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Adult Latina Drug Use & HIV Risks:
Clinical Implications from an Intergenerational
Study of Mothers & Daughters
Patria Rojas, Ph.D., M.P.H., M.S.W.
Frank R. Dillon, Ph.D.
Center for Research for Substance Use and HIV/AIDS
Research on Latinos in the United States (C-SALUD)
Florida International University
Prepared for: C-SALUD Bi-Annual conference, April 26, 2011
ACKNOWLEDGEMENTS This study was supported by award
number P20MD002288 from the National Institute on Minority Health and
Health Disparities. The content is solely the responsibility of the authors and
does not necessarily represent the official views of the National Institute on
Minority Health and Health Disparities, or the National Institutes of Health
.
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Road Map
 Why Study Adult Latina Mother-Daughter Drug
use and HIV/AIDS risk?
 Overview of Study Methods and Sample
 Main Findings
 Questions and Discussion
 How do study findings inform clinical services
for Latina women in Miami Dade county?
 Your recommendations for integrating findings
with community practice?
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Background
The Women’s Study
• Primary Study of The Latino Minority Drug
Abuse Research Program (NIDA
R24DA14260, Dr. Mario De La Rosa, PI)
• Foundation for Ongoing Longitudinal
Study - Trajectories of Drug Abuse and
HIV Risk among Latina Mother-Daughter
Dyads (NINR R01NR012150).
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Why Study Adult Latina MotherDaughter Drug use & HIV/AIDS risk?
 HIV/AIDS & Drug Abuse among Latinas in the U.S.
 Escalating health disparities
 Nationally, the rate of infection among Latina
women is nearly four times that of non-Latina
White women (CDC, 2010).
 HIV/AIDS is the 3rd leading cause of death
among Latina women in Florida age 25 - 44
years (Florida Department of Health-FDOH,
2011).
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Why Study Adult Latina MotherDaughter Drug use & HIV/AIDS risk?
 Latino illicit drug use rates have increased steadily since
2002 [Substance Abuse and Mental Health Services
Administration (SAMHSA), 2008].
 Latina adults also experience disparate negative
consequences from drug use disorders (Amaro et al.,
2006)
 Intimate partner violence
 Incarceration
 Homelessness
 Medical problems
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Why Study Adult Latina MotherDaughter Drug use & HIV/AIDS risk?
 Adult Latinas in the U.S.
 A vulnerable & understudied population in
the drug abuse and HIV/AIDS prevention
fields (Volkow, 2006).
 Risk & protective processes determining drug use
& HIV risk behaviors of adult Latinas remain
relatively unknown (Canino, 2004).
 The Women’s Study
 Aims to better understand potential risk &
protective processes by studying adult Latina
mother-daughter dyads
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What is Attachment?
Attachment
 A consistent emotional bond that an individual
experiences toward significant others such as
family, friends, and other important people in his
or her life (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby,
1969/1982, 1973).
 Secure attachment to parents, friends, and others
in adolescents and adults is associated with
psychological adjustment, school achievement,
and self-esteem (Armsden & Greenberg, 1987; Buhrmester,
1990; Bukowski, Hoza, Boivin, 1993; Hartup, 1996; Nickerson &
Nagle, 2004).
The Importance of Latina MotherDaughter Attachment
 Latina Mother-Daughter Attachment
 Armsden & Greenberg (1987) conceptualized attachment
beyond childhood (across all stages of development) to consist
of:
 Mutual trust of others
 Communication with others
 Closeness to others
 The Women’s Study was also guided by the Bogenschneider
(1996) ecological risk / protective model
 A theoretical perspective that emphasizes family
relations as the primary context for human development
across the lifespan
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The Importance of Latina MotherDaughter Attachment
 Supportive parent-child relations play a powerful positive
role in the lives of Latinos (De La Rosa & White, 2001;
Gonzalez Castro et al., 2007).
 E.g., Healthy family cohesion or familismo is associated
with Latina/o adult functioning and wellness across the
lifespan (Gil, 1996; Gil & Vega, 1996; Vega, Kolody, &
Valle, 1986; Rivera et al., 2008).
 We expected that mother-daughter attachment would be
inversely linked to drug abuse and HIV risk behaviors
among Latina mothers and their daughters.
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Overview of Study Methods
and Sample
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Methods
 Data collected from drug abusing and nonabusing mother-daughter dyads in MiamiDade via interviews from 2002-2005.
 Criteria for mothers & daughters to be
included into community-based study:
 consenting to be interviewed for at least 2-3 hours
 18 years old or older
 self-identifying as Latina
 living in Miami-Dade County, Fl.
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Methods
 Participants recruited via snowball
sampling method
(chain referral; McCracken et al., 1987)
 Non-drug abusing Latinas:
 community health fairs, health clinics, radio
announcements on local Spanish-language stations, and
advertisements on local television channels
 Drug abusing Latinas:
 substance abuse support groups such as Narcotics
Anonymous (NA) and Alcoholics Anonymous (AA) meetings
and by advertising in a local alternative newspaper, FM
radio station, and announcements posted at local drug
court program
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Methods
 All measures were pilot-tested to ensure cultural and
linguistic sensitivity to Latino culture and to women
 Interviews were conducted in either Spanish (65%) or
English (35%) by trained women interviewers using a
structured questionnaire
 The interview took 2-3 hours to complete, and took place
at locations convenient to participants.
 69% at home
 19% at university’s offices
 12% other places (work, public places)
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Methods
 316 mothers & daughters were interviewed
 On average, mothers were 52 years old (range of 33-88),
daughters were 28 years old (range of 18-48)
 Each participant was classified as a non-substance abuser
or substance abuser based on the following criteria:
 Alcohol abuser: at least 4-5 glasses of wine, 3-4 cans/bottles of
beer, or 3-4 four-ounce drinks of hard liquor per occasion-during
the 12 months prior to assessment (adapted from Naimi et al.,
2003)
 Illicit drug abuser: at least 3 days per week of marijuana use, 2
days per week of cocaine use, one or more occasions of heroin
use per week, and/or least 3 ecstasy use occasions per month
during the 12 months prior to assessment (adapted from Turner
et al., 2001)
 Abuse of prescribed medication: medicine use without a doctor’s
authorization, in larger amounts than prescribed, or for longer
periods than prescribed, in the 12 months prior to assessment
(adapted from Turner et al., 2001)
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Methods
 Mothers & daughters were classified into 4
types of dyads
 Dyad 1: mother-daughter both drug or alcohol
abusers (n=40)
 Dyad 2: mother-abuser and daughter–non-abuser
(n=19)
 Dyad 3: mother-non-abuser and daughter-abuser
(n=51)
 Dyad 4: mother-daughter both non-abusers (n=48)
 Total Dyads = 158
Top Drugs of Abuse
Mothers
Daughters
1. Alcohol Use (59.6%)
1. Alcohol Use (79.2%)
2. Non-medically
prescribed sedative
use (27.5%)
2. Marijuana Use
(35.8%)
3. Marijuana Use (8.1%)
3. Cocaine Use (12.8%)
4. Cocaine Use (6%)
4. Non-medical
prescription drugs
(12.2%)
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55.4
30
24.58
23.42
Age
40
30.67
Dyad 1 Both abusers (n=40)
28.86
47.95
50
46.67
60
55.43
Differences in Age across Dyads
20
10
0
Mothers
Daughters
Dyad 2 - Mother
abuser,
Daughter non-abuser
(n=19)
Dyad 3 - Mother non
abuser,
Daughter abuser
(n=51)
Dyad 4 - Both nonabusers (n=48)
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Demographics: Nativity
 Most mothers were immigrants (84%, n = 133)
 Approximately half of daughters (54%, n = 86)
were immigrants.
MOTHERS
Born in
the US
16%
Other
35%
DAUGHTERS
Cuba
15%
Cuba
31%
Colombia
18%
Colombia
10%
Born in the
US
54%
Other
21%
Countries of Origin Across Dyads
40
35
38
37
36
32
30
30
28
Caribbean
25
20
19 18
17
15
10
11
10
7
5
14
12
7
0
0
Dyad 1 Both abusers
(n=80)
Dyad 2 Mother
abuser,
Daughter
non-abuser
(n=38)
Central
America
South
America
USA
Dyad 3 - Dyad 4 - Both
Mother non non-abusers
abuser,
(n=96)
Daughter
abuser
(n=102)
Demographics and Drug Abuse
 Findings suggest that age and nativity
(acculturation) are related to adult Latina
drug abuse.
 Additional age related finding
 On average, the younger a drug abusing mother
started using illicit drugs (M = 26.5 years), the
younger her daughter reported starting using illicit
drugs (M = 18.4 years).
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Demographics: Personal Income
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 Personal Income during past year
 median = $5,000 to $9,999
Number of participants
 No significant difference across dyads
120
100
80
60
40
20
96
63
48
36
22
18
7
6
6
0
$0 to $5000 $10000 $15000 $20000 $25000 $30000 $40000 $50000
$4999
to
to
to
to
to
to
to
+
$9999 $14999 $19999 $24999 $29999 $34999 $44999
Demographics: Education Level
 Education Level
 Median = “post-high school training”
 No significant difference across dyads
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Percentage
30
25
20
32
28
20
16
15
10
4
5
0
less than HS HS diploma
post HS
training
Bachelor's
degree
Graduate
degree
22
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Demographics: Employment Status
 Current Employment Status
 No significant difference across dyads
60
Percentage
50
48.4%
51.6%
40
30
20
10
0
Unemployed
Employed
Demographics: Others
 Marital Status:
 41% of mothers married
 29% of daughters married
 No significant difference across dyads
 Separation from Mother
 Approximately 18% of daughters were
separated from mothers during development
 A control variable
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Main Results
Main Results
Mother-Daughter Attachment &
Drug Abuse (De La Rosa et al., 2010)
120
100
80
98.27
81.53
80.51
94
96.39
95.89
94.19
91.44
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Mothers'
Attachment
40
20
0
Dyad 1 Both
abusers
(n=80)
Dyad 2 Dyad 3 Dyad 4 Mother
Mother non Both nonabuser,
abuser,
abusers
Daughter
Daughter
(n=96)
non-abuser
abuser
(n=38)
(n=102)
Daughters'
Attachment
Mother-Daughter Attachment &
Drug Abuse (De La Rosa et al., 2010)

IMPLICATIONS:

Mother-daughter attachment & drug
abuse findings emphasize the need for
mother-daughter-based
prevention/treatment efforts;
especially with drug abusing mothers,
to reduce potential intergenerational
transmission of drug use disorders
among Latina women.
Mother-Daughter Attachment & HIV
Risk Behaviors (De La Rosa et al., 2010)
 Sex Under the Influence (SUI)

61% of daughters engaged in SUI of
alcohol during past year

28% reported engaged in SUI of illicit
drugs during past year
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Mother-Daughter Attachment & HIV
Risk Behaviors (De La Rosa et al., 2010)
 Sex under the Influence of Illicit
Drugs (SUI-D)
 Drug abusing daughters with a
drug abusing mother (dyad 1)
reported more SUI-D.
 Daughters who reported less
attachment reported more SUI-D.
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Mother-Daughter Attachment & HIV
Risk Behaviors (De La Rosa et al., 2010)
 Sex under the Influence of Alcohol
(SUI-A)
 Younger daughters reported more SUI-A.
 Unmarried daughters (81%) reported more
SUI-A.
 Non-abusing daughters with non-abusing
mothers (Dyad 4) reported less sex
under the influence of alcohol than all
other dyads.
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Mother-Daughter Attachment & HIV
Risk Behaviors (De La Rosa et al., 2010)

IMPLICATIONS:

Attachment and SUI findings
emphasize the need for motherdaughter-based prevention/treatment
efforts; especially with drug abusing
mothers, to reduce HIV risk behaviors
among young Latina women.
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Age of Sexual Debut (Dillon et al.,
2010; Rojas et al., 2010)
 Averages among Daughters:
 Vaginal Sex = 16 years
 Oral Sex = 17 years
 Anal Sex = 22 years
 Daughters reported younger ages of sexual debut when
they
 spent more time in the U.S. (M= 65% of life)
 experienced maternal drug abuse during development.
 The younger daughters started having sex, the more likely
they reported
 Future drug abuse and HIV risk behaviors (greater number of
sexual partners, sex under the influence) as adults.
 IMPLICATIONS: These findings inform HIV/AIDS and drug abuse
clinical services with Latina population in Miami-Dade County.
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Condom Use Among Latinas
 133 women engaged in vaginal sex and were told about HIV
by their healthcare providers.
 75% of the participants used condoms sometimes
 Reasons they did not use condoms in instances:
 Wanted pregnancy
 Condoms were not available
 They were in a monogamous relationship and trusted
partners.
 Reasons women used condoms in instances:
 They were with a new partner
 To prevent STDs and HIV
 Because they were available
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4.48
4.48
4.48
Does not feel at risk
of STDs
Ttrust/No
contraceptive
needed
7.46
Careless/ negligence
7.46
Never used it before
10.45
Does not like it
Partner does not like
it/ want
Contraceptive
reasons
50
45
40
35
30
25
20
15
10
5
0
Trust/ monogamous
relationship
Percentage
Condom Use Among Latinas
Reasons why participants never used
condoms during vaginal sex.
43.28
16.42
Condom Use Among Latinas
Reasons for using condoms all the time
during vaginal sex
HIV/STD protection
4%
STD/ contraceptive
4%
8%
8%
Uses routinely
48%
Contraceptive
New partner
28%
Because HIV+ status
Condom Use Among Latinas
Implications:
 Latinas associate condoms with distrust
in a relationship or partner.
 Latinas believe that being in a
monogamous relationship means that
they are not at risk of acquiring HIV or
other STIs.
 Married or women with a main partner
were less likely to use condoms.
Questions & Discussion
 Implications of study findings for
clinical services for Latina women in
Miami Dade county?
 Recommendations for integrating
findings with community practice?
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