María Oliva Márquez-González, Andrés Losada, and Rosa Romero-Moreno
Dementia caregiving is associated with negative physical and psychological health consequences. Multicomponent, behavioural, and psychotherapeutic interventions for reducing caregivers’ distress, particularly the cognitive-behavioural ones, present the greatest effect sizes, but nevertheless these effects are only moderate. The third wave of behavioural therapies and, specifically acceptance and commitment therapy (ACT), offers interesting therapeutic tools aimed at fostering the acceptance of aversive internal experiences and the commitment to personal values. Given the chronic nature of the caregiving situation and the unchangeability of many of its elements (e.g. feeling sadness or grief), ACT represents a promising and potentially helpful therapeutic approach to help dementia caregivers to decrease their emotional distress. Very few studies have so far analysed the efficacy of ACT or some of its components (e.g. mindfulness) in this population, but these provide some preliminary support for the utility of this approach in improving caregivers’ psychological well-being. Assuming the need for further research in order to consider ACT as an empirically validated therapy for dementia caregivers, in this chapter we analyse, in the context of caregiving, the psychological processes highlighted in the ACT model of psychopathology, such as experiential avoidance, describing examples of them in cases of caregivers we have assisted in our clinical work, and outlining ACT-based therapeutic strategies that we have found useful on a clinical basis for modifying them.
Miguel Pinedo, Sarah Zemore, Cheryl Cherpitel, and Raul Caetano
This chapter reviews a study exploring the influence of acculturation on alcohol use disorders (AUD) among a sample of Mexican-origin participants residing on and off the US-Mexico border region. The purpose of this study was to: (1) determine what domains of US acculturation predict AUD; (2) determine whether retaining aspects of Mexican culture protects against AUD; (3) examine potential mediators that might explain the relationship between acculturation and AUD, including factors relevant to a stress-based model and a normative model; and (4) determine whether the relationship between acculturation measures and AUD differs by environmental contexts. Findings suggest the influence of acculturation on Mexican women’s drinking behaviors might vary across environmental contexts. Characteristics of the border environment might exacerbate alcohol problems among more acculturated women. Findings also support a normative model of acculturation. Programs and prevention strategies at the border targeting drinking norms and motives might be particularly beneficial for women.
Acculturation and Alcohol Use Among Hispanic and Asian American College Students: What Do We Know and Where Could We Go?
Byron L. Zamboanga, Cara C. Tomaso, and P. Priscilla Lui
Many college students, are susceptible to alcohol use and related problems, including Hispanic and Asian Americans. A potential factor contributing to this risk is acculturation, which can be defined as the process of psychological, behavioral, social, and cultural change and adaptation that occurs when individuals or groups from different cultural backgrounds come in contact. This chapter provides a narrative review of the literature examining acculturation and alcohol use among these populations. One key theme to emerge from this review is that the exact direction of the association between these variables is unclear and therefore should be considered with caution. While the existing evidence is relatively limited, gender and, to some extent, ethnic group membership appear to moderate the association between acculturation and alcohol use. Several methodological issues pertaining to the study of acculturation, future research directions, and implications for intervention and prevention are discussed.
Seth J. Schwartz and Jennifer Unger
The purpose of this book is to bridge “basic” theory and research on acculturation—that is, what acculturation is, how it operates, and what are the appropriate methods to study it—with “applied” acculturation research—that is, how acculturation affects various health behaviors and outcomes among migrant populations. This introductory chapter reviews current theory and research on acculturation and health and points to future directions for the field. We also propose some new ideas to help move the field forward. The chapter also lays out the structure of and goals for the book. Fundamental definitional issues regarding what acculturation is, and how it could relate to health outcomes, are covered.
Ana F. Abraído-Lanza, Karen R. Flórez, and Rachel C. Shelton
Despite the many health benefits of physical activity (PA), the majority of Latinos do not meet recommended levels of PA. This chapter provides an overview of research on acculturation and PA among adult Latinos in the United States. It identifies gaps in knowledge concerning the association between acculturation and different types of PA, the joint effects of socioeconomic position and acculturation on PA, and research on gender. It suggests several areas for further research related to acculturation and PA, including an exploration of norms, social networks, and broader social contexts. It concludes that although the bulk of evidence indicates that greater acculturation is associated with increased PA, more complex research designs and greater methodological and conceptual rigor are needed to move forward research in this area.
Acculturation and Risky Sexual Behavior Among Adolescents and Emerging Adults from Immigrant Families
Jennifer Tsai, Davida Becker, Steve Sussman, Ricky Bluthenthal, Jennifer Unger, and Seth J. Schwartz
Adolescents and emerging adults who engage in risky sexual behaviors (RSBs), such as inconsistent condom use, having multiple partners, having sex at a young age, and having sex while intoxicated or high, are at elevated risk of acquiring sexually transmitted diseases (STDs) and unplanned pregnancy. The chapter discusses the relationship of acculturation (along with associated intrapersonal and interpersonal mediators and moderators) with RSB outcomes. Acculturation can be a protective or risk-enhancing factor for RSBs among adolescents. Intrapersonal variables, such as academic achievement, sexual intention, and sexual health knowledge, and interpersonal variables, such as parent, peer, and partner relationships, can act as mediators between acculturation and RSBs. The strength of these relationships may be further moderated by religiosity and gender. Implications for future research and interventions are proposed.
Alan Meca, Lauren G. Reinke, and Lawrence M. Scheier
This chapter explores the incipient role of acculturation in cigarette smoking, tobacco use, and use of illicit drugs in Hispanic youth in the United States. It first examines the conceptual foundations of acculturation, including early unidimensional models and later bidimensional and multicomponent perspectives of acculturation. It then reviews empirical studies linking acculturation with cigarette/tobacco and, separately, illicit drug use among Hispanic youth. The cumulative body of evidence is reviewed in terms of methodological strengths and weaknesses and how they sharpen our focus on acculturation in development. The chapter also examines three key developmental mechanisms that may account for the underlying relations between acculturation and drug use: (1) cultural stress, (2) family functioning, and (3) change in cognitive functioning related to drug use. The chapter closes with several recommendations that may help clarify the developmental linkages between acculturation and Hispanic youth drug use and should be addressed by future research.
Paul Richard Smokowski, Martica Bacallao, Corrine David-Ferdon, and Caroline B.R. Evans
This chapter provides a comprehensive review of research linking acculturation and violent behavior for adolescents of three minority populations: Latino, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN). Studies on Latino and A/PI youth indicate that higher levels of adolescent assimilation were a risk factor for 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 emerging trend, in both the Latino and A/PI youth literature, shows the impact of acculturation processes on youth aggression and violence can be mediated by family dynamics.
Marina Doucerain, Norman Segalowitz, and Andrew G. Ryder
This article discusses the importance of clear and precise conceptualizations of acculturation as well as the need for consistencies in definition, operationalization, and measurement. More specifically, it argues for an expanded acculturation research toolkit that does not rely too heavily on self-report acculturation scales. The article begins with an overview of the state of affairs with respect to acculturation conceptualizations and methods, paying particular attention to the unidimensional, bidimensional, and multidimensional frameworks of psychological acculturation. It then considers ways in which commonly used definitions and methods of acculturation can be used more intelligently. It also describes alternative methods for researchers interested in moving beyond self-report rating scales, a tiered approach to acculturation research, and method-specific health considerations. Finally, it offers some recommendations aimed at helping the field of acculturation and health research move forward.
Andrea Romero and Brandy Piña-Watson
This chapter discusses the concepts of acculturative and bicultural stress, the theory and method behind the measurement, and the implications of the US immigration policy context for stress. The central sources of acculturative and bicultural stress are reviewed, including intergroup discrimination, language stress, intragroup marginalization, and family cultural conflict. In particular, literature is reviewed that examines the association between mental health and acculturative or bicultural stress. Extant research does demonstrate that degree of stress varies for individuals and that acculturative/bicultural stress is experienced not only by immigrants but also by minorities in the United States. Therefore, the present chapter reviews literature that connects the acculturative/bicultural stress process across generations. The immigration context is considered for future research in the area of acculturation and stress.
Kelly B. Haskard-Zolnierek and Summer L. Williams
This chapter outlines the ways in which depression and other mental health issues influence adherence and health-behavior change. Patient adherence and health-behavior change are defined and described. Common mental health issues including depression and anxiety are described as well as the prevalence of nonadherence to treatment for these conditions. Next, comorbidity of physical and mental health issues are discussed, such as depression co-occurring with various chronic diseases, providing evidence of the effects of mental health on adherence and health-behavior change. The mechanisms for the relationship of mental health to adherence and health-behavior change are discussed through the framework of the information-motivation-strategy model, with adherence being affected due to cognitive factors, motivational factors, and resource-related factors. The chapter concludes with a discussion of what health-care professionals can do to address and reduce this barrier to adherence and health-behavior change.
Annette L. Stanton and Tracey A. Revenson
Chronic illnesses carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing primarily on cancer and rheumatic diseases, we review longitudinal investigations of proximal (personality attributes, cognitive appraisals, coping processes, interpersonal relationships) and distal (socioeconomic variables, culture/ethnicity, gender-related processes) risk and protective factors for adjustment across the illness trajectory. We conclude that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify important issues for future application and research.
Adjustment to Chronic Illness and Disabilities: Theoretical Perspectives, Empirical Findings, and Unresolved Issues
Hanoch Livneh and Erin Martz
Chronic illnesses and disabilities (CID) are integral parts of life, and their likelihood of occurrence increases with one's age. The experience of CID invariably necessitates personal adaptation to both the individual's diminished functional capacities and their altered interactions with the physical and social environments. The field of psychosocial adaptation (PA) to CID has exponentially grown during the past 30 years and can be conveniently collapsed into two broad domains, namely, conceptual and empirical approaches to the study of PA to CID. The conceptual approach is mostly rooted in extensive clinical observations of individuals following the aftermath of CID onset and has led to the development of numerous theoretical frameworks of PA to CID and coping with CID. Here, we provide a review of the most influential conceptual models of PA to CID. The empirical literature is examined in this chapter by focusing on those studies that have directly sought to investigate the relationships (albeit not necessarily causal in nature) among a wide range of sociodemographic characteristics, CID-linked factors, personality attributes and coping strategies, and environmental influences (these four classes of variables are typically considered as predictors, mediators or moderators), and measures of PA to CID (the latter commonly regarded as outcomes). Due to space restrictions, our review of the empirical literature only focuses on certain types of CIDs, namely, spinal cord injuries, cancer, and multiple sclerosis. This chapter concludes with a discussion of those issues that need to be addressed by future researchers in the field of adaptation to CID.
Tammy Chung and Kristina M. Jackson
Alcohol is the substance most commonly used by youth. Problematic alcohol use can be considered a developmental disorder, which typically has its origins in an individual’s genetic liability, temperament, and experiences in childhood and adolescence. To provide a context for the emergence of alcohol use in adolescence, this chapter briefly reviews biological substrates of risk that include genetic liability and processes of developmental maturation (e.g., puberty, brain development). The chapter then addresses the prevalence of alcohol use and alcohol-related problems in adolescence, trajectories of youth alcohol use, and internalizing and externalizing behavior pathways associated with adolescent alcohol use. Risk and protective factors influencing adolescent alcohol use are discussed as targets to guide developmentally informed prevention and intervention.
Adolescent Cultural Contexts for Substance Use: Intergroup Dynamics, Family Processes, and Neighborhood Risks
Seth J. Schwartz, Sabrina E. Des Rosiers, Jennifer Unger, and José Szapocznik
This chapter reviews the role of cultural processes in substance use and other health problems among adolescents. The chapter focuses on Hispanics because of their status as both a minority group and an immigrant group, and because Hispanics have been a “lightning rod” for political discourse about immigration and US national identity. The core argument is that intergroup processes such as social dominance and system justification are responsible, at the population level, for unequal allocation of social resources—which, in turn, creates health disparities. These intergroup processes compound the effects of more proximal contexts such as individual, family, and neighborhood. It is argued that interventions to combat the social/cultural determinants of health disparities should be multilevel, including individual-, family-, community-, and population-level strategies.
Advancing Health Behavior Theory: The Interplay Among Theories of Health Behavior, Empirical Modeling of Health Behavior, and Behavioral Interventions
Leona S. Aiken
Intervention research aimed at modifying health behavior can go beyond merely assessing behavioral outcomes to characterizing the putative mechanisms by which interventions bring about behavior change. To characterize these mechanisms, a two-stage research program is required. The first stage involves the development and evaluation of a psychosocial model of the putative determinants of a particular health behavior. This may be a hybrid model that draws constructs from existing theories and models, and it may also integrate constructs from related areas of scholarship. The second stage involves translation of the psychosocial model into a multicomponent intervention to encourage behavior adoption. Here, each model construct is transformed into a component of the intervention and becomes a candidate mechanism by which the intervention may bring about behavior change. The intervention is evaluated in an experimental trial, followed by mediation analysis to examine putative linkages from the intervention to change on model constructs to change on behavior outcomes. This two-stage approach is illustrated with examples of health behaviors aimed at disease detection and prevention, at distal and proximal threats to health, and at private and public health-related behaviors. Examination of the putative mechanisms by which interventions bring about behavior change reverses the flow of information from health behavior model to intervention. Instead, the findings from health behavior interventions can lead to theoretical advances in our understanding of health protective behavior.
Wendy Berry Mendes and Keely A. Muscatell
This chapter provides an overview of how emotions can contribute to poorer health among stigmatized populations. First, it describes some of the primary affective responses that stigmatized individuals might experience, including externalizing emotions, uncertainty, and anxious affect. These affective responses can occur as a result of interacting with individuals who display subtle or overt signs of bias or perceiving a system as unfair, or they can occur from expectations based on prior experiences that shape perception. Second, this chapter reviews how these affective states may alter underlying biological processes to directly influence health. Finally, it examines indirect pathways whereby emotion processes potentiate health-damaging behaviors, such as poor eating habits, restless sleep, excessive alcohol and drug abuse, and risky behavior. Overall, research in this area suggests that affective experiences resulting from stigmatization can change biology and behavior in ways that can ultimately lead to poor health.
Shelley E. Taylor
Affiliation with others is a basic human coping response for managing a broad array of stressful circumstances. Affiliating with others is both psychologically and biologically comforting, and biologically may depend upon oxytocin and brain opioid pathways. The origins of affiliative responses to stress include early life experiences, genetic factors, and epigenetic processes that interact with the availability of supportive others during times of stress. The beneficial consequences of affiliation for mental and physical health are strong and robust. Future research will continue to clarify the underlying biopsychosocial pathways that explicate why this is the case.
Karen S. Rook, Susan Turk Charles, and Jutta Heckhausen
The biopsychosocial model of health views health and illness in old age as resulting not only from biological and physical factors but also from the cumulative effects of a lifetime of psychological, social, and behavioral processes. This model recognizes the biological trajectory of decline throughout the adult lifespan and the fact that physical changes increase older adults’ susceptibility to acute and chronic conditions. In addition, this model acknowledges that psychological and social processes interact over time with biological changes to influence physical functioning, onset and progression of disease, and adaptation to illness. The chapter is organized in three main sections. The first section emphasizes the biological component of the model, discussing trajectories of physical functioning and health in old age, including physical decline, morbidity, and mortality. The second section focuses on the psychosocial component of the biopsychosocial model, emphasizing psychosocial factors that influence physical health and functioning in old age. The chapter concludes by discussing two very different scenarios that researchers have projected for the health of future cohorts of older adults.
Kenneth J. Sher, Amelia E. Talley, Andrew K. Littlefield, and Julia A. Martinez
Heavy alcohol use in the general population, especially among late adolescents and young adults, is highly prevalent and associated with a range of adverse health outcomes, such as unintentional injury and sexually transmitted infections, as well as fetal injury in pregnant women. Although heavy consumption tends to decrease as individuals age, the cumulative effect of alcohol exposure increases risk for some forms of cancer, gastrointestinal disease, dementing illnesses, and other serious conditions. Alcohol use can also interfere with treatments for medical illnesses via drug interactions and poor compliance with prescribed treatments. Against this backdrop of considerable health burden associated with alcohol use in the population are findings that, at least among certain subgroups of the population, there are health benefits of moderate consumption. Additionally, alcohol use disorders (AUDs; alcohol abuse and alcohol dependence), are among the most prevalent mental disorders in the United States and elsewhere. AUDs are frequently comorbid with other psychological disorders which in themselves have important implications for health. A number of approaches to the prevention and treatment of problematic alcohol use have been developed and are effective. Some of these can be employed during primary care visits or other contacts with health professionals (e.g., emergency room visits).