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Overview of Core Concepts and Elements of Culture

Introduction

Issues of culture and human diversity that exist between and within cultural groups can be perplexing as research investigators and health service providers alike attempt to understand the “real-world” complexities inherent in the study of culture. In this chapter we will examine cultural variables and dimensions of culture, as applied to the study of addictive behaviors. No one model fully captures this rich diversity, and thus we will examine select models which serve as frameworks for organizing and understanding how “culture” influences human behavior, including addictive behaviors. We will complete our analysis with commentaries on methodological approaches for conducting more integrative analyses that can inform our understanding of these complex cultural effects. The aim is to do so with sensitivity to complex cultural processes, yet also with rigorous research designs for conducting scientific studies that “do justice” to the analysis of cultural influences on human behavior.

Concepts of Culture and Race and Ethnicity

Concepts and Definitions of Culture

“Culture” is a multifaceted and pervasive construct which is as old as human civilization. Culture is a human construction—a product of human experience. Culture emerged when humans organized their perceptions of the environment, recorded their observations and used language to communicate to others their thoughts and feelings about the world (Roberts, 2003). “Culture” consists of beliefs, practices, values and other “world views.” Ostensibly, the beliefs, practices, and values that were most adaptive for survival were preserved and passed along from parents to children (Shiraev & Levy, 2010).

Culture has been defined in over 100 ways (Baldwin & Lindsley, 1994), although collectively these definitions echo certain core themes. These themes are that: (a) culture is constructed by a people and emerges from the social and ecological environment in which people live; (b) cultural knowledge and skills are transmitted from elders to children; (c) culture confers people with a sense of “peoplehood” and of belonging; (d) culture provides norms and expectations regarding socially acceptable behaviors; (e) culture is a distinctive human capacity for adapting to life’s circumstances; (f) culture evolves across time; (g) cultural practices include traditions and customs that emerge when a community develops adaptive coping responses to environmental challenges; and (h) cultural adaptations to a new environment include changes in beliefs, attitudes, values, and norms that promote a group’s survival within the new environment. Thus, culture consists of a system of communications—shared symbols and meanings that are utilized by members of a given ethnic group or community. Given its complexity, often the deepest facets of a culture are captured through folk art, music, and drama (McGoldrick & Giordano, 1996). A fitting metaphor for culture is that: “Culture is an ocean that shelters the diverse creatures of the sea—it exists everywhere around them, yet they seldom notice it. Nonetheless, were this ocean to disappear, all of these creatures would die.” And so it is with people and their culture.

Race and Ethnicity in Cultural Formulations Within the USA

The constructs of race and ethnicity are typically measured as categorical variables based on a respondent’s self-classification (U.S. Census Bureau, 2008). As one important distinction, the U.S. Census distinguishes “racial” categories from “ethnic” categories, i.e. being Hispanic (U.S. Census Bureau, 2008). However, considerable variation exists in the conceptualization and measurement of race and ethnicity (Bonham, 2005). Scholars have argued that race is not a biological construct, but rather, a sociocultural one (Smedley & Smedley, 2005). In many epidemiological studies, race is utilized as a categorical grouping variable for conducting group comparisons (Karasz & Singelis, 2010), as for example to examine health-related disparities across racial/ethnic groups (i.e., in comparing Hispanics/Latinos and Blacks/African Americans with non-Hispanic White Americans). Such group comparisons, however, do not explain the underlying mechanisms that produce these differences. To further examine within-group variations, relevant cultural variables such as level of acculturation have been used as more refined indicators of within-group variability. As contrasted with the construct of race, ethnicity is primarily a cultural variable, and refers to “a common ancestry through which individuals have evolved shared values and customs. It is deeply rooted to the family to which it is transmitted” (McGoldrick & Giordano, 1996, p. 1).

Aptly describing “culture” is not a simple task, although scholars have attempted to create relevant and meaningful conceptualizations to promote a better understanding of culture. For example, Chao and Moon (2005) introduced a cultural framework that they call the “cultural mosaic.” Under this organizing framework, a given person’s identity consists of a unique combination of discrete elements (cultural tiles), such as demographic elements (e.g., age, race, ethnicity, gender), geographic elements (e.g., urban–rural status, region or country), and associative elements (e.g., family, religion, profession). As an extension of this framework, an ethnic group consists of a collective of individuals who share many common elements (e.g., a common heritage, religion or ethnic identity). This mosaic may appear quite intricate, although on closer inspection it exhibits a coherent and identifiable structure. Thus, this integrative systemic approach captures in part the complexities of culture, as these exist within their natural ecological context.

Ecodevelopmental Models and Conditions

Bronfenbrenner (1986) proposed a systems model that describes a hierarchy of social systems, including family systems, as these systems directly or indirectly affect child development. This model emphasizes various levels of ecological influences that range from macro-level societal factors, such as social policies and community norms, to micro-level individual factors, such as a child’s temperament. In a contemporary elaboration of Bronfenbrenner’s systems model, Pantin and collaborators proposed a modified ecodevelopmental model (Pantin et al., 2003; Szapocznik & Coatsworth, 1999). These investigators present additional ideas about the role of cultural factors, such as immigration stressors, as well as ecological factors, as these influence the development of minority-culture families and their children.

In a similar ecological analysis, Wandersman and Nation (1998) introduced an environmental stress model that examines the influences on psychological well-being of four types of environmental stressors that occur within urban neighborhoods. These are types of environmental stressors are: (a) cataclysmic events, (b) stressful life events, (c) daily hassles, and (d) ambient stressors. Higher levels of exposure to these stressors are “associated with negative effects on mental and physical health” (Wandersman & Nation, 1998). Within this model, ambient stressors consist of environmental stressors that, “interfere with important goals or affect physical or psychological health,” e.g., noise and crowding (Wandersman & Nation, 1998). Chronic ambient stressors can deplete a person’s coping resources, leading to psychological problems, such as youth behavioral problems.

From a family strengthening perspective, one may ask, “What factors promote resilience and survival in the midst of ongoing exposures to such toxic neighborhood stressors?” Wandersman and Nation (1998) identified these resource factors within two domains: (a) individual factors, such as resourcefulness in new situations and school achievement and (b) community factors, such as supportive relationships with other community members, e.g., church leaders and teachers. In particular, community-based supportive relationships involve the presence of: (a) caring adults and role models who “have made it;” (b) the presence of social bonding and social supports; (c) exposure to positive influences such as adult–child connections that create a safe setting in which a child can develop and achieve (Wandersman & Nation, 1998).

In summary, ecodevelopmental models such as these highlight the effects of environmental and interpersonal contexts on human behavior. One of the several environmental “surrounding” conditions may be regarded as a contextual factor. A contextual factor can operate as moderator of effects, as for example, in the differential effect of gender norms on the onset of a disease that differs in prevalence rates by gender, e.g., rates of depression, where it is well established that women, as compared with men, experience higher rates of depression.

Cultural Factors and Dimensions of Culture

Castro and Hernández-Alarcón (2002) have identified and described a set of cultural variables or factors that are mentioned frequently within the literature on Hispanic/LatinoFootnote 1 health, and also regarding the health of other racial/ethnic minority populations of the USA. Table 9.1 presents these variables. In cross-cultural psychology, some of these cultural variables have been described as dimensions of culture (Shiraev & Levy, 2010). The analysis of these dimensions aids in describing core features of a cultural or subcultural group. Here we examine three of these ­dichotomous dimensions: (a) individualism–collectivism, (b) modernism–traditionalism, and (c) acculturation–enculturation (levels of acculturation).

Table 9.1 Cultural variables
Full size table

Individualism Vs. Collectivism

Many Latinos and other racial/ethnic minority groups value certain relational styles, such as family unity, i.e., familism/familismo, and harmony in interpersonal relationships, i.e., simpatia. These values regarding interpersonal relations are associated with the cultural dimension of: interdependence (collectivism) (Oyserman, Coon, & Kemmelmeier, 2002) vs. personal autonomy (individualism). To this dimension of individualism–collectivism, Triandis (1996) added the dimension of “vertical–horizontal,” to describe distinct types of cultural syndromes. The vertical dimension (e.g., vertical collectivist vs. a vertical individualist) refers to variations in types of power, while the horizontal dimension refers to variations in types of equity. In research on variations of individualism and collectivism as observed among certain countries, the vertical–horizontal dimension provides a more detailed framework for understanding national cultural attitudes and practices that involve individualism and collectivism (Shiraev & Levy, 2010).

Modernism Vs. Traditionalism

Traditionalism refers to an individual’s or group’s adherence to conservative “old world” familial norms and values. This typically involves an acceptance of “old-fashioned lifeways” that have survived across generations based partly on their utility for promoting group survival and in maintaining the cultural group’s sense of “peoplehood” (Castro & Coe, 2007; McGoldrick & Giordano, 1996). In addition, traditionalism often consists of conservative cultural norms that emphasize a strict adherence to restrictive cultural beliefs, behaviors and norms, including a resistance to change (Castro & Coe, 2007). However, expressions of traditionalism can vary across cultural groups, as in the use of alcohol and drugs, where in some traditional subcultural groups alcohol use is strictly forbidden or highly discouraged. For instance, alcohol use is strictly forbidden among devout Muslims, whereas among some Native American tribes in the Southwest, the ceremonial and nonaddictive use of peyote, a psychoactive drug, is a core aspect of cultural rituals and allowed among male members of these tribal communities (Julien, Advokat, & Comaty, 2008; McKim, 2003).

Traditionalism also sanctions prescribed gender role expectations of behaviors that are considered appropriate based on gender. Such traditional expectations, norms and behaviors are usually more salient within agrarian societies, which also typically endorse collectivistic forms of familial and social relations. Traditional gender norms tend to be prescriptive and also restrictive, as contrasted with modernistic open-ended and more permissive gender role expectations that are observed within modern Westernized societies (Castro & Garfinkle, 2003; Costa, Terracciano, & McCrae, 2001; Schwartz, Montgomery, & Briones, 2006). Perhaps due to this restrictiveness, these conservative traditional norms when directed from parents to their children tend to confer protection against antisocial behaviors, including the early use of tobacco, alcohol and drugs, so long as the youth obeys and adheres to these conservative traditional norms (Cuadrado & Lieberman, 1998; Gil, Wagner, & Vega, 2000).

For this dimension of traditionalism–modernism, among specific subcultural groups and within a society, an abiding tension exists between the cultural norms that favor change, i.e., modernism, as contrasted with the norms that favor adherence to long-standing traditions, i.e., traditionalism. Individual members of a family, community and nation may thus disagree among themselves regarding which of these norms are best in order to live “the good life.” Accordingly, among most minority people and their families, variations exist in their acceptance of these conservative beliefs, attitudes and norms that favor preserving traditions, relative to those that favor modernistic change.

Acculturation, Enculturation, and Biculturalism

Acculturation is a worldwide phenomenon that occurs when individuals and families migrate from one sociocultural environment to another, usually in quest of better living conditions and opportunities (Lopez-Class, Castro, & Ramirez, 2011). Often, acculturation into a new ecological environment covaries with upward socioeconomic mobility, although in some cases it covaries with downward sociocultural mobility. These differences in socioeconomic upward mobility may result from exposure to specific opportunities or to specific barriers, such as racial or other forms of discrimination, including xenophobia, an “attitudinal, affective, and behavioral prejudice towards immigrants and those perceived to be foreign” (Yakushko, 2009, p. 43). In the USA, and primarily among immigrating groups or individuals, acculturation refers to a process of sociocultural learning, change, and adaptation. Within the USA this includes the acquisition of mainstream American cultural norms, values, behaviors, and skills, including leaning to speak English (Trimble, 1995). It is noteworthy that acculturative change does not only occur during cross-national migration, but also during migration within a nation’s geographic boundaries, such as in migration from rural to urban environments (Portes & Rumbaut, 1996).

At the individual and group levels, cultural adaptation and integration into a new society or to a new environment typically involves the acquisition of new cultural traits or competencies. These include: (a) acquiring new knowledge about local and regional laws and social customs; (b) learning new skills including occupational and linguistic skills; (c) establishing new networks of neighbors, acquaintances, friends, and other sources of social support; and (d) acquiring new values, norms, and behaviors that are prevalent or valued within the new cultural environment. For immigrant children, the acquisition of these competencies typically occurs as a natural part of their youth development, and often occurs at a faster rate than among their parents. These parent–child generational differences that occur during the process of acculturation have been described as “differential acculturation” (Szapocznik & Kurtines, 1989). Moreover, this change can be stressful, i.e., acculturative stress, depending on the ecological environment and the available opportunities or barriers under which this change occurs. Acculturation stress occurs when a person faces threats to their well-being within the new community or environment (Farver, Narang, & Bhadha, 2002; Yakushko, 2009).

How May Racial and Ethnic Factors Be Associated with Addictive Behaviors?

Addictive Behaviors in Minority Youth Development

As with many complex human behaviors, addictive behaviors occur and develop within the context of a person’s environmental ecology. Thus, the meaning of a compulsive, repetitive, and destructive behavior depends in part on the local community’s acceptance or prohibition of that pattern of behavior. Based on DSM-IV diagnostic criteria, there are two forms of addictive behaviors, (a) substance abuse, and (b) substance dependence. Substance abuse refers to a, “maladaptive pattern of substance use, leading to clinically significant impairment or distress” (American Psychiatric Association, 1994, p. 182). Substance abuse includes a failure to fulfill major role obligations, substance use in hazardous situations, the occurrence of legal problems, and continued use despite the occurrence of social or occupational problems.

Beyond substance abuse, substance dependence refers to, the presence of these criteria for abuse, with the addition of three or more of seven other symptoms: tolerance, withdrawal, use of larger amounts than intended, persistent desire for the substance along with unsuccessful attempts to cut down, considerable time spent pursuing the substance of choice, a reduction or impairment in social or occupational activities, and continued use despite the occurrence of physical or ­psychological problems (American Psychiatric Association, 1994). Thus, relative to substance abuse, substance dependence is a more extreme form of addiction. This conception of addiction provides a medical psychiatric view of the adverse ­consequences resulting from behaviors that involve excessive substance use, and thus which is considered to be an “addictive behavior.” From these definitions, as a basis of maladaptive substance use, a major question is “How do cultural factors operate as antecedents, mediators or moderators of these forms of addictive behavior?”

Changing Concepts of Addiction

In May of 2013 the fifth edition of the DSM will be published, and within this latest edition significant changes to the diagnostic criteria of substance use and addictive behaviors are expected. For example in the fifth edition, the addictions will include not only substance-related disorders but also non-substance related addictions, such as gambling, which is currently listed as an “Impulse Control Disorder—Not Elsewhere Classified” (American Psychiatric Association, 2010). The DSM classification of substance-related diagnoses is anticipated to change from “Substance-Related Disorders,” to “Substance Use and Addictive Disorders.” Moreover, it is anticipated that the DSM will move away from the terms substance abuse and dependence and towards a more singular diagnosis of a “Substance Use Disorder.” In other words, the DSM’s conceptualization of additive behaviors will no longer be limited to substance abuse and will include a broader diagnostic lens from which addictions will be viewed. In fact, it is interesting to point out that the current edition of the DSM does not include any diagnostic section with the term “addiction.”

Discrimination/Oppression/Barriers

Among racial/ethnic minority individuals and groups, perceived discrimination has been associated with psychological distress and with emotional responses that include anger and anxiety (Clark, Anderson, Clark, & Williams, 1999; Yakushko, 2009). Responses to this emotional distress can include coping via the use of alcohol, legal and illegal drugs (Castro, Brook, Brook, & Rubenstone, 2006; Felix-Ortiz & Newcomb, 1995; Nieri, Kulis, & Marsiglia, 2007; Vega, Gil, & Zimmerman, 1993). Coping with discrimination to reduce stress via the use of alcohol and other drugs has been described as an “escapist” form of substance use (Martin, Tuch, & Roman, 2003). Under a stress-coping paradigm such behavior may be regarded as maladaptive, where a more adaptive form of coping with the stressors of discrimination involves seeking social support from family and friends. These findings suggest that minority parents and members of the family can and should communicate actively and often with their children, while offering them social support as one form of parental influence that can prevent substance use in response to ­distress (Kelly, Comello, & Hunn, 2002). A more complete understanding of the ­associations of youth emotional distress and substance use can aid in the development of more efficacious prevention interventions. Such interventions may provide parents with insights on how discrimination and acculturation-related conflicts can be stressful, and how parents can support their child in ways that discourage substance use.

Social Justice Issues: Racial/Ethnic Disparities in Arrests and Incarceration

It is often noted that minorities comprise a disproportionate percentage of prison inmates and convicted criminals. However, what percentage do racial and ethnic minorities actually represent among convicted felons, and what are possible explanations for any observed race-related disparities? First, according to U.S. Census, 72.4% of the US population is non-Hispanic white, i.e., Caucasian. In addition, in 2003 it was estimated that 3.2% of America’s adults (age 18 and above) were incarcerated, or were still involved with the criminal justice system, such being on probation. Although racial/ethnic minorities, i.e., nonwhites, only constitute about 25% of the total US population, studies have shown that the majority of individuals in jails or prisons are racial/ethnic minorities, at a rate between 62–57% (Primm, Osher, & Gomez, 2005). Moreover, researchers have also described the racial breakdown of this incarcerated nonwhite population: African Americans (46%), Hispanics (16%), Whites (36%), American Indians or Alaskan Natives (1%), and Asian Americans or Pacific Islanders (1%) (Primm et al., 2005). Thus, African Americans and Hispanics are overrepresented among those who are committed to jails or prisons.

It has also been documented that racial/ethnic minorities are more likely to be unfairly treated within the criminal justice system. For instance, close to 75% of men that have been wrongfully convicted of a crime are either African American or Hispanic, and minorities represent the bulk of individuals, 55%, on death row (Porter, 2009). Such findings may lead one to wonder how and why minority status would be associated with criminal behavior. Among various explanations, it is possible that higher rates of criminality are associated with a biased and prejudiced legal system. For example, Keen and Jacobs (2009) found that racial arrests and imprisonments were higher in states where there was a smaller than average African-American population. Keen and Jacobs (2009) assert, along with other researchers, that these racial disparities in rates of arrests and imprisonments may be influenced by the “minority threat” effect, which occurs when members of the dominant culture group believe they have special privileges and that they must protect these from growing groups of minorities. This form of racial intolerance is difficult to address, although many people of color are observant and sensitive to these social inequalities.

Frameworks for Understanding Culture and Context in the Addictions

Models of Acculturation with Implications for Substance Use and Abuse

The construct of acculturation has a long history in the study of immigrant and minority populations. The process of acculturation appears important in the occurrence of substance use and abuse among Hispanic/Latino, African American, Asian American, and Native American youths and families. Acculturative change towards mainstream American culture has been associated with increased risks of alcohol, tobacco, and illegal drug use (Vega, Alderete, Kolody, & Aguilar-Gaxiola, 1998). In several studies, higher levels of acculturation to the mainstream US American culture and society have been associated with: more frequent substance use, greater quantities of use, and higher rates of lifetime use of hard drugs (Amaro, Whitaker, Coffman, & Heeren, 1980; Gil et al., 2000; Brook, Whiteman, Balka, Win, & Gursen, 1998; Felix-Ortiz, & Newcomb, 1995). Accordingly, we will examine aspects of acculturation, with implications for substance use among racial/ethnic minority populations.

Unidimensional Model of Acculturation

Acculturation was originally formulated by anthropologists as a group-level phenomenon involving a cultural group’s change and adaptation (Redfield, Linton, & Herskovitz, 1936). As noted previously, acculturation consists of a sociocultural process in which members of one cultural group adopt the beliefs and behaviors of another group, where this includes changes in language, socioeconomic status, and/or cultural orientation, and including changes in values and attitudes (Berry, 2005). During the 1980s, the measurement-focused approach to acculturation pursued by psychologists (Cuellar, Arnold, & Gonzalez, 1995; Cuellar, Harris, & Jasso, 1980), introduced a change in the conceptualization of acculturation by conceptualizing and measuring it as a personal trait that relates to individual changes upon migration to a new host culture or environment (Farver et al., 2002; Lopez-Class et al., 2011).

Early conceptions of acculturation described it as a linear, unidirectional process involving the eventual loss of elements of the immigrant’s original culture, i.e., language, customs, and traditions, upon adopting the lifeways of the new host culture or society (Ryder, Alden, & Paulhus, 2000). In this regard, the term assimilation has been used to refer to the final outcome, with this being the complete loss of ethnic identity resulting from a total immersion into the new host culture, i.e., a “melting pot” model.

Two-Factor Models of Acculturation

More recently, an orthogonal acculturation model was proposed that describes variations in acculturation and related cultural identity formation that would occur along two dimensions: (a) an orientation towards a new host culture, i.e., acculturation, and (b) an orientation towards the culture of origin, i.e., enculturation (Cuellar et al., 1995; Marin & Gamboa, 1996; Oetting & Beauvais, 1991). It is now well recognized that the acquisition of elements of a new culture does not necessarily produce an automatic loss of elements from the culture of origin (Rogler, 1994; Rogler, Cortes, & Malgady, 1991), thus challenging the major premise of the “melting pot” model. For example, a Spanish-speaking 12-year-old child whose family migrates from Mexico to the USA will not necessarily lose his or her ability to speak Spanish after several years of living within the USA and as they learn to speak English. Any reduction in Spanish-speaking skills or behaviors, if occurring, may instead be the consequence of other identity-related issues, such as suppressing their use of Spanish to avoid discrimination.

Berry (1994, 1997, 2005) is the major proponent of this two-factor (orthogonal) model that describes four acculturation outcomes: (a) marginalization (low affiliation with both cultures); (b) separation (high origin-culture affiliation, low new-culture affiliation); (c) assimilation (high new-culture affiliation, low origin-culture affiliation); and (d) integration (high affiliation with both cultures). Despite its improvement over the original unidimensional model of acculturation, this orthogonal model has also been criticized, with one concern being that these four forms of acculturative change do not actually occur as postulated (Rudmin, 2003).

Today, more advanced conceptions of acculturation acknowledge the role of context as an important determinant of the acculturation process (Lara, Gamboa, Kahramanian, Morales, & Hayes Bautista, 2005). Contextual factors, such as one’s place of residence, the size and form of a family unit, the school system, can affect the manner and course in which the process of acculturation occurs and progresses. This consideration has prompted studies that utilize various factor mixture model analyses, e.g., latent class or latent profile analyses (Flaherty, 2010; Lubke & Muthen, 2005) to detect latent acculturation groups and their differential trajectories of acculturative change across time (Castro, Marsiglia, Kulis, & Kellison, 2010).

From this perspective, the occurrence of variations in trajectories of sociocultural and socioeconomic mobility across time has been described as segmented assimilation (Abraido-Lanza et al., 2005; Castro, Marsiglia, et al., 2010). Segmented assimilation refers to the differential assimilation trajectories that are experienced by diverse immigrant individuals and groups. Segmented Assimilation Theory (Portes & Zhou, 1993) postulates three outcomes from this process of assimilation: (a) acculturation change towards the mainstream White American culture, coupled with upward socioeconomic mobility (upward assimilation); (b) acculturation change albeit with downward socioeconomic mobility into an underclass (downward assimilation); and (c) resistance to acculturation and to assimilation into the mainstream society subsequently leading to some degree of downward assimilation (Portes & Rumbaut, 1996). Downward assimilation is believed to occur among immigrant groups that migrate to a new environment while having low levels of social capital (few sources of social support), and/or low levels of human capital (low levels of education, income and other professional resources) (Portes & Rumbaut, 2001). Thus as a result of having low levels of “marketable” skills and resources, these immigrants are less competitive within the new cultural environment and society.

Ethnic Identity with Implications for Substance Use

Overview of Identity Issues

In America during this first decade of the twenty-first century, the construct of ethnic identity has become more complex and diversified. One consequence of the Civil Rights Movement of the 1960s and the reduction in overt racial segregation, was an increase in racially mixed marriages beginning in the 1970s (McGoldrick & Giordano, 1996). This cultural change in the USA produced children of mixed racial and ethnic backgrounds who today may face more complex issues in their identity formation (Marks, Flannery, & Garcia Coll, 2011).

Ethnic identity refers to ways in which a youth identifies with his or her ethnic group, which involves a process of exploration and commitment (Erickson, 1968). Phinney (1990, 1993) proposed a three-stage model of ethnic identity development, which involves the three stages of: (a) unexamined ethnic identity, (b) ethnic identity search, and (c) ethnic identity achievement. In Stage 1, unexamined ethnic identity, the adolescent has an unexplored identity, and accepts without question the values and attitudes communicated by the mainstream culture, including negative views of the youth’s own ethnic group. In Stage 2, ethnic identity search, the ethnic youth develops an awareness of own ethnic identity, along with a sense of dissonance when experiencing a discriminatory personal or social event. This includes a sense of anger from an awareness that certain values that are espoused by the dominant culture group are discriminatory towards one’s own racial/ethnic group. This stage is followed by Stage 3, ethnic identity achievement, in which the youth develops a more defined and confident sense of their own ethnicity.

Today, ethnic identity formation may involve an identification with multiple groups including: (a) with one’s own ethnic group, (b) with the mainstream group, and (c) in some instances with a generic pan-ethnic group, such as being an “Asian American” or an “Hispanic” (Chung, Kim, & Abreu, 2004; Marks et al., 2011). Some evidence has accrued which suggests that mixed racial/ethnic youth face greater obstacles in youth development, and as a group they may also experience higher rates of some psychiatric disorders, although the evidence for this is mixed (Shih & Sanchez, 2005).

In this regard, adolescents having low self-worth, unclear value orientations, and undefined or ambiguous life goals may experience identity confusion and related feelings of emptiness, worthlessness, and alienation. Some theories of youth ­development have postulated that a diffuse and marginalized personal identity prompts adolescents to affiliate with deviant peers (Andrews & Hops, 2010; Lettieri, Sayers, & Pearson, 1980). Such peer affiliations have been associated subsequently with experimentation in early adolescence with alcohol and cigarettes, which may later progress to regular and heavier use of alcohol and tobacco, and subsequently progressing to the use of illegal drugs (Castro et al., 2007).

In examining the process of acculturation as it may influence identity formation, Schwartz et al. (2006) conceptualized identity as a complex construct that consists of several components including: (a) personal identity—personal goals, values, and beliefs, (b) social identity—group identification and affiliation, and (c) cultural identity, which is a subset of social identity. Cultural identity refers to a youth’s solidarity and connectedness with their own cultural or ethnic group. These investigators assert that personal identity, “anchors” the person. For immigrant and minority youths, the development of a stable personal, social, and cultural identity, identity integration, appears characterized by the capacity for effective coping with cultural conflicts. Ostensibly, a stable and integrated bilingual/bicultural identity likely promotes the development of certain skills for coping with dialectical cultural conflicts, i.e., for resolving conflicts involving individualism vs. collectivism, or traditionalism vs. modernism (La Fromboise, Coleman, & Gerton, 1993).

Bicultural Identity, Ethnic Pride, and Resilience

A dual-cultural identity, that is, bicultural competence (La Fromboise et al., 1993) has been described as the capacity for cultural flex—the ability to “shuttle” or transition between majority and minority cultures (La Fromboise et al., 1993; Ramirez, 1999). This bicultural orientation includes positive skills and attitudes towards both cultures, ostensibly fostering positive emotions and a positive self-concept (Izard, 2002; Tugade & Frederickson, 2004). From a cultural strengths perspective, ethnic minority youth who develop a well-defined ethnic identity schema (Alvarez & Helms, 2001) along with ethnic pride are regarded to have a greater intercultural competency (Torres & Rollock, 2007), the capacity for active problem solving, including adaptive ways to avoid risk behaviors, including early alcohol and tobacco use (Brook et al., 1998). Racial/ethnic minority youth who recognize their ethnic identity and express a positive self-appraisal, i.e., ethnic pride, despite their minority status, may be expressing resiliency (Klohnen, 1996; Masten, 2001), and self-confidence, forms of personal agency that operate as a resources that can strengthen a youth’s resolve to refuse or to avoid offers or temptations to use tobacco, alcohol, and illegal drugs. As one example, research with American Indian youth has shown that ethnic pride is associated with stronger antidrug norms (Kulis, Napoli, & Marsiglia, 2002).

Despite experiencing psychological distress and conflict, mixed-racial identity youth can develop adaptive ways of coping with temptations to use drugs. Effectively resolving conflicts involving acculturation stress, complex identity issues, and ­discrimination may lead to the development of a unique and complex yet integrated personal identity, one that transcends struggle and evolves towards personal growth based on a full appreciation for the richness and complexity of one’s dual racial–ethnic heritage. In this regard, an abiding question is, “What aspects of ethnic identity formation may operate as potent protective factors for youth, as these factors can protect them against negative developmental outcomes?”

The Risk and Protective Factor Paradigm

Substance use often begins in adolescence, and thus research studies have examined factors that may constitute risk and protective factors for the onset of substance use in early adolescence (Hawkins, Catalano, & Miller, 1992). Researchers have identified several risk and protective factors for substance use. Taylor defines a risk factor as a variable that increases the likelihood that a person will initiate the use a substance such as marijuana (Taylor, 2010, p. 604). Numerous studies have identified several life conditions as risk factors for substance use, and these include: a chaotic home life, parents who use or abuse substances or suffer with mental disorders, poor parenting, children having irritable temperaments (impulsivity, attention deficit disorder), oppositional and defiant behaviors, aggressive conduct, shy or aggressive behavior at school, poor academic performance, lack of social coping skills, associating with deviant peers, and approval of drug use that is communicated from significant others within their social environments (Taylor, 2010). Similarly, risk factors associated with alcohol consumption include alcohol use to reduce negative affect, being from a family that has a history of alcoholism, and being in a family in which alcohol is consumed to reduce negative affect, i.e., to feel better when under stress (Patrick, 2010).

In contrast to risk factors, protective factors are those that safeguard an individual from substance use, either currently or in the long term (Taylor, 2010, p. 605). Protective factors include cultural factors such as family support and familial norms that discourage the use of alcohol, tobacco, and other drugs. For instance, high levels of familism (called familismo in Spanish) appear to protect Hispanic youths from substance use perhaps in relation to the value placed on simpatia and respeto, relational styles that emphasize the importance of maintaining harmony in relations to parents and other family members. Similarly, in Asian cultures the tradition of respect for elders appears to protect Asian adolescents from substance use, because these adolescents may be disinclined to disobey rules and expectations that are set by their parents. Nonetheless, cultural values do not always operate as protective factors. For example, among substance users in drug abuse treatment, Wong and Longshore (2008) postulate that high familismo, which emphasizes the importance of family cohesiveness, can also make it more difficult for adult Hispanics to separate from their drug-using family and friends (Wong & Longshore, 2008). Thus, risk and protective factors need to be considered within the context of specific social and familial situations and ecological environments (Warner et al., 2006).

Shih, Miles, Tucker, Zhou, and D’Amico (2010) examined racial and ethnic ­differences in substance use among middle-school students. Using a sample from 16 different middle schools in Southern California (n  =  5,500), these researchers examined differences in alcohol, cigarette, and marijuana use, and how they may be related to race and ethnicity. Their multiethnic sample included: White Americans (Caucasians), Hispanics, African Americans, and Asian/Pacific Islanders. Mixed-race adolescents were not included in this study. These investigators assessed lifetime and past-month use of several substances. Other measures addressed other important factors, such as individual, family, and school (Shih et al., 2010). Using path analytic models, these researchers found that the Hispanic students exhibited a higher likelihood of using drugs, as compared with their White American (Caucasian) peers (an odds ratio, OR  =  1.58 for the past year). By contrast, Asian youths exhibited a lower likelihood of using any substance during the past year, when compared with White American youths (OR  =  0.25). Additionally, this study found no statistically significant difference between the White American and African-American students (Shih et al., 2010).

In this regard, one emerging question from this study is why the Hispanic youths were more likely to use, whereas the Asian youths were less likely to use, when compared with the White American youths? First, it was found that drug use among Hispanic and Asian youths was significantly mediated by resistance self-efficacy (the belief they could resist drugs if given the opportunity to use), and by negative expectancies towards the use of a given substance (Shih et al., 2010). Additionally, for the Asian youths lower substance use was also mediated by family factors, which included parental respect and less substance use by older siblings. In other words, among Asian youths, the family unit operated as a protective factor against substance use. This study is just one of the many that attempt to explain variations in substance use among different racial and ethnic groups. Clearly, understanding the factors that influence youth substance use is not a simple endeavor, given that this involves a complex process that includes several interacting factors.

From 25 years of data as observed for several cohorts of adolescents, Johnson and colleagues have indicated that two of the most potent protective factors, those that are negatively correlated with the use of a particular substance are: (a) perceived risks, youth perceptions regarding impairments to own health that are associated with the use of a particular drug such as cocaine, and (b) perceived disapproval, youth perceptions of the disapproval they would receive from parents or peers as a consequence of their use of a particular substance (Bachman, O’Malley, Schulenberg, Johnson, Bryant, & Merline, 2002). Similarly, negative youth attitudes towards the use of alcohol, tobacco and illegal drugs, and expectations of harm from substance use may contribute to a preparedness to avoid the use of these substances. Such attitudes when coupled with self-efficacy for refusing these substances portend a low risk of developing an addiction to these substances (Hecht et al., 2003; Sturges & Rogers, 1996). Moreover, among racial/ethnic minority adolescents, the motivational effects of ethnic pride enhancement and of cultural traditions are cultural processes that may offer “value added” competencies that would be protective in resisting the use alcohol, tobacco, or illegal drugs (Castro et al., 2007; Torres & Rollock, 2007).

Towards a Framework for Integrating Culture into Research and Interventions on the Addictions

Considerations for More Culturally Informed Research

The prior research suggests that the effects of culture on the behavior or racial/ethnic minority youth manifests itself via a process that exerts its influences within three domains: (a) the individual domain of the person (beliefs, attitudes, values, expectations, norms); (b) the interpersonal domain involving social relations with siblings, parents, other family, and peers; and (c) the environmental domain (community factors including ambient stressors, community norms, civic rules, and sociopolitical effects, including racial discrimination) (Wandersman & Nation, 1998). An examination of the aforementioned multilevel relationships, as informed by the complex effects of culture, will require novel research designs that allow a deep-structure analysis (Resnicow, Soler, Braithwait, Ahluwalia, & Butler, 2000) of cultural effects on the initiation and development of substance use, abuse, and other addictive behaviors. Regarding this approach, we offer a few observations about research approaches that are needed for the design and conduct of culturally responsive and also scientifically rigorous research with racial/ethnic populations.

Community-Based Participatory Research

Culturally responsive research can be developed by using a community-based participatory approach in which a planned research study requests input and advice from members of the local cultural community to ensure proper conceptualization, operationalizations and interpretation of research constructs and variables, as grounded within the local community (Dickens & Watkins, 1999; Minkler & Wallerstein, 2003). These approaches have been used successfully in several drug use research studies (e.g., Gosin, Dustman, Drapeau, & Harthun, 2003). The inclusion of community leaders, key informants and stakeholders, in the design and development of a research study that is also scientifically rigorous, gives voice to the local community, while also informing the proposed study of “real-world” considerations as voiced by local community residents (Parsai, Castro, Marsiglia, Harthun, & Valdez, 2011).

Qualitative and Mixed Methods Designs

As noted previously, the use of novel yet rigorous research designs will aid in examining the rich and complex effects of culture and cultural factors in the study of addictive behaviors, as these occur among diverse racial/ethnic minority ­populations. This section presents methodological issues in the use of qualitative and mixed methods methodologies to conduct more probing and informative research studies.

Qualitative Approaches

Qualitative approaches emphasize the need for depth of analysis in the study of culture, as it affects the lives of diverse subcultural groups. Such depth of analysis is necessary to, “tell the full story” of these peoples’ complex and intriguing lives. The in-depth study of persons’ lives within the context of their local community and culture is facilitated by the well-planned use of various qualitative research methods. Among these, focus groups allow the analysis of group process that confers a deeper-level of analysis on a given a topic, e.g., parenting conflicts among Mexican heritage parents. Informative discussions can be elicited from group members’ responses to a specific focus question, such as, “What issues do you face in communicating with your adolescent child about the use of alcohol?” Collective parental narratives obtained from a purposive sample of focus group participants can provide key ideas as perceived by representatives from a specific demographic group. Such responses aid in inductively discovering themes which can be derived from answers to a given focus question. Similarly, in-depth interviews that include open-ended questions provide the opportunity for a one-to-one, face-to-face dialogue that aids in understanding, “why people do what they do” (Karasz & Singelis, 2010, p. 911). From a more in-depth perspective, classical anthropological ethnographies provide the most comprehensive “real-world” analysis of the lives of actors as they operate within their native environments (Page & Singer, 2010). As this work is conducted via participant observation within participants’ community or dwellings, such analyses are “fully contextualized” within these environments.

Some qualitative investigators have asserted that qualitative researchers, “stress the socially constructed nature of reality and also emphasize,” “the value-laden nature of inquiry” (Denzin & Lincoln, 1994, p. 4). However, this approach which emphasizes the constructionist and interpretive perspectives may be at odds with the scientific approach which emphasizes objectivity and the avoidance of bias in the measurement and interpretation of research data. Grounded theory offers a more balanced approach that aims to capture the richness of qualitative inquiry, with a theory-driven, organized, and systematic qualitative approach that typifies scientific research. When using grounded theory the investigator organizes and encodes textual information via the use of open coding, axial coding, and selective coding (Straus & Corbin, 1998). These grounded theory procedures aid in giving form and structure to recorded text narratives, thus helping to conceptualize and interpret the contents from the narratives obtained, while also contributing towards theory building. In this regard, the in-depth analyses of life story narratives can offer deep insights into the mental and emotional lives of selected cases of participants, an approach that can “do justice” to the study of culture and its complexities. In contrast to conventional questionnaire studies, “qualitative approaches emphasize an in-depth understanding of the experiences and perspectives of research participants, … [and such] discovery-oriented data from qualitative studies can creatively disrupt pat assumptions and provide a basis for the development of new culturally appropriate theories of psychological phenomenon” (Karasz & Singelis, 2010, p. 914).

Qualitative approaches, however, also present some distinct limitations. For example, in many qualitative studies it is difficult to conduct an unequivocal and specific synthesis and integration of textual evidence across cases or units of analysis. It has also been argued that scientifically oriented objective, reliable, and valid conclusions cannot be obtained from qualitative text analysis, due to its subjectivity and putative bias in data gathering and interpretation. In addition, it has also been argued that much qualitative analysis is affected by investigator bias, especially under an interpretive approach to inquiry, data gathering, and analysis (Karasz & Singelis, 2010).

Mixed Methods Approaches

Combined Qual-Quant (mixed methods) designs aim to capture the “best of both” forms of data/evidence, which, if well designed, can yield reliable and informative research results. Qual and Quant “data” or “evidence” can offer complementary information, the property of complementarity, whereby each form of data can offer unique and important types of information that can enrich a research study (Jick, 1979). If Qual-Quant data can be reliably integrated within studies of culture, this can offer the capacity for generating important outcomes that include: (a) the confirmatory testing of research hypotheses using conventional scientific deductive methodology, as well as offering, (b) an in-depth descriptive and discovery analyses via a qualitative inductive methodology. However, the reliable integration of text data and numeric data has posed perhaps the greatest challenge in the conduct of generative mixed methods research (Bryman, 2007).

Two basic approaches in mixed methods design methodology are to: (a) examine Qual-Quant data in phases, that is, sequentially, or (b) within a single phase, that is concurrently. Indeed, the major mixed methods research designs consist of variations on two dimensions: (a) concurrent vs. sequential, and (b) exploratory vs. confirmatory. From this framework, six major mixed methods research designs have been identified (Hanson, Creswell, Clark, Petska, & Creswell, 2005).

One criticism of the Mixed Methods Research approach (MMR) is described by the “Incompatibility Hypothesis,” which asserts that it is not feasible to reliably synthesize verbal (textual) and quantitative (numeric) evidence because both forms of evidence are fundamentally incompatible (Karasz & Singelis, 2010). Conversely, the “Compatibility Hypothesis” argues that the objective scope and nature of inquiry remains consistent across paradigms (Karasz & Singelis, 2010). Thus, a central question is, “Is the compatibility hypothesis stronger than the incompatibility hypothesis?,” where if so, then this supports the viability of conducting integrative mixed methods research. If a fully integrative mixed methods design can be developed which allows for a reliable and rigorous integration of text narrative data/evidence and numeric data, then this would form the basis for generating a rich and informative dataset that allows the exchange and integration of both forms of data (Castro, Kellison, Boyd, & Kopak, 2010). That is, with this integration as a core design feature, data gathering and data analytic methods can be synchronized to allow for this complete integration. Gelo and colleagues have asserted that the field of mixed methods research (MMR) has now advanced to the stage in which, “MMR may reasonably overcome the limitations of purely quantitative and purely qualitative approaches…[thus] providing a fruitful context for a more comprehensive psychological research” (Gelo, Braakman, & Benetka, 2008, p. 266).

Concluding Comments

Integrative approaches to theory, research design, data analysis, and interpretation can aid in understanding the influences of “culture” on human behavior, and in particular, on addictive behaviors. We recognize that culture is a complex multidimensional construct which is difficult to capture via simple numeric measures. Accordingly, by deconstructing the actual experience of culture into its core dimensions and cultural elements, we can begin to examine in depth the influences of specific cultural factors on targeted health-related outcomes. We can also do so by incorporating these factors into theoretically driven models that can test hypotheses and generate new knowledge about the unified effects of several of these cultural factors. Multivariate quantitative methods provide a powerful tool for confirmatory analysis of certain cultural effects. As a complement to these multivariate quantitative analyses, well-designed qualitative research study and data analyses can aid in capturing the rich complexity of culture, although significant challenges arise in reliably integrating evidence that is derived from both forms of data/evidence. Today mixed methods research designs and methodologies provide new and more rigorous approaches for the study of cultural influences (Gelo et al., 2008), with methods that allow the integration of qualitative and quantitative data into a unified research approach. Research investigators may now use theory-driven and well-designed integrative mixed methods methodologies, to aid in concurrently generating both confirmatory and explanatory outcomes, to better inform the study of cultural influences on addictive behaviors among racial/ethnic minority populations.