The Role of Acculturation in the Relation Between Intimate Partner Violence and Substance Misuse Among IPV-victimized Hispanic Women in the Community

Abstract

Hispanic women in the United States are disproportionately affected by intimate partner violence (IPV). One correlate of IPV among Hispanic women with important public health implications is substance misuse. However, limited research has identified culturally relevant factors that may impact the strength of the IPV-substance misuse association in this population. The present study examined the moderating role of acculturation in the relation between IPV types (i.e., physical, psychological, and sexual) and substance (i.e., alcohol and drug) misuse. Participants were 150 IPV-exposed Hispanic women in the community (M age = 35.13). IPV types, substance misuse outcomes, and acculturation were significantly and positively correlated with each other at zero-order. Moderation analyses indicated that the relations between IPV and substance misuse were stronger among Hispanic women with higher (vs. lower) levels of acculturation. These findings suggest the potential utility of considering acculturation when assessing and treating substance misuse among IPV-exposed Hispanic women.

Keywords

intimate partner violence domestic violence acculturation substance misuse alcohol misuse drug misuse

In the past 30 years, the Hispanic population in the United States has experienced exponential growth, more than doubling in size (22.6 million in 1990 to 57.5 million in 2016) and accounting for almost half of the population growth since 2000 (Flores, 2017; Krogstad 2016). Currently representing 17.8% of the United States population, the Hispanic population is expected to increase by approximately 86% between 2018 and 2060 (U.S. Census Bureau, 2018). Notably, although epidemiological studies suggest that rates of substance use among Hispanic individuals are comparable to, if not less than, those of non-Hispanic Whites (McCabe et al., 2007; Substance Abuse and Mental Health Services Administration [SAMHSA], 2012, 2015; Thompson & Kingree, 2006; Wallace et al., 2002), Hispanic individuals who use substances have generally been found to experience greater substance-related problems than non-Hispanic Whites (Haiman et al., 2006; Jones-Webb & Karriker-Jaffe, 2013; Pedersen et al., 2012; Wu et al., 2014). This includes higher rates of substance use disorders (McCabe et al., 2017), greater social consequences (Mulia et al., 2009), and more legal problems (Zapolski et al., 2014). It is therefore critical that research identify risk factors for substance misuse among Hispanic individuals. Such findings may inform substance misuse prevention and intervention efforts tailored to the unique needs of Hispanic individuals.

An association between intimate partner violence (IPV) and substance misuse has been well-documented in the literature (Devries et al., 2014; Foran & O’Leary, 2008; Graham et al., 2011; Waller et al., 2012), including among Hispanic individuals (Caetano et al., 2001b, 2005; Cummings et al., 2013; Gonzalez-Guarda et al., 2011a). Hispanic women experience lower or equivocal rates of IPV compared to their Black and White racial and ethnic counterparts (Black et al., 2011; Cho, 2012), with one larger epidemiological study reporting 37.1%, 43.7%, and 34.6% of Hispanic, non-Hispanic Black, and non-Hispanic White women, respectively, had experiences of rape, physical violence, and/or stalking by an intimate partner in their lifetime (Black et al., 2011). However, Hispanic women have been found to be disproportionately affected by the sequelae of IPV (Sabina et al., 2015). Indeed, Hispanic IPV-exposed women exhibit higher rates of negative physical (Bonomi et al., 2009) and psychological (Cuevas et al., 2010) health consequences of IPV compared to non-Hispanic IPV-exposed women, including the highest rate of partner homicide, with 27%, 32.7%, and 70.5% greater odds for non-Hispanic White, non-Hispanic Black, and Hispanic women, respectively (Swatt & Sabina, 2013). One of the most common issues experienced by IPV-exposed Hispanic women is substance misuse (Gonzalez-Guarda et al., 2011b; Hazen & Soriano, 2007; Jennings et al., 2012; Newcomb & Carmona, 2004). Of note, existing research and conceptual frameworks suggest that the relation between IPV and substance misuse may be bidirectional in nature (Foran & O’Leary, 2008). Specifically, the self-medication model suggests that earlier experiences of IPV may increase later substance misuse, such that IPV-victimized women may use substances to cope with trauma and related distress (Khantzian, 1997). Alternatively, the alcohol myopia model posits that substance misuse may facilitate IPV by resulting in impairments in cognitive processing that narrow attention to immediate versus long-term consequences within specific contexts (Steele & Josephs, 1990).

There are a limited number of studies that have examined the influence of culturally relevant factors in the relation between IPV and substance misuse; this is an important avenue for future research. Past research has suggested that cultural factors (e.g., birthplace, acculturation) can have a tremendous impact on substance-related outcomes for Hispanic individuals (Caetano et al., 2009). Acculturation is one cultural factor that may play a critical role in the relation between IPV and substance misuse. Acculturation is a sociocultural process in which members from one cultural group adopt the behaviors and beliefs of another cultural group (Hazuda et al., 1988; Lopez-Class et al., 2011). An individual that has a high level of acculturation usually demonstrates behaviors and beliefs that are more aligned to the mainstream culture they live in (e.g., prefers speaking English in different social settings; adopts modern views on gender roles; displays help seeking behaviors). Past literature has shown that a high level of acculturation can have a negative impact on the health of Hispanic individuals living in the United States (Caetano et al., 2008; Lara et al., 2005). Regarding substance misuse in particular, high acculturation among Hispanics has been associated with substance-related outcomes, such as greater volume of drinking and binge drinking (Alvarez et al., 2004; Vaeth et al., 2012); more illicit drug use (Alvarez et al., 2007; Gonzalez-Guarda et al., 2011b; Miller, 2011); and elevated rates of alcohol and drug use disorders (Alvarez et al., 2004, 2007; Caetano et al., 2007, 2008; Gonzalez-Guarda et al., 2011b). Although the specific mechanisms through which acculturation is related to substance misuse are not fully understood, several hypotheses have been proposed in the literature. For instance, it has been suggested that acculturation produces a general effect of liberalizing norms and attitudes towards drinking, which in turn lead to increased drinking patterns (Caetano et al., 2007; Gonzalez-Guarda et al., 2011b; Vaeth et al., 2012). Additionally, acculturation has been identified as a complex process involving difficult daily challenges, such as adapting to new cultural norms and learning a new language. This process can produce intense psychosocial strain on an individual, which could then lead to increased drinking as a coping mechanism (Caetano et al., 2007; Gonzalez-Guarda et al., 2011b; Vaeth et al., 2012). This literature underscores the need for additional research on the relation between acculturation and substance misuse among IPV-victimized Hispanic women.

Indeed, acculturation has been linked to IPV among Hispanic women in the United States (Alvarez & Fedock, 2018; Caetano et al., 2007; Newcomb & Carmona, 2004; Sabina et al., 2013). Specifically, high acculturation has been associated with greater intensity, frequency, and type of IPV among Hispanic women (Alvarez & Fedock, 2018; Caetano et al., 2000; Cummings et al., 2013; Garcia et al., 2005; Martin & Garcia, 2011; Moreno et al., 2011). Hispanics who have a high level of acculturation may experience additional life stressors (e.g., nontraditional work arrangements, an unwillingness to adhere to traditional beliefs) that increase the incidence of IPV (Kantor et al., 1994). For instance, a high level of acculturation among Hispanic women may increase risk for IPV due to heightened conflict related to changes in cultural identity and gender norms (Lewis et al., 2005). Indeed, it has been shown that as Hispanic women seek employment opportunities, their sense of empowerment is strengthened, which can cause conflict within their partnership as both members negotiate the division of labor and power (Gonzalez-Guarda et al., 2009; Grzywacz et al., 2009). Studies have also found that highly acculturated Hispanic women may be sexualized, for example viewed as permissive, and that this could heighten their risk for sexual victimization (Ahrens et al., 2010; Suárez-Orozco & Suárez-Orozco, 2001). These findings suggest that acculturation may be particularly salient among IPV-victimized Hispanic women.

In summary, previous studies have shown evidence of associations among IPV, acculturation, and substance misuse, separately. Extending on existing research, the current study examined whether acculturation attenuates (i.e., moderates) the relations between IPV types (i.e., physical, psychological, and sexual victimization) and substance misuse (i.e., alcohol and drug). Referencing prior literature examining associations among IPV, acculturation, and substance misuse, we hypothesized that the associations between IPV types and alcohol and drug misuse would be strongest amongst Hispanic women who reported higher (vs. lower) levels of acculturation.

Methods

Participants

The current study utilized a subsample of women who identified as Hispanic (n = 150) from a larger sample of community women reporting physical victimization by their current male intimate partner in the past 30 days (N = 412). Inclusion criteria for the larger study were the following: (a) female sex; (b) current involvement in a heterosexual intimate relationship of at least six months duration; (c) a woman’s commission of at least one act of physical aggression against her male partner within the past six months; (d) age 18 to 65; (e) residency in the greater urban area; and (f) household income of less than $50,000 (determined a priori to methodologically control for the differential resources associated with higher income).

The average age of participants was 35.13 years (SD = 10.08), with a range of 18 to 65 years. Most women (32%) worked part-time for over a month prior to the study; 28% were unemployed, 20.7% worked full-time, 18% were unable to work, and 1.3% were not working because they were students. Mean level of education was 12.43 years (SD = 2.36); 24% of the women did not complete high school, 46% completed a high school degree or equivalent, 21.4% had some education beyond high school, and 8.6% had an advanced degree. Approximately one-third (38.7%) of women reported a yearly family income between $10,000 and $19,999, whereas 32% reported earning less than $10,000, 18.7% reported between $20,000 and $29,999, 7.3% reported between $30,000 and $39,999, and 3.3% reported between $40,000 and $49,999. Less than half (39.3%) of the sample were married, 38% were unmarried and cohabitating with their partners, 20.7% were in a dating relationship but lived apart, and 2% were separated or divorced from their partners. Mean years in the current relationship was 9.39 (SD = 2.08). (See Table 1 for Sample Characteristics).

Procedure

Data were collected as part of a larger study examining women’s use of aggression in heterosexual relationships. All procedures were reviewed and approved by Yale University’s Institutional Review Board. Recruitment materials (i.e., English- and Spanish-language fliers, brochures, and posters that included a study telephone number) were posted in multiple community locations (e.g., health care clinics, churches, grocery stores). Individuals who were interested in learning more about and/or participating in this study called the study telephone number for more information. Eligibility was determined utilizing a phone screening procedure (see Inclusion Criteria in Participants). Women who met the screening criteria were interviewed individually by female interviewers of the same race/ethnicity. Following informed consent, participants completed a semistructured, computer-assisted interview administered by trained master- or doctoral-level female research associates or postdoctoral fellows in private offices to protect participants’ safety and confidentiality. Hispanic participants were interviewed by a bilingual/bicultural interviewer and had the option of being interviewed in Spanish. After completion of the interview, participants were debriefed, remunerated $50, and provided with a list of community resources.

Measures

Physical IPV. Physical IPV was measured by the Revised Conflict Tactics Scale (CTS-2; Straus et al., 2003). A six-month time period was used. Response options were: 0 (never), 1 (once in the past 6 months), 2 (twice in the past 6 months), 4 (3–5 times in the past 6 months), 8 (6–10 times in the past 6 months), 11 (more than 10 times in the past 6 months), and 0 (not in the past 6 months but it happened before). The 12 physical victimization items were summed to create a total physical IPV score. Cronbach’s α in the current study was .88.

Psychological IPV. Psychological IPV was measured by six items from the CTS-2 emotional-verbal scale (Straus et al., 2003), fourteen items from the Psychological Maltreatment of Women—Short version (PMWI-S; Tolman, 1999), and one item to assess stalking (“Has your partner followed you out of the house to check on what you were doing?”; Basile & Hall, 2011). Both the CTS-2-emotional-verbal scale and PMWI-S were included because they each measure different dimensions of psychological IPV (the CTS-2 assesses psychological aggression; the PMWI-S assesses dominance/isolation). In order to obtain a comprehensive assessment of psychological IPV, we used items from the CTS-2 emotional-verbal abuse scale that did not overlap with the PMWI-S. The full PMWI-S scale was used. A six-month time period was used to assess psychological IPV. The 21 psychological victimization items were summed to create a total psychological IPV score. Cronbach’s α in the current study was .85.

Sexual IPV. Sexual IPV was measured by the 10-item Sexual Experiences Survey (SES; Koss & Oros, 1982). This measure assesses sexual victimization more comprehensively than the CTS-2 (the CTS-2 does not measure sexual coercion using drugs or alcohol). The 1982 version of the SES requires a fairly high reading level and has been utilized primarily with college populations. To make sure that participants were able to understand items within this measure, item wording was simplified, consistent with Testa et al., 2004. A six-month time period was used to assess sexual IPV. CTS-2 response options were used. The 12 sexual victimization items were summed to create a total sexual IPV score. Cronbach’s α in the current study was .90.

Acculturation. Acculturation was measured by the 12-item Short Acculturation Scale for Hispanics (SASH; Marin et al., 1987). This self-report measure assesses level of acculturation on three factors: (a) Language Use; (b) Media; and (c) Ethnic Social Relations. The Language Use factor assesses proficiency/preference for speaking in a given language depending on the setting (e.g., “What language(s) do you usually speak at home?”). The Media Factor assesses preference for consuming English/Spanish language media (e.g., “In what language(s) are the T.V. programs you usually watch?”). The responses for these two factors were on a 5-point Likert scale in which options ranged from 1 (“Only Spanish”) to 5 (“Only English”). The Ethnic Social Relations factor assesses the preferred ethnicity of those an individual interacts with on a daily basis (e.g., “You prefer going to social gatherings/parties at which people are?”). The responses for this factor were on a 5-point Likert scale in which options ranged from 1 (“All Latinos/Hispanics”) to 5 (“All non-Latinos/non-Hispanics”). A continuous acculturation score was obtained by summing all items, with higher scores indicating higher levels of acculturation. Cronbach’s α in the current study was .88.

Drug misuse. The Drug Abuse Screening Test (DAST; Skinner, 1982) is a 10-item self-report questionnaire designed to assess drug misuse. Items assessed the presence of problems related to participants’ drug use, such as regret, illegal activities, or occupational/relational problems. Participants can respond to each item by choosing 1 (yes) and 0 (no) options. A total drug misuse score was obtained by summing all items, with higher scores indicating greater drug misuse. Cronbach’s α in the current study was .92.

Alcohol misuse. The Alcohol Use Disorder Identification Test (AUDIT; Saunders et al., 1993) is a 10-item self-report measure that assesses alcohol consumption, adverse reactions to drinking, alcohol-related problems, and drinking behaviors. Participants rated each item using a 5-point Likert-type scale (0 = never, 4 = daily or almost daily). An alcohol misuse score was obtained by summing all items, with higher scores indicating a greater alcohol misuse. Cronbach’s α in the current study was .84.

Analytic Plan

Descriptive data was calculated. Next, Pearson product–moment correlations between the primary study variables were evaluated. Finally, to address the question of whether IPV types (i.e., physical, psychological, or sexual), acculturation, and their interaction are associated with alcohol and drug misuse, six moderation analyses were conducted with the PROCESS SPSS macro (Hayes, 2013). The PROCESS procedures utilize ordinary least squares regression and bootstrapping methodology, which confers more statistical power than standard approaches to statistical inference and does not rely on distributional assumptions (Edwards & Lambert, 2007; Wiedemann et al., 2009). Bootstrapping was done with 1,000 random samples generated from the observed covariance matrix to estimate bias-corrected 95% confidence intervals and significance values. Following the methods described by Aiken and West (1991), we plotted regression lines one standard deviation above and below mean levels of acculturation and substance misuse (i.e., alcohol, drug) in Hispanic participants. Follow-up analyses were to examine whether the slopes of the regression lines differed significantly from zero.

Results

Descriptive Data

Most women disclosed experiencing psychological (98.7%) and physical (87.3%) IPV in the past six months; almost half (43.3%) disclosed sexual IPV. Further, 56.0% and 28.0% of women reported symptoms consistent with alcohol and drug misuse, respectively. The mean level of acculturation in the current sample was 32.22 (SD = 8.08). Most women reported that they were not born in the United States (96.0%) and that their average length of time living in the United States was 15.27 years (SD = 12.08).

Correlations Among IPV Types, Substance Misuse, and Acculturation

IPV types (i.e., physical, psychological, and sexual), substance misuse (i.e., alcohol and drug misuse), and acculturation were significantly and positively correlated with each other with two exceptions: the associations between psychological IPV and drug misuse and sexual IPV and acculturation were nonsignificant (See Table 2).

Table 1.

Sample Characteristics.

Total Sample (N = 150)
	M, SD, Range	n (%)
Age	35.13, 10.08, 17–46
Relationship Status
Married		59 (39.3%)
Unmarried (Living with Partner)		57 (38.0%)
Separated or Divorced		3 (2.0%)
Dating (Not Living with Partner)		31 (20.7%)
Length of Partnership	9.39, 2.08, 1–35
10 months up to 1 Year		4 (2.7%)
Over 1 year up to 2 years		13 (8.7%)
Over 2 years up to 3 years		16 (10.7%)
Over 3 years up to 4 years		15 (10.0%)
Over 4 years up to 5 years		20 (13.3%)
Over 5 years up to 10 years		37 (24.7%)
Over 10 years up to 15 years
Over 15 years up to 20 years
Over 20 years
Born in U.S.
Yes		6 (0.4%)
No		144 (96.0%)
Length of residence in U.S.	15.27, 12.08, 1–50
Ethnic background
Argentina		2 (1.3%)
Brazil		2 (1.3%)
Chile		1 (0.7%)
Colombia		11 (7.3%)
Cuba		2 (1.3%)
Dominican Republic		3 (2.0%)
Ecuador		5 (3.3%)
El Salvador		1 (0.7%)
Guatemala		6 (4.0%)
Mexico		17 (11.3%)
Paraguay		1 (0.7%)
Peru		4 (2.7%)
Puerto Rico		80 (53.3%)
Uruguay		1 (0.7%)
Venezuela		8 (5.3%)
Employment status
Unemployed		42 (28.0%)
Unable to work		27 (18.0%)
Part-time		48 (32.0%)
Full-time		31 (20.7%)
Not working (full-time student)		2 (1.3%)
Income
Less than $10,000		48 (32.0%)
$10,000 to $19,999		58 (38.7%)
$20,000 to $29,999		28 (18.7%)
$30,000 to $39,999		11 (7.3%)
$40,000 to $49,999		5 (3.3%)
$50,000 to $59,999		0 (0%)
$60,000 to $69,999		0 (0%)
$70,000 and over		0 (0%)
Education status
High school		77 (51.3%)
GED		19 (12.7%)
Vocational		10 (6.7%)
Some college		22 (14.7%)
Finished college		11 (7.3%)
Postgraduate		2 (1.3%)
Victimization
Physical IPV		131 (87.3%)
Psychological IPV		148 (98.7%)
Sexual IPV		63 (43.3%)
Perpetration types
Physical IPV		149 (99.3%)
Psychological IPV		149 (99.3%)
Sexual IPV		19 (12.7%)
Substance misuse
Alcohol misuse		84 (56.0%)
Drug misuse		42 (28.0%)
Alcohol and drug misuse		98 (65.3%)

Note. IPV = intimate partner violence. GED = general education development.

Role of Acculturation in the Relations between IPV Types and Substance Misuse

A moderation analysis examined the main and interactive effects of physical victimization and acculturation on drug misuse (See Table 3). The overall model was significant. The main effect for physical victimization was significant, B = –0.11, SE = 0.04, t = –3.03, p ≤ .001, 95% CI: [–0.18, –0.04]. The main effect for acculturation was nonsignificant, B = 0.01, SE = 0.03, t = 0.22, p = .82, 95% CI: [–0.05, 0.60]. Consistent with study hypotheses, the interaction between physical victimization and acculturation was significant, B = 0.004, SE = 0.001, t = 4.28, p ≤ .001, 95% CI: [0.002, 0.01]. Analysis of simple slopes revealed that physical victimization was significantly related to drug misuse when the level of acculturation is high (+1 SD), B = 0.06, SE = 0.01, t = 5.94, p ≤ .001, 95% CI: [0.04, 0.08], but not low (–1 SD), B = –0.01, SE = 0.01, t = –0.74, p = .46, 95% CI: [–0.04, 0.02].

Table 2.

Intercorrelations Among IPV Types, Substance Misuse, and Acculturation.

	1	2	3	4	5	6	M	SD
1. Psychological IPV	–	–	–	–	–	–	76.11	41.21
2. Physical IPV	.63**	–	–	–	–	–	15.20	20.42
3. Sexual IPV	.50**	.49**	–	–	–	–	5.97	13.38
4. Drug misuse	.15	.36**	.19*	–	–	–	0.85	2.46
5. Alcohol misuse	.34**	.36**	.25**	.63**	–	–	2.01	3.83
6. Acculturation	.25**	.16*	.09	.25**	.24**	–	32.22	8.08

Note. IPV = intimate partner violence. *p < .05. **p < .01.

Table 3.

Moderation Analyses Examining Intimate Partner Violence Types, Acculturation, and Alcohol and Drug Misuse.

	B	SE	t	p	95% CI	R ²	F
Model with physical IPV as predictor of drug misuse						0.28	18.71*
Physical IPV	–0.11	0.04	–3.03*	<.001	[–0.18, –0.04]
Acculturation	0.01	0.03	0.22	.82	[–0.05, 0.06]
Physical IPV × acculturation	0.004	0.001	4.28*	<.001	[0.002, 0.01]
Model with psychological IPV as predictor of drug misuse						0.14	8.00*
Psychological IPV	–0.04	0.02	–2.31*	.02	[–0.08, –0.01]
Acculturation	–0.03	0.05	–0.66	.51	[–0.12, 0.06]
Psychological IPV × acculturation	0.001	0.001	2.78*	.01	[.0004, .003]
Model with sexual IPV as predictor of drug misuse						0.14	8.01
Sexual IPV	–0.08	0.05	–1.70	.09	[–0.18, 0.01]
Acculturation	0.06	0.02	2.28*	.02	[0.01, 0.11]
Sexual IPV × acculturation	0.003	0.001	2.34*	.02	[0.001, 0.01]
Model with physical IPV as predictor of alcohol misuse						0.22	13.68*
Physical IPV	–0.15	0.06	–2.72*	.01	[–0.26, –0.04]
Acculturation	–0.01	0.04	–0.36	.72	[–0.10, 0.07]
Physical IPV × acculturation	0.01	0.002	3.86*	<.001	[0.003, 0.01]
Model with psychological IPV as predictor of alcohol misuse						0.15	8.57*
Psychological IPV	–0.03	0.03	–1.09	.28	[–0.09, 0.02]
Acculturation	–0.05	0.07	–0.76	.45	[–0.19, 0.08]
Psychological IPV × acculturation	0.002	0.001	2.11*	.04	[0.0001, 0.003]
Model with sexual IPV as predictor of alcohol misuse						0.10	5.28
Sexual IPV	–0.06	0.08	–0.74	.46	[–0.21, 0.10]
Acculturation	0.07	0.04	1.71	.09	[–0.01, 0.14]
Sexual IPV × acculturation	0.003	0.002	1.44	.15	[–0.001, 0.01]

Note. *p < .05.

A moderation analysis examined the main and interactive effects of psychological victimization and acculturation on drug misuse. The overall model was significant. The main effect for psychological victimization was significant, B = –0.04, SE = 0.02, t = –2.31, p = .02, 95% CI: [–0.08, –0.01]. The main effect for acculturation was nonsignificant, B = –0.03, SE = 0.05, t = –0.66, p = .51, 95% CI: [–0.08, –0.01]. Consistent with study hypotheses, the interaction between psychological victimization and acculturation was significant, B = 0.001, SE = 0.001, t = 2.78, p = .01, 95% CI: [0.0004, 0.003]. Analysis of simple slopes revealed that psychological victimization was significantly related to drug misuse when the level of acculturation is high (+1 SD), B = 0.02, SE = 0.01, t = 2.82, p = .01, 95% CI: [0.01, 0.03], but not low (–1 SD), B = –0.01, SE = 0.01, t = –1.05, p = .29, 95% CI: [–0.02, 0.01].

A moderation analysis examined the main and interactive effects of sexual victimization and acculturation on drug misuse. The overall model was significant. The main effect for sexual victimization was nonsignificant, B = –0.08, SE = 0.05, t = –1.70, p = .09, 95% CI: [–0.18, 0.01]. The main effect for acculturation was significant, B = 0.06, SE = 0.02, t = 2.28, p = .02, 95% CI: [–0.01, 0.11]. Consistent with study hypotheses, the interaction between sexual victimization and acculturation was significant, B = 0.003, SE = 0.001, t = 2.34, p = .02, 95% CI: [0.001, 0.01]. Analysis of simple slopes revealed that sexual victimization was significantly related to drug misuse when the level of acculturation is high (+1 SD), B = 0.04, SE = 0.01, t = 2.90, p = .004, 95% CI: [0.01, 0.07], but not low (–1 SD), B = –0.01, SE = 0.02, t = –0.47, p = .64, 95% CI: [–0.05, 0.03].

A moderation analysis examined the main and interactive effects of physical victimization and acculturation on alcohol misuse. The overall model is significant. The main effect for physical victimization was significant, B = –0.15, SE = 0.06, t = –2.72, p = .01, 95% CI: [–0.26, –0.04]. The main effect for acculturation was nonsignificant, B = –0.01, SE = 0.04, t = –0.36, p = .72, 95% CI: [–0.10, 0.07]. Consistent with study hypotheses, the interaction between physical victimization and acculturation was significant, B = 0.01, SE = 0.002, t = 3.86, p ≤ 0.001, 95% CI: [0.003, 0.01]. Analysis of simple slopes revealed that physical victimization was significantly related to alcohol misuse when the level of acculturation is high (+1 SD), B = 0.08, SE = 0.02, t = 5.37, p ≤ .001, 95% CI: [0.05, 0.11], but not low (–1 SD), B = –0.02, SE = 0.02, t = –0.66, p = .51, 95% CI: [–0.06, 0.03].

A moderation analysis examined the main and interactive effects of psychological victimization and acculturation on alcohol misuse. The overall model is significant. The main effect for psychological victimization was nonsignificant, B = –0.03, SE = 0.03, t = –1.09, p = .28, 95% CI: [–0.09, 0.02]. The main effect for acculturation was nonsignificant, B = –0.05, SE = 0.07, t = –0.76, p = .45, 95% CI: [–0.19, 0.08]. Consistent with study hypotheses, the interaction between psychological victimization and acculturation was significant, B = 0.002, SE = 0.001, t = 2.11, p = .04, 95% CI: [0.0001, 0.003]. Analysis of simple slopes revealed that psychological victimization was significantly related to alcohol misuse when the level of acculturation is high (+1 SD), B = 0.04, SE = 0.01, t = 4.13, p ≤ .001, 95% CI: [0.02, 0.06], but not low (–1 SD), B = 0.01, SE = 0.01, t = 0.93, p = .35, 95% CI: [–0.01, 0.03].

A moderation analysis examined the main and interactive effects of sexual victimization and acculturation on alcohol misuse. The overall model was not significant. The main effect for sexual victimization was nonsignificant, B = –0.06, SE = 0.08, t = –0.74, p = .46, 95% CI: [–0.21, 0.10]. The main effect for acculturation was nonsignificant, B = 0.07, SE = 0.04, t = 1.71, p = .09, 95% CI: [–0.01, 0.14]. Inconsistent with study hypotheses, the interaction between sexual victimization and acculturation was not significant, B = 0.003, SE = 0.002, t = 1.44, p = .15, 95% CI: [–0.001, 0.01].

Secondary Analyses

There was a significant and positive correlation between length of residence in the United States and acculturation (r [138] = 0.48, p < .001), such that the longer Hispanic women in this sample resided in the United States, the more acculturated they were likely to be. Moderation analyses were reran adjusting for length of residence in the United States. The strength and direction and the interactions in each of these models remained the same.

Discussion

The goal of the present study was to better understand the associations among IPV types, acculturation, and substance misuse among IPV-victimized Hispanic women. Specifically, we aimed to further clarify the role of acculturation in the relations between physical, psychological, and sexual IPV and alcohol and drug misuse. Partially consistent with study hypotheses, we found that the associations between physical and psychological (but not sexual) victimization and alcohol misuse were stronger among IPV-victimized Hispanic women who disclosed a high (vs. a low) level of acculturation. Additionally, we found that the relations between each of the IPV types (i.e., physical, psychological, and sexual) and drug misuse were stronger among IPV-victimized Hispanic women who disclosed a high (vs. a low) level of acculturation. Although preliminary, these findings demonstrate the potential utility of considering acculturation when understanding and treating alcohol misuse among IPV-victimized Hispanic women if replicated using longitudinal methods.

There is a well-established association between IPV and substance misuse among Hispanic individuals (Caetano et al., 2007, 2008; Chartier & Caetano, 2010; Jennings et al., 2012). It has been suggested that substances may be used as a coping mechanism to deal with stressors related to acculturation (e.g., changes in gender norms, difficulty learning a new language, and unemployment; Lewis et al., 2005). Highly acculturated Hispanics may be more likely to use substances to cope because they exhibit greater normative approval of substance use and higher rates of substance use (Marsiglia et al., 2005). Additionally, through English language acquisition, highly acculturated Hispanic individuals may have broader social networks, thereby increasing access to substances (Warner et al., 2006). Indeed, highly acculturated Hispanic individuals have been found to be more likely to turn to substances to cope, whereas their less acculturated counterparts rely on other methods of coping (e.g., religion [Farley et al., 2005]). Although these findings are preliminary in nature and limited through the use of a cross-sectional design, they extent the extant literature and highlight potential avenues for future research and practice. Investigations that examine the role of acculturation in the IPV-substance misuse relation utilizing longitudinal designs are needed to confirm the current findings.

Regarding the specific implications for treatment, our results underscore the potential utility of assessing acculturation among IPV-victimized Hispanic women as a means of identifying risk for substance misuse. Specifically, preliminary findings indicate that women high in acculturation would benefit the most from prevention and intervention efforts aimed at reducing substance misuse. Importantly, Sabina et al. (2013) found that Hispanic women who disclosed a higher level of acculturation showed a greater likelihood for demonstrating help seeking behaviors. Moreover, these individuals were more likely to seek treatment for substance misuse because they were better able to navigate health and legal systems due to fewer language barriers (Cuevas et al., 2014) and greater awareness about one’s rights and access to treatment (Alvarez & Fedock, 2018; Brabeck & Guzman, 2009). Additionally, our results highlight the potential utility of integrating culturally specific intervention techniques into treatments for IPV-victimized Hispanic women who misuse substances. These interventions could strengthen traditional cultural factors such as faith, community ties, and importance of family as a means of preventing or reducing substance misuse among IPV-victimized Hispanic women. Indeed, recent research emphasizes the importance of addressing positive aspects of Hispanic culture in the development of programs addressing concerns for this population (Arciniega et al., 2008; Gonzalez-Guarda et al., 2010). Studies have indicated that traditional Hispanic cultural attributes, such as community support networks, faith/spirituality, familial influence, could be protective factors in preventing negative health outcomes among Hispanic women (de las Fuentes et al., 2003; Gonzalez-Guarda et al., 2010, 2011b, 2013; Harris et al., 2005). Given the findings of the current study, future research is needed to further examine the effects of interventions that incorporate specific cultural factors, including an emphasis on support from extended family and interpersonal relationships (Alvarez et al., 2007), positive aspects of traditional culture norms (e.g., honoring/respecting women [Gonzalez-Guarda et al., 2013]), and cultural considerations in the delivery of substance abuse services (Alvarez et al., 2007; Porter, 1999).

Inconsistent with our other findings, the strength of the association between sexual victimization and alcohol misuse was not found to significantly vary as a function of level of acculturation among IPV-victimized Hispanic women. It may also be that other factors play a more critical role in the sexual IPV-alcohol misuse relation. Indeed, research suggests that the correlates of sexual IPV may diverge from that of physical or psychological IPV (Caetano et al., 2009). This may be due to the fact that sexual IPV was less prevalent than physical or psychological IPV. Future studies should focus on identifying factors that may attenuate the sexual victimization-alcohol misuse relation among IPV-victimized Hispanic women.

Although preliminary findings from the present study improve our understanding about the relations between IPV, acculturation, and substance misuse among IPV-victimized Hispanic women, there are a few important limitations that should be considered. First, data were collected utilizing a cross-sectional and correlational design, which precludes determination of the causal nature of associations. Future studies should examine these associations utilizing longitudinal designs. For example, given evidence for the bidirectional nature of the relation between IPV and substance misuse (Foran & O’Leary, 2008), investigations of the moderating role of acculturation on their reciprocal associations are warranted. Existing evidence suggests that acculturation may influence the relation between IPV and substance misuse, such as by necessitating greater coping efforts to manage stressful experiences associated with acculturation (Caetano et al., 2007) or impacting norms around gender-based violence (Lewis et al., 2005). In addition, although examination of these relations among IPV-victimized Hispanic women is a strength of the current study, more research and larger studies are needed to further examine the influence of other cultural factors relevant to this population. Past research has shown that Hispanic individuals are typically classified as a single ethnic group (González Burchard et al., 2005). However, Hispanic individuals represent a heterogeneous population, which includes various national origins that each have their own culture (González Burchard et al., 2005). Other cultural factors that should be further examined include country of origin (e.g., nativity to Latin countries such as Mexico, Puerto Rico, Brazil), generational status (e.g., first vs. second generation), and immigration status (e.g., documented vs. undocumented). Examination of the role of these cultural factors in the associations among IPV, acculturation, and substance misuse may further contextualize the findings of the current study. Such investigations would better speak to the generalizability of our findings to IPV-victimized Hispanic women more broadly. Finally, the findings from this study cannot be assumed to be generalizable to other trauma-exposed populations (e.g., military veterans, men). Replication in larger samples is necessary to confirm the results of the current study.

Despite these limitations, the findings of this study highlight the role of acculturation in the relations between IPV types and alcohol and drug misuse. Specifically, our preliminary results suggest that the associations between IPV types and alcohol and drug misuse are only significant among IPV-victimized Hispanic women with a higher (vs. a lower) level of acculturation. This indicates that level of acculturation may play an important role in determining risk or substance misuse in the context of IPV, highlighting the need for considering the role of acculturation in the assessment and intervention of IPV-victimized Hispanic women. Assessing level of acculturation among IPV-exposed Hispanic women may help in identifying those who are at greatest risk for developing or experiencing substance misuse. Moreover, substance use prevention and intervention efforts may demonstrate greater efficacy among IPV-victimized Hispanic women if they are modified to contain a focus on acculturation.

Footnotes

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the National Institutes of Health or the Department of Justice.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The research described here was supported by Grant No. 2001-WT-BX-0502 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. This research was also supported, in part, by a grant from the National Institutes of Health awarded to the second author (K23DA039327).

ORCID iDs

Miranda E. Reyes

Tami P. Sullivan

Author Biographies

Miranda E. Reyes, MA, is a graduate student in the clinical psychology doctoral program at the University of Rhode Island. Her research focuses on the role of contextual and cultural factors in trauma/PTSD and risky behaviors.

Nicole H. Weiss, PhD, is an assistant professor in the Department of Psychology at the University of Rhode Island and director of the Study of Trauma, Risk-taking, Emotions, and Stress Symptoms (STRESS) Lab. Her clinical and research interests focus on the role of emotion dysregulation in PTSD and related risky, self-destructive, and health compromising behaviors, most notably substance use and HIV/sexual risk. She is also interested in the influence of cultural and contextual factors, including race/ethnicity and gender, on the interrelations among PTSD, emotion dysregulation, and risky behaviors.

Suzanne C. Swan, PhD, is an associate professor in the Department of Psychology, Clinical-Community Program, and the Women’s and Gender Studies Program at the University of South Carolina. Her research interests are in the field of interpersonal violence and aggression, with a focus on two main areas: interventions to prevent violence, particularly among college populations, and women’s use of violence and aggression in intimate relationships.

Tami P. Sullivan, PhD, is an associate professor in the Department of Psychiatry at the Yale University School of Medicine and the director of Family Violence Research and Programs. Her program of research focuses on individual- and system-level factors that affect the mental and physical health of women victims of intimate partner violence (IPV). At the individual level, she focuses on advancing knowledge of IPV, post-traumatic stress, substance use, and HIV/sexual risk—as well as other co-occurring problems. At the system-level, she focuses on understanding the capacity of systems (e.g., criminal justice system) to meet the unique needs of IPV-exposed women.

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