (60.8%) of 79 who did not experience this trauma experience (Chi square=4.047, P=0.044), those who were separated from family and friends developed significantly more PTSD 72 (76.6%) of 94 than those who were together with theirs 25 (51.0%) of 49 (Chi square=9.655, P=0.002), adolescent who reported experience of severe fear had PTSD prevalence 56 (77.8%) of 72 significantly more than those who did not reported severe fear 41 (57.8%) of 71 (Chi square=6.574, P=0.01). Among Srebrenica respondents, who survived killing of their fathers from enemy, PTSD was significantly higher 35 (85.4%) of 41 than among their peers who had not such trauma 62 (60.8%) of 102 (Chi square=8.099, P=0.004); also, those young people who experienced maltreatment of their fathers from enemy reported significantly more PTSD prevalence 48 (77.4%) of 62 than those who had no such experience 49 (60.5%) of 81 (Chi square=4.611, P=0.032); experience of killing other men from enemy among Srebrenica adolescents, increased significantly more occurrence of PTSD 41 (78.9%) of 52, than among participants from the same group who did not experience this 56 (61.5%) of 91 (Chi square=4.543, P=0.033). In Semberija group, collective settlement during displacement/exile and acclimatization problems after displaced highly positively correlated with PTSD prevalence (ρ=0.222, P=0.045; ρ=0.325, P=0.003, respectively). Among Semberija adolescents who reported difficulties during returning to Bosnia-Herzegovina 16 (72.7%) of 22 developed PTSD, what was significantly more than among their peers who had no severe difficulties during going back to home country 27 (45.0%) of 66 (Chi square=4.962, P=0.026). Among those from Semberija group who saw forced expelling of people, PTSP prevalence was significantly more 27 (67.5%) of 40 than among those who did not see such scenes 15 (of 41 (36.6%) (Chi square=7.751, P=0.005).

Age, Gender, Refugee Status, Father Loss as Risks for PTSD Adolescents who lost their fathers 44 (84.6%) of 52 in Srebrenica group had significantly more PTSD prevalence than those with complete families 53 (58.2%) of 91 (Chisquare=10.549, P=0.001). Age, gender and refugee status of Srebrenica participants had no substantial influence on PTSD prevalence. In Semberija group older adolescents 24 (64.9%) of 37 had significantly more prevalence of PTSD than younger ones 19 (42%) of 45 (Chi-square=4.174, P=0.041). Gender, refugee status and father loss had no substantial influence on PTSD prevalence in Semberija group.

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Association of Neuroticism, Sociability, Activeness and Extroversion with PTSD in Groups Neuroticism highly positively correlated with PTSD prevalence (ρ=0.473, P<0.001) while the sociability and extroversion correlated negatively with PTSD occurrence in Srebrenica group (ρ=-0.317, P<0.001; ρ=-0.165, P=0.049, respectively). In Semberija group PTSD prevalence highly positively associated with neuroticism (ρ=0.411, P<0.001), in the same time PTSD did not correlates with sociability, activeness and extroversion.

Severity of Social-Emotional/Behavioral Problems Reported by School Teachers According to the teachers‘ reports behavioral problems were more severe among Srebrenica participants. These adolescents reported significantly more severe: anxious/ depressed and withdrawal/depressed behavior, internalizing behavior, thought problems and attention problems than Semberija group subjects (table 8). In the Srebrenica and Semberija groups, internally displaced adolescents had significantly more severe behavioral problems reported from school teachers than repatriated adolescents, except for rule breaking behavior and externalizing behavior in Srebrenica group; and for withdrawal/depressed behavior in Srebrenica group. Older participants in both groups had significantly more severe behavioral problems than younger ones, except for withdrawal/depressed behavior in both group (table 9). Gender and father loss did not influence on behavioral problems severity regarding school teachers‘ reports.

Prevalence of Social-Emotional/Behavioral Problems Reported by School Teachers According to the teachers‘ reports, refugee adolescents from Srebrenica had more problems than refugee adolescents from Semberija in borderline and clinical range (table 9). School teachers reported significantly higher prevalence of anxious/depressed behavior in Srebrenica group: clinical range (16.8%) and borderline range (16.0%) of 143 subjects than in Semberija group: clinical range (9.8%) and borderline range (4.9%) of 82 participants (Chisquare=9.611, P=0.008). Also teachers reported significantly higher prevalence of thought problems in Srebrenica group: clinical range (9.1%) and borderline range (9.8%) of 143 subjects than in Semberija group: clinical range (6.1%) and borderline range (1.2%) of 82 participants (Chi-square=7.143, P=0.028). Among both groups, teacher did not report any clinical range for attention problems, rule-breaking behavior and aggressive behavior, there were reported only few borderline range of these problems (table 9).

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Association of Age, Gender, Refugee Status, Father Loss, PTSD Prevalence, Psychoactive Substances Abuse and Social-Emotional/Behavioral Problems in School In Srebrenica group being internally displaced adolescent highly positively associated with anxious/depressed behavior (ρ=0.183, P=0.028; Spearman‘s correlation), withdrawn/depressed behavior (ρ=0.190, P=0.023), internalizing behavior (ρ=0.180, P=0.031), social problems (ρ=0.241, P=0.004), thought problems (ρ=0.21, P=0.012), attention problems (ρ=0.176, P=0.036), ―other problems‖ (ρ=0.291, P<0.001) and with ―total problems‖ (ρ=0.256, P=0.002). Table 8. Social-emotional/behavioral problems in 225 internally displaced and refugee adolescents from Bosnia and Herzegovina who were originally from Srebrenica (n=143) and Semberija regions (n=82) reported by school teachers mean±standard deviation Behavioral problems* Srebrenica Sembnerija (T-score) n=143 n=82 t-test P Anxious/depressed 58.8±10.7 54.9±8.9 2.790 0.006 Withdrawn/depressed 57.6±11.2 53.4±9.5 2.868 0.005 Somatic complains 55.5±8.8 54.1±7.9 1.201 0.231 Internalizing 57.3±8.96 54.1±7.5 2.703 0.007 Social 56.1±7.9 54.1±7.3 1.928 0.055 Thought 54.5±8.04 51.6±5.99 2.843 0.005 Attention 52.99±4.5 51.8±3.5 2.141 0.033 Rule Breaking Behavior 53.9±5.6 52.7±5.4 1.593 0.112 Aggressive behavior 53.7±6.3 52.2±5.8 1.790 0.075 Externalizing 53.8±5.6 52.4±5.26 1.799 0.073 Other problems† 68.95±12.4 68.4±12.2 0.351 0.726 Everything listed 58.1±58.1 56.4±6.2 1.799 0.073 *Syndrome/profiles of participant s according to Achenbach‘s Child Behavior Check List – Teacher report Form (CBCL-TRF) (ref) † Bowel movements out of toilet, bragging, cruelty to animals, poor appetite, biting nails, overeating, overweight, other physical problems, showing off, sleeping more, talking too much, wetting self during the day, wetting the bed, whining, and wishes to be of opposite sex.

Girls were more withdrawn/depressed (ρ=-0.242, P=0.004), and had more thought problems (ρ=-0.246, P=0.003), while boys had more aggressive behavior (ρ=0.174, P=0.038). Age of Srebrenica participants highly positively correlated with all school behavioral problems (P<0.001), except for attention problems (ρ=0.188, P=0.025), aggressive behavior and externalizing behavior (P>0.05). Father loss among these participants highly correlated with attention problems (ρ=0.196, P=0.019), but negatively highly correlated with externalizing problems (ρ=-0.171, P=0.041). PTSD prevalence highly correlated with thought problems (ρ=0.178, P=0.034), but negatively correlated with aggressive behavior (ρ=-0.195, P=0.02). Smoking of cigarettes highly associated with attention problems (ρ=0.171, P=0.041). Abuse of illegal drugs were

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highly associated with withdrawn/depressed behavior (ρ=0.228, P=0.006), somatic complains (ρ=0.259, P=0.002), internalizing behavior (ρ=0.221, P=0.008), social problems (ρ=0.253, P=0.002), thought problems (ρ=0.227, P=0.006), attention problems (ρ=0.451, P<0.001) and ―total problems‖ (ρ=0.309, P<0.001). In Semberija group of refugee adolescents, being internally displaced person highly positively associated with anxious/depressed behavior (ρ=0.320, P=0.003; Spearman‘s correlation), withdrawn/depressed behavior (ρ=0.296, P=0.007), internalizing behavior (ρ=0.296, P=0.007), social problems (ρ=0.533, P<0.001), thought problems (ρ=0.464, P<0.001), aggressive behavior (ρ=0.322, P=0.003) and with ―total problems‖ (ρ=0.421, P<0.001). Among these refugee adolescents prevalence of PTSD was highly associated with withdrawn/depressed problems (ρ=0.341, P=0.002), somatic complains (ρ=0.261, P=0.018) and internalizing behavior (ρ=0.228, P=0.040). Prevalence of father loss was positively associated only with attention problems (ρ=0.364, P=0.001), but it was negatively associated with externalizing problems (ρ=-0.171, P=0.041). Boys were more aggressive (ρ=0.226, P=0.041) and girls had more ―other problems‖ (ρ=-0.221, P=0.046). Secondary school students had more withdrawal/depressed behavior (ρ=0.346, P=0.003), somatic complains (ρ=0.231, p=0.037), thought problems (ρ=0.31, P=0.005), and ―total problems‖ (ρ=0.281, P=0.011). Prevalence of rule-breaking behavior was highly correlated with smoking of cigarettes (ρ=0.268, P=0.015) and alcohol drinking (ρ=0.268, P=0.015).

Cigarettes, Alcohol and Illicit Drugs Abuse In the sample there were no any elementary school participant who reported smoking cigarettes, but in secondary school there were 23 (21.5%) of 107. Semberija participants 12 (32.4%) of 37 reported significantly more smoking cigarettes than Srebrenica ones 11 (15.7%) of 70 (Chi square=4.009, P=0.045). Elementary school participants reported that they did not drink alcohol except two of them, one in Srebrenica and one in Semberija group (Chisquare=0.121, P=0.728), while 24 (22.4%) of 107 secondary school participants reported that drink alcohol occasionally; 13 (18.6%) of 70 in Srebrenica group and 11 (29.7%) of 37 in Semberija group, with no significant difference between group (Chi-square=1.732, P=0.188). Elementary school participants reported that they did not misuse any illicit drug except two of them, one in Srebrenica and one in Semberija group (Chi-square=0.121, P=0.728), while 9 (8.4%) of 107 secondary school participants reported that misuse some of illegal drugs occasionally; 4 (5.7%) of 70 in Srebrenica group and 5 (13.5%) of 37 in Semberija group, with no significant difference between group (Chi-square=1.911, P=0.167). In Srebrenica group smoking cigarettes highly correlated with age of participants (ρ=0.295, P<0.001). Occasional alcohol drinking was highly associated with age (ρ=0.289, P<0.001) and cigarettes smoking (ρ=0.346, P<0.001) of adolescents. Misuse of illicit drugs highly correlated with father loss (ρ=0.173, P=0.039), cigarettes smoking (ρ=0.231, P=0.006) and drinking alcohol (ρ=0.193, P=0.021).

Table 9. Withdrawal/depressed behavior

Behavioral problem (T scores) Anxious/depressed Withdrawn/depressed Somatic complains Internalizing Social problems Thought problems Attention problems Rule Breaking Behavior Aggressive behavior Externalizing Other problems Everything listed

Anxious/depressed Withdrawn/depressed Somatic complains Internalizing Social problems Thought problems Attention problems Rule Breaking Behavior Aggressive behavior Externalizing Other problems Everything listed

Srebrenica (n=143) Mean±Standard Deviation Repatriated (n=49) IDP (n=94) t-test

P

55.8±7.8 55.0±6.8 53.0±6.0 54.6±5.9 53.6±6.4 52.0±5.7 51.6±2.8 53.7±5.4 51.8±4.4 52.8±4.7 63.4±11.4 54.2±4.5

60.4±11.6 59.0±12.7 56.8±9.7 58.7±10.0 57.4±8.4 55.8±8.8 53.7±5.1 54.0±5.7 54.7±6.8 54.3±6.0 71.8±11.9 57.6±7.0 school elementary (n=73) secondary (n=70)

-2,476 -2.029 -2.534 -2.669 -2.808 -2.775 -2.741 -0.248 -2.612 -1.576 -4.083 -3.084

0.014 0.044 0.012 0.009 0.006 0.006 0.007 0.804 0.010 0.117 <0.001 0.002

t-test

P

54.9±7.5 55.9±6.8 51.9±5.1 54.2±5.6 52.8±5.9 50.8±4.1 51.5±3.2 51.4±4.1 50.8±4.4 51.1±4.1 64.4±10.4 53.4±4.0

-4.784 -1.884 -5.536 -4.458 -5.591 -6.359 -4.256 -6.279 -6.427 -6.868 -4.862 -6.492

<0.001 0.062 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

62.8±11.96 59.4±14.3 59.3±10.1 60.5±10.6 59.6±8.3 58.3±9.2 54.5±5.2 56.5±5.7 56.8±6.6 56.7±5.6 73.7±12.5 59.6±7.0

Semberija (n=82) Mean±Standard Deviation Repatriated IDP (n=22) t-test (n=60) 52.8±6.1 60.6±12.5 -3.744 53.1±5.7 54.2±16.0 -0.456 52..2±5.6 59.3±10.7 -3.943 52.7±5.2 58.0±11.0 -2.968 52.2±5.5 59.1±9.1 -4.144 50.1±2.5 55.7±9.8 -4.103 51.1±2.8 53.6±4.4 -3.023 51.8±4.7 55.2±6.3 -2.651 50.7±4.0 56.3±7.7 -4.280 51.2±4.1 55.7±6.6 -3.698 65.8±10.5 75.2±14.2 -3.270 52.9±3.9 58.2±7.7 -4.148 school elementary secondary (n=37) t-test (n=45) 52.8±6.4 57.4±10.9 -2.407 52.7±4.9 54.2±13.1 -.737 52.4±5.5 56.1±9.7 -2.170 52.6±4.96 55.9±9.5 -2.013 52.5±5.9 56.0±8.4 -2.228 50.0±2.7 53.5±8.2 -2.708 51.1±2.9 52.5±4.0 -1.806 50.9±4.0 54.8±6.0 -3.528 50.7±4.0 53.95±7.0 -2.606 50.8±3.9 54.4±6.1 -3.241 65.2±11.0 72.2±12.6 -2.699 52.7±3.8 56.3±6.8 -3.006

P <0.001 0.650 <0.001 0.004 <0.001 <0.001 0.003 0.010 <0.001 <0.001 0.002 <0.001 P 0.018 0.463 0.033 0.047 0.029 0.008 0.075 0.001 0.011 0.002 0.008 0.004

Table 10. Syndromes of Behavioral Problems Behavioral problems* Anxious/depressed Withdrawn/depressed Somatic complains Internalizing Social Thought Attention Rule Breaking Behavior Aggressive behavior Externalizing Other problems† Everything listed

Range Clinical Borderline Clinical Borderline Clinical Borderline Clinical Borderline Clinical Borderline Clinical Borderline Borderline Borderline Borderline Borderline Clinical Borderline Clinical Borderline

Total (n=225) 32 (14.2) 27 (12.0) 31 (13.8) 24 (10.7) 22 (9.8) 7 (3.1) 21 (9.3) 14 (6.2) 13 (5.8) 20 (8.9) 18 (8.0) 15 (6.7) 9 (4.0) 4 (1.8) 8 (3.6) 12 (5.3) 150 (66.7) 24 (10.7) 13 (5.8) 8 (3.6)

No (%) of participants Srebrenica (n=143) Semberija (n=82) 24 (16.8) 8 (9.8) 23 (16.0) 4 (4.9) 23 (16.1) 8 (9.8) 19 (13.3) 5 (6.1) 17 (11.9) 5 (6.1) 3 (2.1) 4 (4.9) 16 (11.2) 5 (6.1) 11 (7.7) 3 (3.7) 11 (7.7) 2 (2.4) 12 (8.4) 8 (9.8) 13 (9.1) 5 (6.1) 14 (9.8) 1(1.2) 8 (5.6) 1 (1.2) 3 (2.1) 1 (1.2) 5 (3.5) 3 (3.7) 7 (4.9) 5 (6.1) 95 (66.4) 55 (67.1) 16 (11.2) 8 (9.7) 10 (6.99) 3 (3.7) 6 (4.2) 2 (2.4)

Chi-square 9.611

2

df 0.008

P

5.3001

2

0.071

3.136

2

0.208

3.324

2

0.190

2.691

2

0.260

7.143

2

0.028

2.598 0.230 0.004 0.149

2 2 2 2 2

0.107 0.631 0.950 0.699 0.943

2

0.448

0.118 1.604

*Syndrome/profiles of participant s according to Achenbach‘s Child Behavior Check List – Teacher report Form (CBCL-TRF) (ref) † Bowel movements out of toilet, bragging, cruelty to animals, poor appetite, biting nails, overeating, overweight, other physical problems, showing off, sleeping more, talking too much, wetting self during the day, wetting the bed, whining, and wishes to be of opposite sex.

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In Sembefija group smoking cigarettes highly correlated with age of participants (ρ=0.457, P<0.001). Occasional alcohol drinking was highly associated with age (ρ=0.387, P<0.001) and cigarettes smoking (ρ=0.512, P<0.001) of adolescents. Misuse of illicit drugs highly correlated with age (ρ=0.217, P=0.050), cigarettes smoking (ρ=0.286, P=0.009) and drinking alcohol (ρ=0.286, P=0.009).

Association of School Behavioral Problems and Acculturation Problems Among Srebrenica refugee adolescents the acculturation problems ―sleeping disturbances, alimentary problems, preventing to play outside in the refugee environment and acceptance of new environment‖ highly positively associated with the most of school/behavioral problems reported by school teachers. Also, other listed acculturation problems highly positively associated with school/behavioral problems but more seldom then previous four. Only ―listening to news from native place‖ highly negatively correlated with aggressive behavior of these participants (table 11). In Semberija group ―listening to news from native place‖ highly positively correlated with withdrawn/depressed behavior (ρ=0.341, P=0.002) and with thought problems (ρ=0.267, P=0.015). ―Wanted to return home‖ highly positively associated with anxious/depressed behavior (ρ=0.322, P=0.003), withdrawn/depressed behavior (ρ=0.337, P=0.002), somatic complains (ρ=0.237, P=0.013), internalizing behavior (ρ=0.256, P=0.02) and with thought problems (ρ=0.219, P=0.048). ―Sadness after exile/displacement‖ highly positively correlated with anxious/depressed behavior (ρ=0.230, P=0.038), withdrawn/depressed behavior (ρ=0.369, P=0.001), somatic complains (ρ=0.219, P=0.049), thought problems (ρ=0.240, P=0.030), externalizing behavior (ρ=0.218, P=0.05) and with total problems (ρ=0.217, P=0.05). ―Thinking about native place‖ highly correlated with anxious/depressed (ρ=0.235, P=0.034) and withdrawal/depressed behavior (ρ=0.246, P=0.026). Sleeping disturbances after exile/displacement‖ highly correlated with aggressive behavior (ρ=0.257, P=0.02). ―Alimentary problems‖ highly positively correlated the most frequently among Semberija refugee adolescents with school/behavioral problems from all listed acculturation problems. It correlated with anxious/depressed behavior (ρ=0.458, P<0.001), internalizing behavior (ρ=0.275, P=0.013), social problems (ρ=0.317, P=0.004), attention problems (ρ=0.235, P=0.034), rule breaking behavior (ρ=0.235, P=0.034), aggressive behavior (ρ=0.412, P<0.001), externalizing behavior (ρ=0.275, P=0.012) and with total problems (ρ=0.268, P=0.015). ―Acceptance of refugee environment‖ highly positively correlated with withdrawn/depressed behavior (ρ=0.367, P=0.001), internalizing behavior (ρ=0.228, P=0.039), thought problems (ρ=0.261, P=0.018) and with total (ρ=0.245, P=0.026).

Table 11. Parametric correlation (Pearsons’ r) of severity of trauma symptoms, Neuroticism, Sociability, Activeness and School Behavioral Problems in Srebrenica group; (n=143) Srebrenica

Stress level Reexperience

Anxious/ depressed. r* 0.371 P† <0.001 r 0.328

P r P Hyper arousal r P Bad Social r functioning P Neuroticism r P Sociability r P Activeness r P Extroversion r P Avoidance

<0.001 0.294 <0.001 0.304 <0.001 0.175 0.036 0.170 0.042 -0.113 0.178 -0.009 0.916 -0.082 0.331

Withdrawn/ depressed

Somatic Internalizing Social complains behavior problems

Thought problems

Attention problems

0.182 0.030 0.143

0.312 <0.001 0.245

0.325 <0.001 0.270

0.329 <0.001 0.276

0.380 <0.001 0.329

0.088 0.122 0.146 0.121 0.149 0.112 0.184 0.231 0.006 -0.132 0.115 0.002 0.977 -0.123 0.144

0.003 0.234 0.005 0.276 0.001 0.173 0.039 0.181 0.030 -0.086 0.305 0.076 0.365 -0.013 0.877

0.001 0.244 0.003 0.262 0.002 0.172 0.039 0.223 0.007 -0.128 0.127 0.022 0.791 -0.088 0.297

0.001 0.295 <0.001 0.292 <0.001 0.140 0.095 0.167 0.047 -0.084 0.321 0.104 0.218 0.009 0.913

<0.001 0.326 <0.001 0.340 <0.001 0.203 0.015 0.136 0.105 -0.061 0.466 0.102 0.225 0.034 0.690

*Pearsons‘ correlation coefficient. †Significance of parametric correlation.

Aggressive Externalizing Other Everything behavior behavior problems listed.

0.259 0.002 0.196

Rule Breaking Behavior 0.180 0.032 0.147

0.275 0.001 0.202

0.245 0.003 0.187

0.284 0.001 0.201

0.304 <0.001 0.190

0.019 0.229 0.006 0.242 0.004 0.116 0.167 0.164 0.050 -0.124 0.140 0.061 0.471 -0.086 0.306

0.081 0.157 0.061 0.190 0.023 0.053 0.528 0.089 0.291 0.029 0.730 0.054 0.525 0.049 0.562

0.015 0.252 0.002 0.278 0.001 0.095 0.259 0.088 0.297 -0.063 0.453 0.123 0.143 0.027 0.746

0.025 0.220 0.008 0.251 0.002 0.080 0.342 0.094 0.266 -0.021 0.802 0.096 0.254 0.040 0.638

0.016 0.269 0.001 0.248 0.003 0.096 0.253 0.095 0.260 0.036 0.671 0.010 0.902 0.045 0.591

0.023 0.213 0.011 0.240 0.004 0.169 0.044 0.175 0.036 -0.207 0.013 0.042 0.623 -0.159 0.058

Table 12. Non-parametric correlations (Spearmans’ ρ) of acculturation problems and school behavior problems among Srebrenica adolescents (n=143) Acculturation problems: Missed friends after exile/displacement Listened to news from native place Wanted to return to native place/home Sad after exile/displacement Thinking about native place Sleeping disturbances Alimentary problems Prevented to play outside in exile Accepting of new environment

Anxious/ Withdrawn/ Somatic Internalizing Social Thought depressed depressed complains behavior problems problems

Attention problems

Ρ* P†

0.073 0.385

0.076 0.365

0.164 0.050

0.131 0.119

0.182 0.030

0.247 0.003

ρ P ρ P

0.197 0.018 0.150 0.073

0.203 0.015 0.205 0.014

0.130 0.120 0.140 0.095

0.156 0.063 0.141 0.094

0.114 0.175 0.112 0.182

ρ P ρ P ρ P ρ P ρ P ρ P

0.059 0.487 0.178 0.033 0.143 0.089 0.219 0.009 0.203 0.015 0.082 0.328

0.162 0.053 0.236 0.005 0.277 0.001 0.250 0.003 0.276 0.001 0.242 0.004

0.185 0.027 0.123 0.145 0.287 0.001 0.296 <0.001 0.290 <0.001 0.207 0.013

0.161 0.055 0.205 0.014 0.354 <0.001 0.347 <0.001 0.336 <0.001 0.215 0.010

0.164 0.050 0.137 0.102 0.337 <0.001 0.449 <0.001 0.287 0.001 0.208 0.012

* Spearman‘ correlation coefficient. † Significance of nonparametric correlation.

Aggressive Externalizing Other behavior behavior problems

Everything listed

0.125 0.136

Rule Breaking Behavior 0.075 0.371

0.098 0.244

0.117 0.164

-0.102 0.226

0.183 0.029

0.309 <0.001 0.179 0.032

0.157 0.061 0.111 0.185

-0.120 0.154 0.067 0.426

-0.212 0.011 0.087 0.301

-0.138 0.099 0.104 0.217

0.203 0.015 0.153 0.068

0.138 0.100 0.162 0.053

0.268 0.001 0.160 0.057 0.297 <0.001 0.289 <0.001 0.184 0.028 0.160 0.056

0.136 0.106 0.104 0.217 0.144 0.085 0.359 <0.001 0.249 0.003 0.335 <0.001

0.082 0.332 0.062 0.459 0.160 0.056 0.111 0.187 0.231 0.006 0.083 0.322

0.106 0.207 0.081 0.335 0.209 0.012 0.199 0.017 0.132 0.116 -0.017 0.843

0.127 0.132 0.097 0.250 0.118 0.159 0.125 0.136 0.215 0.010 0.023 0.787

0.249 0.003 0.137 0.103 0.228 0.006 0.188 0.025 0.214 0.010 -0.063 0.457

0.198 0.018 0.151 0.072 0.295 <0.001 0.379 <0.001 0.320 <0.001 0.351 <0.001

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Repatriation Problems and School Behavioral Problems In Srebrenica group ―Meeting of new friends‖ negatively correlated with the occurrence of somatic complains (ρ=-0.264, P=0.042). ―Continuing education with the peers‖ negatively correlated with occurrence of anxiety behavior (ρ=-0.357, P=0.012). Those who had ―learning troubles‖ were less frequently withdrawal depressed (ρ=-0.292, P=0.042), but reported more somatic complains (ρ=0.345, P=0.007). ―Troubles with teachers‖ highly positively associated with social problems (ρ=0.315, P=0.027) and other problems (ρ=0.291, P=0.043). ―Problems in communication with friends, relatives and neighbors‖ and ―alimentary problems‖ negatively correlated with other problems (ρ=-0.303, P=0.034; ρ=-0.299; P=0.037 ). In Semberija group there was no any participant who reported any attention, thoughts problem, or rule breaking behavior, also not any participant with aggressive, externalizing behavior nor with any total problems. Meeting of new friends‖ negatively correlated with the occurrence of withdrawn/depressed behavior (ρ=-0.559, P<0.001) but positively correlated with other problems (ρ=0.259, P=0.046). ―Continuing education with the peers‖ positively correlated with occurrence of anxious/depressed behavior (ρ=0.282, P=0.029), withdrawn/depressed behavior (ρ=0.312, P=0.015), somatic complains (ρ=0.282, P=0.029) but negatively correlated with other problems (ρ=-0.27, P=0.037). Those who had ―learning troubles‖ were less frequently withdrawal depressed (ρ=-0.291, P=0.024), but reported more somatic complains (ρ=0.345, P=0.007). ―Sleeping difficulties after return‖ highly positively associated with anxious/depressed behavior (ρ=0.33, P=0.01) and internalizing behavior (ρ=0.287, P=0.026). ―Alimentary problems‖ negatively correlated with other problems (ρ=0.279, P=0.031). ―Preferring to watch satellite TV in language of exiled country after return‖ highly negatively correlated with prevalence of anxious/depressed, withdrawal/depressed behavior and with internalizing behavior (ρ=-0.306, P=0.017; ρ=-0.666, P<0.001, ρ=-0.268; P=0.039, respectively).

Association of Acculturation and Repatriation Problems The acculturation and the repatriation problems in Srebrenica group were mutually highly correlated, positively or negatively, among returnees. ―Listening to news from home country‖ and ―Missing friends in exile‖ were highly negatively associated with ―Sleeping difficulties after return‖ in home country (ρ=-0.302, P=0.035; ρ=-0.332, P=0.02, respectively). ―Thinking about relatives‖ highly negatively correlated with ―Sadness in home country‖ and ―Sleeping disturbances after return‖ (ρ=-0.330, P=0.02; ρ=-0.306, P=0.032, respectively). Returnees who ―Preferred to watch exile country programs on satellite TV‖ in home country, significantly less thought about native place in exile (ρ=-0.288, P=0.044). In Semberija group ―Sadness after return‖ highly negatively correlated with ―missing friends during exile‖ and ―thinking about relatives after exiled‖ (ρ=-0.265, P=0.041; ρ=0.307, P=0.017, respectively). ―Missing friends from pre-war period after return‖ and ―Concentration problems in studying after return‖ highly correlated with ―thinking about native place during exile‖ (ρ=0.426, P=0.001; ρ=0.327, P=0.011, respectively) and ―playing outside in refugee environment‖ (ρ=0.426, P=0.001; ρ=0.457, P<0.001, respectively). ―Lost friends from exile‖ highly negatively correlated with ―thinking about native place after exile‖

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and ―playing outside in refugee environment‖ (ρ=-0.331, P=0.01; ρ=-0.268, P=0.039, respectively). ―Sleeping difficulties after return‖ highly negatively associated with ―thinking about native place after exile‖, ―playing outside in refugee environment‖ and ―thinking about relatives during exile‖, (ρ=-0.254, P=0.05; ρ=-0.335, P=0.009, ρ=-0.448, P<0.001, respectively). ―Preferring to watch exile country programs on satellite TV‖ in home country, highly negatively associated with ―sadness during exile‖ (ρ=-0.302, P=0.019), ―sleeping difficulties in exile‖ (ρ=-0.354, P=0.006), ―alimentary problems‖ (ρ=-0.597, P<0.001), ―missing friend from home country during exile‖ (ρ=-0.423, P=0.001), ―wanting to return to home country‖ (ρ=-0.384, P=0.002) and ―listening to news from home country during exile‖ (ρ=-0.385, P=0.002).

DISCUSSION Our study showed that in both groups, participants being internally displaced or/and refugee adolescents had been exposed to severe war trauma and had reported high level of traumatization more than three years after the war [3,7,10]. The majority had survived the war in Bosnia characterized by massive displacement, disruption, and loss of life, relatives and property [2], separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of trauma experiences were significantly related to their region of residence, with adolescents from the region of Srebrenica having significantly higher prevalence and severity of experiences. The scale and severity of these traumatic experiences appear to have been greater than those reported using a similar survey instrument for war-affected children in Greater Beirut, Kuwait during the Iraqi invasion and occupation [5,11,22]. We found out that adolescents from Srebrenica, after survived the first war experiences in 1992, stayed in homeland significantly more and survived additional trauma exposure to war catastrophes as internally displaced persons in so called ―free territory‖, while number of adolescents from the same region were significantly less exiled out of Bosnia-Herzegovina during and after the war, compared with their peers from Semberija. Being forcedly expelled from private property and homes, 56.6% of Srebrenica participants were resettled as displaced or exiled persons in collective settlements significantly more than those from Semberija. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled [28]. Srebrenica participants survived significantly more war related catastrophic experiences, while participants from Semberija reported significantly more frequently trauma experiences related to process of exile and repatriation. In Srebrenica group severity of trauma experiences was not related to age and gender, but was related to refugee status and father loss. Internally displaced and those who lost father reported significantly more severe trauma experiences [3]. In Semberija group severity of trauma experiences did not related to refugee status or father loss. Being out of war did not help to exiled adolescents to diminish significantly many trauma experiences severity. Girls and older participants had significantly more severe trauma experiences similar to other studies [23,24].

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We found that 36.4% of 143 participants from Srebrenica region lost father what is significantly more than those from Semberija, IDP experienced lost father much more than refugees. It is much more than 28% of 95 Bosnian refugee children what found Papageorgiou et al. in their research [25]. In this research we found in Srebrenica group 45.5% of 143 adolescents who lost some family member(s) and it is significantly more than amongst Semberija participants. Geltman et al. [26] found 71% of 31 Bosnian refugee children that experienced the death of a close friend(s) or relative(s); Husain et al. [27] reported that 66% of 521 Sarajevo children lost a member family; in our previous study [3] we found 61.9% of 239 adolescents that lose family members. Srebrenica participants, of 89.4% of 143, experienced separation from family and friends significantly more than Semberija, it was more than in similar studies [24,26]. The level severity of re-experience cluster symptoms, were significantly higher among adolescents from Srebrenica The prevalence of PTSD in Srebrenica group (67.8%) was significantly higher than 52.4%in Semberija group of respondents. PTSD prevalence were higher in both groups than in other studies. Eytan A. et al in their study about Albanian Kosovar found out 23.5% PTSD prevalence [24], but it was less than 94% of 364 IDP children from central Bosnia in the study of Goldstein et al. [5]. The level of neuroticism severity in both groups did not differ significantly. Adolescents from Srebrenica were significantly less active, less sociable, in other words they were more introverted. Regarding acculturation problems, participants from Srebrenica reported significantly more: Missed friends during exile/displacement, Wanted to return to native place/homeland, Listened to news from native place/homeland and Had alimentary problems after being exiled/displaced. According difficulties experienced during repatriation, Semberija students reported significantly more: Economic situation is worse than before the exile, Preferring to watch programs from exile country on satellite TV and Missed meeting with friends from pre-war period. In both group participant were sad after return 45-48% with no significant difference between groups. Srebrenica adolescents reported significantly more severe anxious/depressed behavior, withdrawn/depressed behavior, and significantly more severe internalizing problems. They had significantly more severe thought problems and attention problems. The prevalence of anxious/depressed behavior and thought problems in clinical range among Srebrenica participants were significantly higher than among their peers from Semberija. Acculturation problems were highly correlated with occurrence of school-emotional/ behavioral problems . We found that in Srebrenica group IDP adolescents had more anxious/depressed behavior, withdrawn/depressed behavior, internalizing behavior, social problems, thought problems, attention problems, ―other problems‖ and ―everything listed - total problems‖ compared with refugees. Girls were more withdrawn/depressed and had more thought problems, while boys had more aggressive behavior. Older Srebrenica participants had more of all school behavioral problems except attention problems, aggressive behavior and externalizing behavior than younger participants. Participants who lost fathers had more attention problems, but externalizing problems than those who had both parents. Participants who developed PTSD had more thought problems and had less aggressive behavior.

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Participants who smoke cigarettes had more attention problems. Participants with withdrawn/depressed behavior, somatic complains, internalizing behavior, social problems, thought problems, attention problems and with ―total problems‖ misused illicit drugs more than those who did not have contact with it. Semberija participants were smoking cigarettes more than Srebrenica ones. Srebrenica participants who lost father misuse illicit drugs, smoke cigarettes and drink alcohol more than those who had both parents. Among Srebrenica adolescents those who reported ―sleeping disturbances, alimentary problems, preventing to play outside in the refugee environment and acceptance of new environment‖ reported the most of school/behavioral problems reported by school teachers. Only ―listening to news from native place‖ highly negatively correlated with aggressive behavior of these participants. In Srebrenica group, participants who meet new friends had somatic complains, those who continued education with the peers had less of anxious/depresse behavior. Participants who had ―learning troubles‖ after return had withdrawal/depressed problems,, but reported more somatic complains. Those who had troubles with teachers had more social and ―other problems‖. Returnees from Srebrenica group who listening to news from home country and who missed friends in exile had more sleeping difficulties after return in home country. Those who were thinking about relatives in exile were more sad in home country and had more sleeping disturbances after return. Those returnees who preferred to watch exile country programs on satellite TV in home country, had less thinking about native place in exile. Semberija returnees who preferred to watch exile country programs on satellite TV in home country, had less sadness during exile, less sleeping difficulties in exile, less alimentary problems, they less missed friend(s) from home country during exile, less wanted to return to home country and less listened to news from home country during exile. Adolescents who stayed in home country whole war and postwar period were faced with different acculturation processes in the new environments but in the same culture and mothers language. They, together with others family members remained exposed to continuallife-threatenig occasions, some time very often. They had more problems to adapt to new life environment that those who were oin exile, probably because they experienced more discomfort and life threatening conditions in war zone of own homeland. The process of acculturation after return to home country is long-lasting and very complex process regarding all emotional, socio-political and financial obstacles they have to face and to go over it with minimal harm [2,3]. The findings of this survey of Bosnia-Herzegovina internally displaced and refugee adolescents living in post war conditions after surviving fighting, expelling homes, displacement, exile, acculturation, repatriation, loss of fathers, close family members‘ loss, loss of property, lack of safety and normal conditions for life today and in future suggest that the impact of the war was both severe and widespread. The young Bosnians examined are a multi-traumatized group [5,22]. Among these groups of adolescents displaced and exiled by the war, virtually all had been exposed to many different traumatic events and survival difficulties, which persists more than three years after the war [3]. Both groups demonstrated persistence of psychological symptoms, indicating severity and chronic of the problems [29]. The stress level in this study was associated with the level of traumatic experiences severity, and both were positively associated with level of neuroticism, but negatively correlated with sociability and activeness. Traumatic symptoms are related to harm avoidant personality

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traits. Certain war experiences were also associated with greater symptomatology. The findings show that there may be more serious longer-term psychological problems in young people who were forced to leave their property, original places, and country during wartime [7]. The adolescents examined revealed a variety of serious psychological manifestations, including PTSD, anxiety, withdrawal, sadness, neuroticism, introversion, thought, and attention problems. The process by which symptoms were identified and measured, however, should be viewed with some caution. Survey techniques cannot replace thorough psychiatric evaluation in determining diagnoses [5]. There were regional variations in warfare [32,33]. Children who had fled their homes together or without complete families were likely to have had particularly harsh war experiences. The wide distribution of the fighting and the large numbers of families displaced by the war suggests that findings from this study are likely to reflect the experience of a large population of Bosnian younger population. This might be considered as general characteristic of society in war [9]. Insights into the effects of war on children and adolescents in Bosnia-Herzegovina have been based on fewer studies of child survivors in active war zones [5, 27]. More other studies were conducted during B-H war but out of B-H territory where Bosnian children/adolescents were exiled. There have been only few researches on the problem of forced migration and psychosocial consequences that follow up such life disruptions in lives of BosniaHerzegovina people, particularly in lives of children and adolescents who are the most vulnerable and the most sensitive part of it [3,5,7,10,11,23-30]. Our findings confirmed prior researches that have shown, that young internally displaced and refugees may be especially traumatized [5,29]. Only fewer studies were done immediately after war finished in previously active war zones to record psychosocial consequences among internally displaced younger. There have no enough research on the experiences of Bosnia-Herzegovina adolescents returning home after a period in exile that were studied, based on quantitative and qualitative data [3,30,31]. The findings of this study document and extend our understanding of the relatively acute effects of war on children and adolescents in the midst of post war conflict, and thus may be viewed differently from studies performed outside of areas of conflict [5] and immediately post conflict, where life conditions were abnormal and conditions for real and completed repatriation were not achieved. An assessment of the children's status before exposure to war trauma or a no displaced control sample would have been particularly helpful [5] in the regard of more real assessment of impact of war trauma experiences on the psychosocial conditions that were observed in our study, but proved impossible under conditions of total and not expected war. Long-term effects of trauma can evolve over time; we cannot say how long period posttraumatic symptoms already persist, and how long in the future will persist [3]. It is known that child survivors of the Holocaust have been shown to have symptoms 50 years after the events, with a continuing correlation between the intensity of the precipitating events and their symptoms [5]. In this study we cannot say if the reported PTSD symptoms were results of war traumatization or acculturation in exile or acclimatization during repatriation. This investigated population could not be followed up in future because of coming different migrations and new resettlements in near perspectives toward their original settlements which are unpredictable. Practically it is impossible collect data again from the same participants to record additional psychosocial changes they will pass through their developmental periods.

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This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children [5] and adolescents. The experiences and psychological states of Bosnian internally displaced and refugee adolescents, exposed to war are important for the educational and medical community to document and understand adolescents‘ postwar problems [3,5,35], such information is useful in reminding those planning and actively engaged in relief operations of the full range of needs that adolescents living in post war and areas of political and economic conflicts may have. There is a strong need to evaluate various methods of delivering help and to develop new ways of reaching needy children and adolescents in a non-stigmatizing way [36]. Understanding these processes and the views of chronically displaced persons and refugees who seek asylum in host country or plan repatriation to home country should guide policies of post-conflict management to plan for the longer-term and to be more focused on the human factors rather than simply rules and properties [8]. The findings point to major challenges with respect to repatriation and going back to own property and reconstruction. They highlight the importance of family reunification and the facilitating of decision-making by affected people themselves[2]. In the postwar Bosnia-Herzegovina people who survived war are faced every day with problems associated with over-dependence on external assistance, this study could hence the need for people to be given the means of using their skills and knowledge to control their day-to-day lives [2].

ACKNOWLEDGMENT The research supported by the Tuzla Canton Ministry for Health, Tuzla Canton Ministry for Culture, Sport and Education, Pharmaceutical Industry ―Bosnalijek‖ Sarajevo, Tuzla Municipality and Medical Center Brčko in Maoča. Our special acknowledgments addressed to adolescents themselves, parents, teachers and many real friends for their contribution to this research. Thanks for invitation and support to Mr. Frank Columbus. Thanks to our wifes and our children who were supportive during the preparation of this paper.

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[22] Elklit A, Norregaard J, Tibor B. Occurrence and type of traumatic experiences among young Bosnian refugees in Denmark. Ugeskr Laeger. 1998;160(29):4310-4. [23] Eytan A, Gex-Fabry M, Toscani L, Deroo L, Loutan L, Bovier PA. Determinants of postconflict symptoms in Albanian Kosovars. J. Nerv. Ment. Dis. 2004;192(10):664-71. [24] Ajdukovic M. Displaced adolescents in Croatia: sources of stress and posttraumatic stress reaction. Adolescence. 1998;33(129):209-17. [25] Papageorgiou V, Frangou-Garunovic A, Iordaniou R, Yule W, Smith P, Vostanis P. War trauma and psychopatology in Bosnian refugee children. Eur. Child Adolesc. Psychiatry. 2000; 9(2):84-90. [26] Geltman PL, Augustyn M, Barnett ED, Klass PE, Groves BM. War trauma experience and behavioral screening of Bosnian refugee children resettled in Massachusetts. J. Dev. Behav. Pediatr. 2000;21(4):255-61. [27] Husain SA, Nair J, Holcomb W, Reid JC, Vargas V and Nair SS. Stress reactions of children and adolescents in war and siege conditions. Am. J. Psychiatry. 1998; 155: 1718-1719. [28] Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA; 294(5):602-12. [29] Lie B.The psychological and social situation of repatriated and exiled refugees: a longitudinal, comparative study. Scand. J. Public Health. 2004;32(3):179-87. [30] Husain SA. Hope for the children: Lessons from Bosnia. Tuzla: Behrambegova medresa. 2001; 17-20. [31] Avdibegović E, Sinanović O, Selimbašić Z. Acculturation problems of Bosnian children during the repatriation. Book of Abstracts of 14-th International Congress of International Association for Children and Adolescent Psychiatry, Stockholm: Research Report Karolinska Institute Department of Women and Child health, Child and Adolescent Psychiatric Unit; 1998. p. 362. [32] UNICEF Report From a Pilot Study in Mostar: Children's Exposure to Violence and Trauma Reactions. Office of the Special Representative for Emergency Operations in the former Yugoslavia; Split, Croatia; February 1994. [33] UNICEF Report on War Trauma Among Children in Sarajevo. Office of the Special Representative for Emergency Operations in the former Yugoslavia; Split, Croatia; February 1994. [34] Robinson S, Rapaport-Bar-Sever M, Rapaport J. The present state of people who survived the Holocaust as children. Acta Psychiatr. Scand. 1994; 89:242-245. [35] Barath A. Children in Sarajevo after war. Croat. Med. J. 2002;43:213-220. [36] Yule W. From pogroms to "ethnic cleansing": meeting the needs of war affected children. J. Child Psychol. Psychiatry. 2000;41(6):695-702.

INDEX A abuse, 7, 18, 27, 28, 31, 39, 123, 136 academic problems, 170 acclimatization, 206, 210, 217, 230 acculturation failure, vii, 47, 59, 60 acculturation level, 23, 28, 37, 98, 137, 138, 173, 177, 178, 186, 188, 190, 191 acculturation success in employment, vii activity level, 186, 187, 189, 192 adaptation, viii, ix, 32, 35, 37, 88, 95, 96, 98, 103, 106, 119, 123, 125, 133, 134, 135, 151, 152, 155, 156, 157, 158, 161, 162, 163, 164, 165, 169, 170, 171, 184, 203 adaptations, 3, 24, 118, 119, 120, 126 ADHD, 105 adjustment, 38, 39, 43, 80, 81, 82, 86, 92, 101, 102, 105, 107, 121, 127, 138, 143, 147, 148, 154, 155, 159, 162, 163, 164, 170, 171, 177, 180, 182, 184, 200 adolescent behavior, 24, 129 adolescent boys, 39, 148 adolescent female, 23 adolescent problem behavior, 31 Africa, 152 African Americans, 2, 65, 89, 92, 97, 118, 134, 182 African-American, 62 age, 201, 203, 207, 208, 209, 220, 223, 227 agencies, 52, 61, 96, 168 aggression, vii, 1, 6, 15, 22, 25, 26, 27, 31, 33, 35, 36, 38, 43 aggressive behavior, 4, 204, 218, 219, 220, 223, 228, 229 agriculture, 154 Alaska, 40, 44 Alaska Natives, 44 alcohol, 220, 223, 229 alcohol abuse, 100

alcohol consumption, 31, 32, 41, 136 alcohol use, 31, 32, 39, 40, 136, 148 Algeria, 124 alienation, 24, 32, 102 alternative treatments, 119, 121 ambivalence, 82 American culture, ix, 79, 97, 100, 101, 102, 106, 107, 109, 111, 116, 118, 119, 120, 122, 133, 140, 144 American Indian/Alaskan Native (AI/AN), vii, 1, 2 American Psychiatric Association, 232 American Psychological Association, 38, 42, 88, 93, 122, 129, 148, 149, 179, 180 American society, ix, 97, 100, 167, 168, 170, 189, 190 anger, 84, 145 Angola, 153 animals, 204, 219, 222 ANOVA, 160, 174 anthropology, 10 antidepressant, 129 antisocial behavior, 128, 129 anxiety, 36, 83, 88, 93, 101, 103, 104, 105, 118, 124, 130, 226, 230 anxiety disorder, 103, 105, 124, 130 appetite, 108, 219, 222 arousal, 207, 210, 212, 224 arrests, 26 AS, 128 Asia, 63, 65 Asian Americans, 34, 79, 89, 105, 108, 109, 110, 113, 115, 118, 123, 178, 181, 183 Asian values, 108, 109 Asian/Pacific, v, vii, viii, 1, 2, 26, 41, 95, 97, 99, 105, 106, 110, 111, 113, 115 assault, 4, 7, 10, 11, 17, 23, 26, 27, 30, 31, 35 assessment, x, 10, 23, 34, 48, 68, 69, 74, 76, 77, 78, 91, 108, 119, 128, 130, 197, 200, 203, 230, 232 assessment tools, 108

236

Index

assets, vii, 1, 28, 33, 35, 36, 43, 62 assimilation, vii, ix, x, 1, 3, 4, 23, 31, 32, 33, 34, 35, 36, 64, 73, 97, 126, 134, 135, 136, 139, 140, 144, 147, 155, 157, 167, 169, 170, 179, 183, 186, 193 asylum, 231 attacks, 199 authorities, 156, 202 autonomy, 62, 107

B Balkans, 199 barriers, viii, 65, 79, 95, 96, 99, 101, 103, 110, 111, 112, 114, 115, 116, 117, 118, 119, 120, 130, 179, 182 behavior, xi, xii, 198, 199, 201, 203, 218, 219, 220, 221, 222, 223, 224, 225, 226, 228, 229 behavioral assessment, 92 behavioral disorders, 112, 126, 201 behavioral problems, viii, ix, x, 95, 102, 104, 105, 111, 112, 113, 114, 118, 151, 156, 161, 163, 197, 204, 218, 219, 223, 228, 229 behaviors, x, 3, 4, 6, 9, 10, 28, 29, 30, 31, 32, 37, 40, 41, 44, 64, 68, 74, 75, 76, 85, 86, 88, 90, 92, 96, 97, 98, 99, 100, 101, 102, 103, 104, 107, 113, 114, 122, 135, 136, 139, 141, 152, 160, 161, 169, 171, 178, 179, 185, 186, 187, 189, 190, 191, 192, 193, 201 belief systems, 85 beliefs, viii, x, 70, 76, 83, 84, 95, 96, 97, 98, 104, 107, 108, 109, 111, 113, 114, 115, 116, 117, 119, 121, 130, 135, 170, 185, 186, 190 benefits, 36, 49, 104, 146 bias, 61, 76, 181, 187 Bicultural skills training, vii, 2, 36, 37 birth rate, x, 5, 6, 185 black hole, 232 Black students, 6, 7, 9 Blacks, 8, 127 body mass index (BMI), 191, 194 bonding, 63 bonds, 154 Bosnia, vi, x, xii, 197, 199, 200, 201, 202, 203, 205, 206, 209, 212, 213, 215, 217, 219, 227, 228, 229, 230, 231, 232, 233 Bosnia-Herzegovina, xii, 199, 200, 206, 217, 227, 229, 230, 231, 232 Bosnians, 200, 229 boys, 207, 208, 209, 211, 214, 215, 219, 228 Brazil, 153 breast cancer, 128, 186 bullying, 4, 26

C cancer, 189, 194 capitalism, 63 caregivers, 98, 126, 127 Caribbean, 2, 15 catastrophes, x, xi, 197, 198, 201, 202, 227 category a, 76 Caucasians, 170 causal beliefs, 113 causal inference, 179 Census, x, 2, 5, 6, 29, 44, 99, 105, 134, 135, 149, 168, 169, 177, 181, 183, 184, 185, 193, 194 chemical, 199, 231 chemical weapons, 199 Chicago, 41 Child Behavior Checklist, 16, 22, 203 childhood, 7, 70, 81, 128, 138, 164, 190, 232 children, xi, 198, 200, 201, 203, 227, 228, 230, 231, 232, 233 Chile, 15 China, viii, 5, 47, 48, 50, 59, 61, 62, 63, 64, 65, 66, 153, 168 Chinese medicine, 108, 115 Chinese migrants, vii, 48, 55 Christianity, 152 chronic diseases, 186, 192 chronic illness, 53 civilization, 199 classes, 48, 54, 55, 140, 142, 143, 144, 187 classification, 155 classroom, 183, 202, 203 clients, 60, 100, 106, 110, 118 clinical trials, 96, 104, 118 closure, 63, 89 clustering, 174 clusters, 207 cocaine, 15, 25, 31, 37, 136 coding, 188 cognition, viii, 67, 68, 69, 71, 73, 78, 83, 84, 85, 86, 89, 90, 91 cognitive ability, 63 cognitive perspective, viii, 67, 76, 79 cognitive process, 69 Cold War, 135 collectivism, 2, 18, 26, 28, 33, 41 college students, 89, 110, 126, 165, 169, 172, 180, 181, 182, 183, 184 Colombia, 142, 145, 146, 147 colon, 186 colon cancer, 186 communication, 33, 35, 102, 119, 121, 226 communication skills, 35

Index community, 4, 27, 39, 44, 65, 83, 90, 96, 109, 116, 118, 120, 121, 122, 123, 130, 137, 164, 182, 189, 191, 192, 193, 194, 231 community service, 130, 137 comorbidity, 38, 122, 232 competition, 63, 143, 144 competitiveness, 59 complement, viii, 61, 67 complexity, x, 3, 136, 167, 169 complications, 190 composition, x, 61, 168, 185 conceptual model, 97, 123 conceptualization, 3, 97, 154 concordance, 106 conduct disorder, 14, 103 conference, 165 configuration, 82 conflict, 12, 13, 14, 15, 18, 19, 21, 22, 24, 27, 28, 33, 35, 36, 43, 81, 82, 87, 102, 106, 109, 129, 136, 143, 147, 162, 180, 199, 200, 230, 231 conformity, 107 Confucianism, 107 Congress, 233 conscious (explicit) modes, viii, 67 conscious awareness, 69, 88 conscious experiences, 77 consensus, 30, 70 consent, 137 construction, 77, 154 consumption, 31, 136, 189, 191, 195 content analysis, 93 contradiction, 60 control, 230, 231 control condition, 36 coping strategies, 107, 108, 180 coronary artery disease, 186 correlation, 106, 161, 186, 191, 204, 207, 210, 212, 219, 220, 224, 225, 230 correlation coefficient, 224, 225 correlations, 37, 69, 161, 173, 225 counseling, 37, 129 country of origin, 13, 101, 144, 152, 172, 186, 190 credentials, 64 criminal activity, 4 criticism, 77, 91, 108 Croatia, 199, 232, 233 cross-cultural differences, 77 crying, 205, 206, 207, 210 Cuba, 15, 187 cultural beliefs, 70, 108, 113, 116, 170 cultural differences, 48, 68, 74, 76, 77, 91, 113 cultural environment, viii, 81, 95, 96, 106 cultural heritage, 82

237

cultural identities, 98 cultural influence, 203 cultural norms, 100, 113 cultural practices, 109, 115, 186 cultural tradition, 157 cultural transition, 163 cultural values, 3, 10, 68, 74, 76, 79, 81, 82, 83, 92, 98, 99, 102, 107, 109, 110, 114, 116, 119, 120, 128, 155 culture conflict, 147, 165 curriculum, 138, 154, 156

D danger, 144, 161, 205 dangerousness, 201 data analysis, 36, 37, 165 data collection, 137, 202 data set, 6, 172, 174 database, 139, 149 death, 4, 228, 232 deficit, 60, 126, 127, 179 delinquency, 2, 10, 12, 13, 14, 17, 18, 22, 23, 26, 27, 28, 33, 38, 39, 41, 42, 43, 44 delinquent behavior, 44 demographic change, 168 demographic characteristics, 161, 204 demographic data, 204 demographic factors, 155, 162, 193 demographics, 203 demography, 180 Denmark, 62, 233 Department of Commerce, 96, 129 Department of Health and Human Services, 5, 44, 129, 130 Department of Justice, 42 Department of the Interior, 5, 44 dependent variable, 10, 160 depreciation, 155 depression, x, 24, 25, 36, 40, 101, 104, 108, 110, 118, 123, 129, 168, 170, 171, 173, 177, 180, 182, 201 depressive symptomatology, 201 depressive symptoms, 10, 16, 25, 43, 109, 177 deprivation, 4, 200, 227 destruction, 138 developmental change, 98 developmental process, 71, 98, 179 deviation, xi, 57, 198, 203, 205, 207, 208, 209, 219 diabetes, 186, 189, 190, 192, 194 diet, 189, 190, 191, 192, 193 digestion, 210 dignity, 33, 101

238

Index

direct measure, 186 disability, 53, 126 disaster, 232 disclosure, 93 discomfort, 229 discrimination, ix, 11, 12, 15, 17, 22, 23, 27, 29, 30, 32, 36, 48, 50, 60, 61, 65, 84, 87, 102, 122, 124, 126, 138, 139, 140, 145, 151, 152, 154, 155, 156, 158, 159, 161, 162, 164, 177, 178, 182, 183 dislocation, 200 disorder, x, 14, 113, 126, 127, 197, 201, 203, 232 displaced persons, 200, 201, 202, 227, 231, 233 displacement, xi, 198, 199, 200, 210, 211, 213, 214, 217, 223, 225, 227, 228, 229, 232 dissociation, 88 dissonance, 18, 27, 28, 41, 106 distress, 65, 81, 91, 109, 112, 113, 116, 200, 231, 232 distribution, 230 diversification, 96 diversity, 38, 89, 90, 123, 148, 154 divorce rates, 100 doctors, 110 domestic conflict, 102 Dominican Republic, 187 downward mobility, vii, 47, 49, 50, 51, 52, 54, 55, 57, 58, 59, 60, 61 drug abuse, 31, 43, 100 drugs, 141, 219, 220, 223, 229 DSM, 203, 207, 210, 212, 217 DSM-IV, 203, 210, 212, 217 dysthymia, 100

E East Asia, 63, 77, 114 economic adaptation, 65 economic change, 62 economic development, 51 economic growth, ix, 167 economic integration, 49 economic sociology, 64 economic status, 87, 171, 172 editors, 232 education, xii, 49, 53, 64, 85, 86, 138, 144, 156, 168, 169, 171, 174, 178, 181, 199, 203, 226, 229 Education, 202, 231 educational attainment, 134, 169, 170, 171, 182, 183 educational process, 179 educational system, 109, 170 educators, 112 El Salvador, 168 elders, 101

elementary school, 194, 202, 207, 208, 211, 220 emigration, 153 emotion, 91, 108 emotional distress, 44, 107, 125 emotional experience, 93 emotional health, 156 emotional state, 88 emotional well-being, 106 empirical studies, 2, 3, 9, 25 employability, 101 employment, vii, viii, 47, 48, 49, 50, 51, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 64, 65, 87, 135, 171, 203 employment status, 203 encouragement, 112, 190 enculturation, 3, 4, 20, 29, 33, 34 enemies, 205, 206 energy, 186, 190 engineering, 154 England, 64 English language proficiency, 171, 187 enrollment, 112, 168 entrepreneurs, 51, 62, 65 environment, 200, 201, 206, 210, 211, 213, 223, 225, 226, 229 environmental factors, 148 environmental influences, ix, 133, 134, 137, 138 epidemiology, 232 ethics, 202 ethnic background, 96, 104, 117, 158, 170 ethnic culture, 79, 152, 155, 160 ethnic groups, 7, 8, 9, 36, 41, 78, 79, 82, 83, 84, 88, 90, 114, 153, 157, 178, 189 ethnic migrants, 83 ethnic minority, viii, 4, 5, 6, 9, 29, 30, 33, 80, 89, 93, 95, 96, 99, 107, 112, 119, 120, 121, 122, 123, 129, 134, 148, 156 ethnicity, 5, 9, 11, 23, 28, 31, 37, 38, 42, 44, 50, 62, 64, 65, 88, 115, 118, 124, 125, 129, 130, 155, 157, 160, 172 etiology, 111, 113, 115 Europe, 199 European Union, 153, 154 evidence-based practices, 125 examinations, 117 exclusion, 10, 48 executive function, 92 exercise, 187, 193 exile, xi, 198, 199, 201, 203, 210, 211, 213, 214, 215, 216, 217, 223, 225, 226, 227, 228, 229, 230, 231, 232

Index expectations, viii, x, 95, 96, 102, 107, 110, 115, 119, 142, 145, 167, 169, 170, 171, 172, 173, 174, 177, 178, 179, 181, 182 expertise, 48, 49 exploitation, 50, 51, 101 exposure, xi, 8, 49, 69, 72, 73, 78, 83, 86, 109, 172, 198, 199, 227, 230, 232 expressiveness, 203 externalizing behavior, 26, 32, 218, 219, 223, 226, 228 extraversion, 203 extreme poverty, 204 extroversion, 201, 203, 208, 209, 210, 218

F family, 200, 201, 203, 204, 205, 206, 207, 217, 227, 228, 229, 231, 232 family conflict, 13, 14, 24, 32, 33, 36, 110 family functioning, 35, 36 family income, 174 family interactions, 86 family life, 100 family members, 102, 107, 109, 112, 115, 119, 136, 138, 141, 142, 145, 147, 177, 188, 228, 229 family physician, 232 family relationships, 155 family support, 101, 182 family system, ix, 37, 134, 142, 147 family therapy, 129 family violence, 37 fast food, 190 fear, 22, 23, 24, 32, 38, 205, 206, 207, 210, 217 feelings, 32, 89, 107, 108, 141, 152, 158, 163, 199, 201 Female migrants, viii, 47, 59 females, x, 197 fiber, 190 Filipino, 18, 19, 27, 44, 105, 124 financial support, 117 Finland, 63, 164 first generation, 23, 27, 71, 72, 80, 152, 172, 173, 183 flexibility, 89, 139 fluid, 146 forced migration, 230 Ford, 115, 123, 124 foundations, ix, 167 framing, 119 France, 155 freedom, 54, 59, 141, 144 fruits, 189, 190, 191 funding, 168, 171

239

G gangs, 8, 32 gender, 201, 203, 207, 209, 211, 217, 227 gender differences, viii, 47, 155 gender equality, 48, 51 gender inequality, 48 generation, 215 generational status, 10, 16, 174, 188, 191 Georgia, 179 Germany, 50, 62, 63, 64, 92, 180 girls, 208, 209, 211, 214, 220 globalization, 59, 62 goals, 201 government, 199 grades, 32, 42, 126, 142 group identity, vii, 1, 33, 35 group work, 41 groups, xi, 198, 202, 203, 204, 205, 206, 207, 208, 209, 210, 213, 215, 218, 227, 228, 229 Guangdong, 53, 65 guidelines, 96, 157, 187, 192 Guinea, 153 Guineans, ix, 151, 157

H Hawaii, 5, 18, 28 health, 201, 231, 232, 233 Health and Human Services, 101, 103, 127 health care, xii, 96, 99, 104, 109, 110, 114, 115, 116, 119, 120, 122, 126, 137, 187, 193, 195, 199 health care system, 122, 126 health insurance, 120 health problems, 96, 102, 105, 106, 109, 112, 114, 115, 117, 201 health psychology, 38, 123, 148 health researchers, 101 health services, viii, 95, 97, 98, 99, 103, 104, 106, 110, 115, 117, 130, 187 health status, viii, 95, 97, 99, 103, 106, 108, 193, 232 heterogeneity, 5, 21, 99, 105 high blood pressure, 31, 43 high school, 7, 9, 24, 28, 38, 40, 41, 142, 165, 168, 169, 171, 174, 175, 180, 182, 183, 184 higher education, 169, 171, 180, 181 Hispanic population, 44, 169 Hispanics, ix, 23, 40, 41, 42, 44, 99, 125, 129, 149, 165, 167, 168, 169, 172, 173, 174, 175, 176, 178, 182, 190, 193, 194 home ownership, 62 homeowners, 138

240

Index

homicide, 4 Honduras, 15 Hong Kong, vii, viii, 47, 48, 49, 50, 51, 52, 53, 54, 55, 58, 59, 60, 61, 62, 63, 64, 65 host, vii, viii, ix, x, 3, 22, 32, 47, 48, 49, 50, 61, 63, 68, 70, 71, 72, 73, 74, 75, 76, 78, 79, 80, 81, 82, 83, 84, 87, 88, 90, 91, 92, 95, 96, 97, 100, 107, 109, 151, 157, 167, 169, 170, 231 host societies, 88 housing, 101, 200 human capital, 48, 50, 60, 63 hyperactivity, 126, 127 hypertension, 186, 189 hypothesis, 32, 64, 65, 81, 89, 102, 115, 129, 160, 162

I identity, ix, 2, 3, 4, 15, 17, 18, 20, 24, 27, 30, 32, 33, 35, 36, 37, 42, 44, 49, 70, 79, 80, 81, 82, 89, 92, 100, 123, 133, 134, 135, 136, 137, 138, 140, 141, 143, 145, 146, 147, 148, 156, 158, 162, 163, 164, 165, 169, 170, 181, 200 ideology, 60 images, 75 immersion, 121 immigrant adolescents, vii, ix, 23, 45, 63, 107, 133, 134, 151, 152, 156, 157, 160, 162, 164 immigrants, ix, 5, 16, 43, 48, 50, 51, 59, 62, 63, 64, 65, 100, 102, 103, 105, 106, 113, 116, 118, 122, 123, 124, 126, 128, 134, 136, 152, 153, 154, 156, 157, 159, 162, 163, 165, 167, 168, 177, 180, 181, 182, 183, 186, 188, 192, 193 immigration, x, 2, 5, 16, 17, 19, 21, 28, 37, 38, 39, 43, 64, 84, 92, 99, 101, 103, 105, 124, 141, 143, 148, 152, 153, 154, 162, 164, 165, 167, 171, 179, 185, 189, 191 impairments, 128 implicit association test, 90, 91 implicit cognition paradigm, viii, 67 in transition, 125 incidence, 84, 121, 189, 194 incorporating new values, viii, 95, 96 increased access, 189 independence, 51, 101, 147, 199 India, 153, 168 Indians, 29, 40, 41, 42, 44 indirect effect, 25, 178 individual character, 62, 170 individual characteristics, 62, 170 individual differences, 68, 90 individualism, vii, 1, 26, 27, 28, 31, 35, 49, 107 industrialization, 65

inequality, 62, 64, 180 infancy, 37 information processing, 69 informed consent, 139 inhibition, 115 initiation, 181 insecurity, 191, 193, 194 institutions, xii, 71, 120, 199 integration, ix, 3, 20, 39, 41, 62, 73, 88, 151, 154, 155, 157, 160, 161, 162, 163, 170, 186 intelligence, 154 intensity, 200, 230 interaction, 232 interaction effect, 28, 179 interdependence, 155 interface, 165 intergroup relations, viii, 67, 72, 74, 78, 82, 83, 85, 87 internal consistency, 158 internalization, 32, 100 internalizing, xi, 10, 24, 27, 29, 32, 43, 105, 198, 218, 219, 220, 223, 226, 228 interparental conflict, 14 interpersonal conflict, 101 interpersonal interactions, 85 intervention, 2, 42, 43, 45, 108, 110, 112, 113, 114, 117, 119, 120, 121, 127, 129, 147, 149, 180 intimidation, 147 introspection, viii, 67, 69, 74 introversion, 199, 201, 203, 208, 209, 230 invisible hand, 64 Ireland, 65 ISC, 16 Islam, 199 Islander (A/PI), vii, 1, 2 isolation, 21, 81, 141, 147, 179, 201 Israel, 65 Italy, 64

J Japan, 5 juvenile delinquency, 103

K killing, 205, 206, 217 kinship network, 101 Korea, 168 Kuwait, 227

Index

L labor force, 59 labour market, 62 language, 201, 206, 226, 229 language barrier, 50, 118, 142, 143, 144 language proficiency, 105, 155, 158, 159, 160, 171, 187 languages, 98, 118 Latin America, 134, 169, 191 Latino women, 5, 189 Latinos, v, vii, x, 2, 5, 13, 21, 24, 25, 33, 38, 39, 89, 97, 99, 100, 103, 104, 105, 115, 118, 124, 134, 136, 145, 146, 148, 179, 184, 185, 187, 188, 189, 190, 191, 192, 193, 194, 195 lead, 69, 73, 77, 81, 83, 84, 86, 97, 101, 104, 107, 109, 110, 111, 119, 138, 170, 186, 189, 191, 201 lean production, 51 learning, 101, 121, 126, 128, 156, 226, 229 leisure, 187, 188, 189, 193 life course, 64 life experiences, 75 life satisfaction, 75, 77, 91, 92, 107 lifestyle behaviors, 191 lifestyle model, 97 lifetime, 18, 27, 28, 38, 100, 123 linear modeling, viii, 37, 47, 55 listening, 223, 227, 229 loneliness, 155 longitudinal study, 38 loyalty, 107, 141

M Mainland China, 48, 49, 50, 52, 59, 61 mainstream society, 106 major depression, 100, 129 majority, ix, 5, 9, 10, 26, 27, 48, 53, 55, 85, 89, 90, 140, 151, 154, 156, 157, 162, 172, 200, 227 majority group, 156 males, x, 197 maltreatment, 217 management, 111, 231 manufacturing, 50, 154 mapping, ix, 30, 133, 139 marginalization, 32, 73, 155, 157, 160 marijuana, 31, 37, 136 marriage, 51, 110, 157 Mars, 189, 193 Maryland, 65 matrix, 64, 161 measures, 203

241

media, 83, 156 median, 134 mediation, 18, 25, 27, 28, 29, 39 medical care, 122 medication, 105 melting, 136 membership, 4, 41 memory, 93, 187 men, 199, 201, 205, 206, 207, 217 mental development, 81 mental disorder, 103, 116, 183, 232 mental health, vii, viii, xii, 1, 2, 5, 24, 28, 30, 32, 39, 42, 43, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 136, 148, 149, 155, 156, 165, 184, 199, 200, 201, 231, 233 mental health of children, 231 mental health professionals, 108 mental illness, 108, 111, 114, 115, 116, 122 mental model, 81 mentor, 145 meritocracy, 49 messages, 78, 87, 88, 145, 147 meta-analysis, 233 methodology, 74, 157 Mexico, 5, 13, 14, 15, 16, 20, 25, 123, 125, 138, 139, 140, 141, 143, 168, 180, 187 Miami, 12, 15, 21, 23, 25, 64 middle class, 48, 49, 53, 54, 55, 56, 58, 138 migrants, vii, viii, 47, 48, 49, 50, 51, 52, 53, 54, 55, 57, 59, 60, 61, 62, 71, 72, 79, 80, 82, 83, 84, 86, 155, 164 migration, 47, 48, 50, 54, 55, 59, 61, 63, 65, 70, 100, 151, 152, 154, 155, 230 military, 200 minorities, ix, 5, 91, 95, 96, 114, 116, 118, 127, 159, 167, 168, 171, 185 minority groups, 5, 34, 89, 115, 116, 121, 171 minority students, 169, 183 models, 36, 54, 65, 88, 97, 108, 109, 120, 135, 169 moderating factors, 35 moderators, 29, 35, 85 modernization, 64 Moldova, 153 mood states, 84 mosaic, 134 mothers, 201, 229 motivation, 84, 87, 91, 98, 122, 143, 183, 184 Mozambicans, ix, 151, 157 Mozambique, 153 multicultural education, 122 multidimensional, 10, 26, 34, 37, 136

242

Index

multi-ethnic, 178 multiple factors, 170 multiple regression, 27, 161 multiple regression analyses, 161 murder, 126, 199 music, 97, 146, 157, 165 Muslims, 199

N narratives, 10 National Center for Education Statistics, 168, 169, 182 national culture, 152, 155, 160 national identity, 89, 158 NCVS, 8 needy, 231 negative attitudes, 97, 104, 114, 115 negative experiences, 87 negative mood, 84 negative outcomes, 81, 82, 84, 87 negative relation, 28, 100 negative valence, 77, 87 neglect, 123 negotiating, 102, 108 Nepal, 163 networking, 61 neuroticism, x, xi, 197, 198, 199, 201, 203, 208, 209, 210, 218, 228, 229 nonconscious, 76 non-conscious (implicit) modes, viii, 67 normative behavior, 32 North America, 125 Norway, 128 nuclear family, 101, 102 nurturance, 119 nutrients, 194 nutrition, 194

O obedience, 107 obesity, 31, 40, 182, 189, 190, 191, 192, 193, 194 obstacles, 48, 51, 111, 229 obstruction, 186 occupational mobility, 64, 65 offenders, 125 openness, viii, 47, 59, 60 operations, 231 opportunities, 49, 59, 121, 146, 171 organizational behavior, 86 organize, 140

osteoporosis, 186 outsourcing, 51 overeating, 204, 219, 222 overlap, 26 overweight, 192, 194, 204, 219, 222 ownership, 48, 55, 58, 59

P Pacific, vii, viii, 1, 2, 5, 17, 26, 40, 41, 44, 63, 65, 95, 97, 99, 105, 106, 110, 111, 113, 115, 116 Pacific Islanders, 2, 5, 41, 44, 97, 105, 106, 110, 111, 115 parallel, 71, 77, 80, 189 parameter estimates, 54, 59 parental attitudes, 115 parental authority, 102, 113, 158 parental influence, 71, 72, 79, 80, 109, 190 parental involvement, 13 parental relations, viii, 67, 78, 81, 82, 85 parental support, x, 168, 170, 174, 177 parenting, 63, 70, 72, 81, 82, 101, 104, 107, 109, 113, 117, 119, 124, 128, 141, 147, 190 parenting styles, 81, 107, 128 parents, 202, 203, 208, 209, 211, 214, 228, 229, 231 path model, 183 pathology, 108, 201 pathways, 25, 29, 126, 181 PCA, 160 peer group, 32 peer review, 10 peers, xi, 198, 201, 209, 214, 216, 217, 226, 227, 228, 229 PEP, 184 permeability, 155 perpetration, 4, 6, 7, 8, 10, 23, 26, 29, 31 personal choice, 61 personal identity, ix, 134, 140 personal relevance, 49 personality, 85, 88, 90, 91, 156, 165, 200, 229 personality traits, 230 pharmacotherapy, 129 Philippines, 168 physical abuse, 4, 18, 27, 28 physical activity, 185, 186, 187, 188, 189, 191, 192, 194, 195 pitch, 142, 146 planning, 231 population, xii, 199, 201, 230 population growth, x, 5, 96, 134, 185 portraits, 91 Portugal, ix, 151, 152, 153, 154, 155, 156, 157, 159, 162

Index Portuguese adolescents, ix, 151, 156, 157 positive attitudes, 154, 160 positive correlation, 188, 207 positive mood, 84 positive regard, 90 positive relationship, 3, 28, 80, 100, 135, 136 posttraumatic stress, 201, 203, 233 post-traumatic stress disorder (PTSD), x, xi, xii, 103, 197, 198, 199, 201, 203, 207, 210, 212, 217, 218, 219, 220, 228, 230, 232 poverty, 100, 102, 112, 134, 171, 204 predictive validity, 34, 75, 90 predictor variables, 161 pregnancy, 101, 121 prejudice, 87, 89, 91, 92, 93, 111, 156 premature death, 186 preparation, iv, 231 preschool, 36, 37 preschool children, 36, 37 prevention, vii, 2, 34, 35, 36, 40, 43, 44, 121, 194 private property, 227 probability, 24, 52, 61, 130 problem behavior, 12, 13, 23, 24, 26, 27, 39, 42, 43, 44, 180 problem behaviors, 12, 26, 27, 42, 43, 44 problem solving, 108 professional mental health services, viii, 95, 97, 99, 104, 121 programming, 2, 180 project, 41, 61, 137, 157, 168 proliferation, 68 propagation, 79 prosocial behavior, 42 protective factors, 2, 5, 20, 30, 31, 33, 34, 38 protective role, 34 psychiatric disorders, 38, 100, 123, 125 psychoactive drug, 15 psychological acculturation, viii, 67, 68, 70, 72, 73, 74, 79, 87, 88, 91, 152, 156 psychological distress, 81, 82, 106, 164, 232 psychological health, 106 psychological problems, 105, 108, 109, 113, 130, 200, 230, 231 psychological processes, 68 psychological states, 231 psychological stress, 106, 108 psychological stressors, 106 psychological variables, 74 psychological well-being, 63, 80, 106, 156, 164, 165 psychology, 10, 37, 44, 88, 89, 90, 123, 148, 164, 165, 179 psychometric properties, 64, 75, 92 psychopathology, 37, 124, 136, 232

243

psychosocial adaptation, viii, 95, 96 psychosocial conditions, 230 psychosocial functioning, 182 psychotherapy, 41, 108, 109, 113, 116, 122, 126 public awareness, 122 public health, 2, 10, 29, 30, 36, 39, 119, 125, 192 public interest, 88 public schools, 27, 157 public sector, 126 Puerto Rico, 5, 15, 187 punishment, 86

Q qualitative research, 136, 139 quality of service, 111

R race, 5, 6, 7, 8, 9, 14, 17, 38, 44, 88, 115, 124, 129, 130, 172 racial minorities, 169 range, xi, 198, 204, 205, 207, 208, 218, 228, 231 rape, 7, 27 reaction time, 70, 74, 75 reactions, 201, 233 reality, ix, 142, 167, 183 reasoning, 69, 73 recall, 61, 69, 77 recalling, 205 reception, 171 recession, 169 reciprocity, 91, 184 recognition, 112, 113 recommendations, viii, 86, 95, 99, 116, 117, 125, 190, 191 reconciliation, 200 reconstruction, 201, 231 recreation, 141 refugee status, 28, 43, 202, 209, 217, 227 refugees, x, xi, 163, 198, 199, 200, 202, 204, 211, 227, 228, 230, 231, 232, 233 regional, 200, 230 regression, 23, 25, 30 regression model, 23, 25, 30 reinforcement, 108 relatives, 114, 172, 190, 200, 205, 206, 210, 211, 213, 215, 216, 217, 226, 227, 229 relearning language, viii, 95, 96 reliability, 78, 158, 173 religion, 14, 17, 154 replication, 33, 36, 139

244

Index

representativeness, 84 reputation, 143, 145, 154 researchers, ix, 4, 7, 32, 33, 34, 68, 69, 76, 77, 86, 99, 106, 118, 134, 136, 147, 154, 156, 192 resilience, 37 resources, 51, 60, 85, 100, 106, 107, 114, 145, 181 respiratory, 201 response time, 75 responsiveness, 129 restructuring, 48, 49, 50 retail, 51 retaliation, 35 rhetoric, 183 risk factors, 24, 27, 28, 32, 33, 35, 37, 38, 43, 103, 134 risk-taking, 61 Romania, 153 romantic relationship, 40 rules, 71, 109, 231 rural areas, 118 Russia, 50, 164

S sadness, 205, 206, 211, 215, 216, 227, 229, 230 safety, 200, 229 sample, x, 197, 202, 207, 217, 220, 230 Sao Tomese, ix, 151, 157 Sarajevo, 228, 231, 233 satellite, 214, 215, 216, 226, 227, 228, 229 scholarship, x, 167, 168, 169, 171, 178 school, x, 197, 201, 202, 203, 207, 208, 214, 215, 216, 218, 219, 220, 221, 223, 225, 228, 229 school achievement, 147 school adjustment, 158 school climate, 163 school performance, 124, 183 schooling, 53, 63, 157, 174, 175, 180 scores, 203, 207, 221 second generation, 27, 64, 71, 72, 80, 152, 164, 172, 173, 180 secondary education, 168, 171, 178, 181 secondary school students, 211 secondary schools, 202 security, 200 sedentary behavior, 194 sedentary lifestyle, 188 segregation, 182 selectivity, 100 self esteem, 77 self-assessment, 171 self-concept, 36, 88, 152, 164, 165 self-control, 36

self-definition, 4 self-directed violence, vii, 1, 2, 4, 6, 8, 9, 10, 21, 22, 25, 26, 27, 29, 30, 33, 34, 35, 37 self-employed, 47, 48, 51, 53, 55, 56, 58, 59 self-employment, 49, 51, 52, 54, 57, 58, 59, 60, 62, 63, 64 self-esteem, ix, 15, 16, 24, 25, 32, 33, 42, 43, 77, 80, 81, 88, 89, 90, 93, 100, 107, 151, 152, 154, 155, 156, 158, 159, 160, 161, 162, 163, 164, 165, 201 self-image, 165 self-regard, 77, 80, 91, 163 self-reports, 101 self-worth, 152 Senate, 183 sensitivity, 118, 122, 128 separation, 201, 204, 205, 206, 207, 210, 228 Serbs, 199 serum, 194 service organizations, 49 service provider, 102 SES, 157 settlements, 200, 204, 205, 227, 230 severity, x, xi, 197, 198, 201, 203, 205, 206, 207, 208, 209, 210, 212, 218, 224, 227, 228, 229 sex, 32, 34, 40, 42, 63, 172, 204, 219, 222 sex differences, 63 sex role, 32, 34, 42 sexual behavior, 181 sexual violence, 6, 7, 17, 22, 26, 27, 30, 31 shame, 108, 114, 115, 122 shape, 86, 170 shock, 69, 165 sibling, 53 siblings, 54, 138 signs, 108, 192 skeletal muscle, 186 skills, 231 skills training, vii, 2, 35, 36, 37, 148 skin, 201 sleeping problems, 211, 214, 216 smoking, 220, 223, 229 sociability, xi, xii, 198, 201, 203, 208, 209, 210, 218, 229 social activities, 87, 157 social adjustment, 63, 178 social attitudes, 87 social behavior, 75, 86, 87 social capital, 49, 50, 63, 64, 184 social categorization, 148 social circle, 101 social class, 47, 48, 54, 55 social cognition, 69, 75, 90, 91 social competence, 60, 61, 92

Index social context, 77 social desirability, 187 social development, 65, 66, 169 social environment, 70, 78, 81, 83, 107, 121, 183 social group, 68, 83 social identity, 163 social indicator, 40 social interactions, 87 social isolation, 201 social network, 54, 100, 105, 112, 115, 120, 122, 178 social norms, 49, 77, 82, 192 social order, 107 social phenomena, 68 social problems, 203, 219, 220, 223, 226, 228 social psychology, 63, 90 social relations, 101, 102 social relationships, 101 social role theory, 60 social roles, 61 social services, 61 social skills, 35, 42, 156 social skills training, 35 social status, 60 social stress, 100 social structure, 64 social support, x, 85, 100, 108, 112, 125, 135, 144, 156, 162, 167, 170, 171, 174, 177, 178, 180, 181, 200, 204 social support network, 112 social welfare, 50 social withdrawal, 108 social workers, 136, 147 socialization, 32, 42, 71, 79, 81, 102, 148 societal changes, ix, 167 society, 230, 232 socioeconomic background, 171 socioeconomic status, 31, 40, 42, 83, 110, 138, 186 sociology, 10 somatization, 108, 109, 123 South Korea, 67 Southeast Asia, 19, 27, 43, 153 special education, 110, 113, 128 speech, 49 spirituality, 20 SPSS, 204 Srebrenica, x, xi, xii, 197, 198, 199, 201, 202, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 231 standard deviation, xi, 53, 198, 203, 205, 207, 208, 209, 219 standard of living, 100 starvation, 199

245

states, 32, 63, 84, 85, 87, 113, 134, 231 statistics, 6, 23, 135, 159, 168, 173 stereotypes, 44, 83, 84, 86, 88, 89, 90, 100 stereotyping, 84, 99, 105 stigma, 114, 115, 116, 119, 120, 122, 123 stimulus, 75, 76 strategy use, 138 stratification, 65, 66, 180 stress, xi, 198, 199, 200, 201, 203, 207, 208, 210, 229, 232, 233 stressors, 18, 27, 28, 34, 43, 107, 108, 113, 180, 201, 232 stroke, 186 structural barriers, 171 structural changes, 170 structural equation modeling, 37 students, 211, 220, 228 style, 89, 101, 113, 119, 124, 127 subgroups, ix, 2, 5, 9, 12, 21, 26, 34, 83, 99, 105, 133, 187, 194, 202 subjective experience, 74 subjective well-being, 92 substance abuse, 42, 101, 121 substance use, 13, 31, 32, 36, 40, 63, 129 suicidal behavior, vii, 2, 22, 25, 26, 28, 29, 30, 33, 37, 40 suicidal ideation, 4, 8, 9, 15, 16, 19, 20, 25, 26, 27, 28, 29, 33, 37, 40, 41, 43 suicide, vii, 2, 4, 8, 9, 15, 16, 18, 19, 20, 25, 27, 28, 29, 33, 34, 35, 40, 41, 44, 45, 101, 103, 199 suicide attempts, 15, 18, 20, 25, 27, 28, 29, 40, 101 suicide rate, 41 surplus, 48 surveillance, 29, 38, 187 survival, 62, 229 Sweden, 65 Switzerland, 39, 155, 164 symptom, 203, 204 symptoms, xi, 4, 15, 24, 29, 32, 42, 43, 103, 105, 106, 108, 109, 110, 112, 113, 116, 124, 126, 184, 198, 200, 201, 203, 207, 210, 212, 217, 224, 228, 229, 230, 231, 233

T target, 29, 48, 74, 75, 85, 119, 135, 136, 147, 193 target behavior, 75 target population, 48, 193 teachers, 23, 50, 142, 144, 145, 201, 203, 215, 218, 219, 223, 226, 229, 231 teenagers, 200 tenants, 138 territory, xi, 198, 199, 227, 230

246

Index

testing, 2, 63, 181 theft, 22, 43 theoretical approaches, 135 therapy, 39, 92, 126, 127, 129 thinking, 211, 226, 229 thoughts, 10, 15, 25, 103, 107, 108, 109, 226 threats, 4, 8, 109, 199 time, 199, 200, 218, 229, 230 time constraints, 87 tobacco, 37 torture, 101 traditional practices, 106 traditions, 12, 101, 157 training, 35, 36, 40, 49, 62, 105, 119, 120, 122, 124, 126, 128 training programs, 36 traits, 76, 113, 230 transcripts, 140 transformation, 62, 63, 182, 184 transition to adulthood, 184 translation, 118, 157 transmission, 80, 82 transportation, 111, 116, 194 trauma, x, xi, 197, 198, 200, 201, 203, 205, 206, 207, 208, 210, 217, 224, 227, 230, 232, 233 traumatic events, x, 197, 203, 229 traumatic experiences, 206, 227, 229, 232, 233 trial, 43, 120, 127 triangulation, 139 truck drivers, 63

U U.S. Department of Commerce, 129 United Kingdom (UK), 62, 64, 66, 165 United Nations (UN), 199 unstructured interviews, 139 upward class mobility, vii, 47, 51, 59, 60 upward mobility, viii, 47, 49, 50, 51, 52, 54, 55, 57, 58, 59, 60, 61 urban areas, 159 urbanization, 51 US Department of Health and Human Services, 184

V Valencia, 171, 184

vandalism, 22, 43 variables, vii, ix, 2, 23, 32, 35, 65, 74, 99, 100, 112, 117, 130, 151, 156, 158, 159, 161, 162, 173, 174, 189, 190 varimax rotation, 160 vegetables, 189, 190, 191 veterans, 231 victimization, vii, 1, 4, 6, 7, 8, 10, 11, 14, 17, 18, 22, 23, 24, 26, 27, 28, 30, 31, 32, 35, 36, 38, 41, 83 victims, 7, 199, 200 Vietnam, 168 violence, vii, 1, 2, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 100, 101, 121, 200, 232 violent behavior, 6, 28, 37 violent crime, 8 vitamins, 190 vulnerability, 23, 32, 42, 119, 231

W wages, 65 war, x, xi, xii, 197, 198, 199, 200, 201, 202, 207, 214, 215, 216, 226, 227, 228, 229, 230, 231, 232, 233 Washington, 38, 40, 42, 67, 88, 92, 93, 127, 129, 148, 149, 179, 180, 181, 182, 183, 184, 195, 232 weakness, 108 weapons, 38, 199 welfare, 50, 63, 200 well-being, viii, 45, 67, 70, 77, 80, 82, 152, 155, 200, 201, 232 well-being outcomes, viii, 67, 70, 155 Western countries, 154 Western Europe, 64 workers, 48, 63, 64, 65, 73, 88, 136, 154, 163 working class, 48, 50, 52, 63 working population, 153 WTO, 65

Y Yale University, 183 young adults, 91, 114, 124, 200 Yugoslavia, 199, 203, 233