Acculturation Groups Research Articles

Nativity/Immigrant Status, Race/Ethnicity, and Socioeconomic Determinants of Breastfeeding Initiation and Duration in the United States, 2003

Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months. Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.

A person‐centred approach to identifying acculturation groups among Chinese Canadians

This study adopted a person‐centred approach to explore acculturation groups among Chinese Canadians and to examine the demographic and adjustment profiles associated with each group. A total of 234 Chinese Canadian university students completed measures assessing different aspects of their Chinese and Canadian cultural orientations. Cluster analyses identified five acculturation groups: Integrated Group, Separated Group, Assimilated Group, Integrated Group without Chinese Practices, and Marginalized Group with Chinese Practices. Three of the five groups resembled Berry's acculturation model, and the other two groups demonstrated unique constellations of cultural orientations. The differences between the current acculturation groups and Berry's acculturation strategies were due to the differentiation between internal and external domains of cultural orientation, the addition of the domain of ethnic group evaluation, which is not typically included in acculturation research, and the use of cluster analysis, which allows for varying degrees of immersion in multiple domains of acculturation. Expected differences among the five acculturation groups in terms of participants' demographic backgrounds (e.g., length of residence in Canada), language preferences, and psychological adjustment supported the validity of the cluster solution. As expected, members of the Marginalized Group with Chinese Practices, the largest single group in the current sample, reported poorer adjustment than the Assimilated Group and the Integrated Group without Chinese Practices. The results of this study highlight the value of simultaneously considering multiple domains of acculturation and argue against research methods that assume acculturation status based on background factors such as place of birth or language use. Implications of these findings for understanding the cultural adaptation of Chinese Canadians are discussed.

Examining Resource and Protective Factors in the Adjustment of Latino Youth in Low Income Families: What Role Does Maternal Acculturation Play?

This longitudinal study examined whether the risk and positive factors contributing to the delinquent behaviors and internalizing problems of 454 Latino adolescents varied across maternal linguistic acculturation and adolescent gender. Although the level of cumulative risk to which the 10-to-14-year old adolescents were exposed did not vary by maternal linguistic acculturation, the factors contributing to their subsequent adjustment 16 months later varied substantially. Multiple regression analyses showed that for boys, maternal monitoring offset cumulative risk effects in the high acculturation group, but was unrelated to adjustment in the low acculturation group. Social competence served a protective function for boys in the high acculturation group, but was detrimental for boys in the low acculturation group and mother-son relationship quality directly predicted more subsequent delinquent behaviors among boys in the low acculturation group. Maternal monitoring was the only positive factor contributing to girls’ adjustment, directly predicting fewer delinquent behaviors for all girls.

Socioenvironmental Risk and Adjustment in Latino Youth: The Mediating Effects of Family Processes and Social Competence

The direct and mediated effects of socioenvironmental risk on internalizing and externalizing problems among Latino youth aged 10–14 were examined using prospective analyses. Participants in this study were 464 Latino mother and child dyads surveyed as part of the Welfare, Children & Families: A Three City Study. It was hypothesized that socioenvironmental risk (i.e., maternal psychological distress, maternal parenting stress, neighborhood disadvantage, and perceived financial strain) would influence later adolescent adjustment by interrupting important family processes and interfering with opportunities for adolescents to develop appropriate social competence. Using path analyses, the mediational model was compared across high and low acculturation groups. With two exceptions, the models for the high and low acculturation groups were equivalent. Results supported a mediated effect between early socioenvironmental risk and later adjustment problems for the low acculturation group through family routines and adolescent social competence. Among families high in acculturation, socioenvironmental risk effects were partially mediated through family routines and adolescent social competence. Finally, a path from gender to maternal monitoring was present in the low acculturation group model but not the high acculturation group model.

The association of subjective social status and health in low-income Mexican-origin individuals in Texas

There is only limited research on subjective social status (SSS) and its effect on health in general and in minority US populations in particular. This study first investigates the determinants of SSS and the relationship between SSS and objective social status. It then explores the relationships of SSS to self-reported physical health, self-reported mental health, and self-rated health (SRH). The study population consists of Mexican-origin individuals living in low-income neighborhoods in Texas and grouped into acculturation categories based on nativity and use of the Spanish language. We also investigate the role of reference groups. Results indicate that there is no disjuncture between subjective and objective status in this population but that the less acculturated groups rank their social status based on different criteria than the more acculturated. People compare themselves mainly with those similar to them and average subjective status in the different acculturation groups accurately reflects the objective status of the group. Sociocultural factors, in particular perceived differences in opportunities, explain differences between subjective and objective status. Subjective status was associated with all health outcomes. When controlling for objective status, subjective status was associated with mental health and SRH but not with physical health. Objective status indicators were consistently associated with all health outcomes, indicating the prominence of objective socioeconomic status in affecting health in this low-income minority population. Sociocultural characteristics appear to mediate the effect of SSS on health. In particular, perceived victimization might mediate the effect of SSS on mental health.

Acculturation and manifestation of depressive symptoms among Korean-American older adults

The present study examined the role of acculturation in manifestation of depressive symptoms among 230 Korean-American older adults (M age = 69.8, SD = 7.05) in Florida. Given the cultural emphasis on modesty and self-effacement in the traditional Korean society, we hypothesized that older Korean-Americans who were less acculturated to American culture, when compared to the more acculturated ones, would be more likely to inhibit positive affects in depressive symptom reports. Using two validated measures of depressive symptoms, the short forms of the Geriatric Depression Scale (GDS-SF) and the Center for Epidemiologic Studies-Depression Scale (CES-D), different response patterns for low and high acculturation groups were identified. First, there was low comparability in the factor structures for both the GDS-SF and the CES-D across low and high acculturation groups. A differential item function (DIF) analysis based on partial correlations indicated that older adults in the low acculturation group inhibited endorsing positive affect items; one item in the GDS-SF (#7 ‘feel happy’) and two items in the CES-D (# 5 ‘felt hopeful’ and # 8 ‘was happy’). The finding suggests the substantial cultural influences in expressing emotions, especially those related to positive affects. Implications are discussed from a cultural perspective.

Maternal Intrusiveness, Maternal Warmth, and Mother–Toddler Relationship Outcomes: Variations Across Low‐Income Ethnic and Acculturation Groups

The present study investigated the extent to which maternal intrusiveness and warmth during play, observed in 579 European American, 412 African American, and 110 more and 131 less acculturated Mexican American low-income families when children were approximately 15 months old, predicted 3 dimensions of the mother-toddler relationship 10 months later. Intrusiveness predicted increases in later child negativity in all 4 groups. Among African Americans only, this association was moderated by maternal warmth. Intrusiveness predicted negative change in child engagement with mothers only in European American families. Finally, near-significant trends suggested that intrusiveness predicted later decreased dyadic mutuality in European American and more acculturated Mexican American families, but not in African American or less acculturated Mexican American families.

Acculturation and dietary habits of Korean Americans.

This is the first study to investigate how food and nutrient intakes vary with the levels of acculturation of Korean Americans using a dietary assessment tool tested for validity and reliability. The respondents were Korean Americans (n 486) resident in the Greater New York metropolitan area, USA. They were divided into two groups according to the total score of acculturation: low- and high-acculturated groups. Using a food-frequency questionnaire and a modified Suinn-Lew Asian self-identity acculturation scale, differences in the frequencies of food items, food groups and nutrient intakes consumed were analysed by level of acculturation. The low-acculturated group tended to consume significantly more rice, mixed rice, soyabean paste chigae (pot stew), saengsun (fish) chigae, kimchi chigae, other fish broiled or baked, eggs, kimchi, spinach, persimmons, and white or brown sugar in coffee or tea. The high-acculturated group demonstrated a statistically greater tendency to consume bread, cereal, spaghetti, ham, green salad, sweetcorn, chocolate, candies and diet soft drinks. The more acculturated an individual, the more significant was the tendency to consume sweets. The more acculturated group had significantly (P<0.05) higher intakes of % energy from total fat, thiamin, vitamin E and folate, while the low-acculturated group consumed greater amounts of Na, niacin and dietary fibre. The information from the present study can be used to describe dietary habits according to various aspects of acculturation, and allows a better understanding of the dynamics of acculturation and dietary habits.

Acculturation, Drinking, and Intimate Partner Violence among Hispanic Couples in the United States: A Longitudinal Study

This article examines the 5-year association between acculturation, drinking, and maleto-female partner violence and female-to-male partner violence among Hispanic couples in the United States. A national representative sample of Hispanic couples 18 years of age or older was interviewed in 1995 and 2000. Both members of the couple were independently interviewed. Differences in prevalence rates of male-to-female partner violence and female-to-male partner violence, incidence, and recurrence across acculturation groups are not significant. Drinking is associated with acculturation among women. Couples with mixed acculturation level (high-medium) are less at risk for maleto-female partner violence. An increase of five standard drinks per week in men’s drinking decreases the risk of female-to-male partner violence by 10%. Acculturation level at Time 1 is not associated with male-to-female partner violence and female-to-male partner violence status 5 years later.

Acculturation and parental attachment in Asian-American adolescents’ alcohol use

Purpose To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. Methods This was a prospective study using a subsample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys ( n = 332) and girls ( n = 382) in grades 7–12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave I, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. Results Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. Conclusions Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

Risk of injury after alcohol consumption: a case-crossover study in the emergency department

This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55–5.27). After controlling for alcohol use in the 1-h period before injury, the relative risks for consecutive 1-h periods (2–6 h) before the injury were not significantly greater than one, indicating that the induction time was less than 1 h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily.

The Construction of Everyday Sacrifice in Asian Americans and European Americans: The Roles of Ethnicity and Acculturation

This research examines the effects of ethnicity and acculturation on everyday sacrifice behaviors in 63 European American and 131 Asian American college students (mean age = 18.60). Asian Americans were divided into more and less acculturated groups using the Suinn-Lew Asian Self-Identity Acculturation Scale. Participants responded to scenarios involving conflict between sacrifice (for parents, siblings, and friends) and the realization of personal goals in three domains (money, dating, and schoolwork). In most domains, Asian Americans were, as predicted, significantly more likely to say they would sacrifice than were the European Americans. Whereas less acculturated Asian Americans were, as predicted, significantly more likely than European Americans to say that they would sacrifice for their parents, European Americans expressed a significantly greater willingness to sacrifice for siblings than for parents. With acculturation to U.S. society, the level of Asian American sacrifice declined, but its distinctive patterning remained.

Behavioural Risk Factors and Protective Factors in Adolescents: A Comparison of Latinos and Non-Latino Whites

Objectives: This study investigated differences in behavioural health protective and risk factors in US Latino and non-Latino White adolescents as well as differences among Latinos with different levels of acculturation using a bicultural acculturation model. The bicultural model is consistent with current understanding of cultural change processes; however it has infrequently been applied to understand adolescent health outcomes. The outcomes included risk and health behaviours as well as mental health factors consistent with Jessor's framework for describing adolescents' health status. Design: Participants included 1119 students randomly selected from all middle schools of a Northern California district. Respondents completed project staff administered self-reports surveys in their schools that included assessments of health behaviours, mental health, and socio-cultural variables--including acculturation level. Results: Latinos were at higher risk than non-Latino Whites in the following areas: academic orientation, physical activity, and sunscreen use. Boys and those of lower social class were more likely to report use of various substances and violence. Among Latinos, those in the marginalised acculturation group--those with less attachments and adaptations to Latino and other cultures, showed less desirable mental health outcomes than the bicultural group. Conclusion: These results extend prior research by assessing the health needs of early adolescent youth. The study found important differences within Latinos using a bicultural acculturation model. The use of a bicultural acculturation model, or cultural orientation approach more generally, may have especial utility for addressing health issues wherever minority populations interact with a dominant society.

Gender, ethnicity, and acculturation in intergenerational conflict of Asian American college students.

This study examined differences in patterns of intergenerational conflict according to gender, ethnicity, and acculturation level of Asian American college students. A survey containing a measure of acculturation and intergenerational conflict was completed by 342 participants. A 2 (gender) x 5 (ethnicity) x 3 (acculturation) multivariate analysis of variance for the 3 subscales of the Intergenerational Conflict Inventory revealed significant F values for all 3 main effects, but none for the interactions. On the subscale of Dating and Marriage, male students reported less conflict than female students, and Japanese Americans reported less conflict than Chinese, Filipino, Korean, and Southeast Asian Americans. On the subscale of Family Expectations, Japanese Americans also reported less conflict than Koreans and Southeast Asians. On both of these and a 3rd subscale of Education and Career, the acculturated group reported lower conflict than both the low-acculturated and bicultural groups. The implications of these findings for research and practice are discussed.

Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento Area Latino Study on Aging.

To determine the association between acculturation, immigration, and prevalence of depression in older Mexican Americans. Cross-sectional analysis from a cohort study. Urban and rural counties of the Central Valley of Northern California. One thousand seven hundred and eighty-nine Latinos recruited from a population-based sample (85% Mexican Americans) with a mean age of 70.6 (range 60-100; standard deviation (SD) = 7.13); 58.2% were women. Depressive symptoms were assessed with the Center for Epidemiologic Studies--Depression scale (CES-D). Acculturation was measured with the Acculturation Rating Scale for Mexican Americans--II. Psychosocial, behavioral, and medical histories were also obtained. The prevalence of depression (CES-D > or = 16) was 25.4%. Women were at greater risk (32.0%) than men (16.3%; male/female odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.90-3.09). The prevalence of depression was higher among immigrants (30.4%, OR = 1.70, 95% CI = 1.36-2.13), bicultural participants (24.2%, OR = 1.66, 95% CI = 1.24-2.24), and less-acculturated participants (36.1%, OR = 2.95, 95% CI = 2.22-3.93) compared with U.S.-born (20.5%) and more-acculturated groups (16.1%). When adjustments for education, income, psychosocial, behavioral, and health-problem factors were made, the least-acculturated participants were at significantly higher risk of depression than highly acculturated Mexican Americans (OR = 1.56, 95% CI = 1.06-2.31). These findings are consistent with previously reported estimates of a higher prevalence of depression for older Mexican Americans than non-Hispanic Caucasians and African Americans and are the first to report the prevalence and risk of depression for older U.S.-born and immigrant Mexican Americans. The high prevalence of depression of the least acculturated group may be related to cultural barriers encountered by immigrants and less-acculturated older Mexican Americans and to poorer health status.

Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department.

This article reports on the selection of screening items to detect Mexican or Mexican-American patients in the emergency department (ED) who have alcohol problems and could benefit from an intervention or a referral for treatment. Items are tested against the Rapid Alcohol Problems Screen (RAPS), which has been optimized from standard screening instruments and has outperformed these instruments. The performance of individual items from standard screening instruments (CAGE, TWEAK, AUDIT, TRAUMA and BMAST) against International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual, Fourth Revision criteria for alcohol abuse and dependence was evaluated in a merged probability sample (N = 869; 72% men) of 537 ED patients from three hospitals in Pachuca, Mexico, and 332 Mexican-American ED patients in Santa Clara County, CA. Logistic regression and tree-classification models were used for item selection. We found a prevalence of 15% for alcohol dependence and a prevalence of 28% for alcohol abuse or dependence in the merged sample. The RAPS items did not perform as well in terms of sensitivity (93%) as the optimal five items identified in these analyses (sensitivity = 98%) for alcohol dependence, but did demonstrate better specificity (79%) than the optimal five items (65%), which is an important consideration in a time of cost containment. Both sets of items showed better sensitivity and positive predictive value but similar Receiver Operating Characteristic values for respondents in the high acculturation group compared to those at other levels of acculturation. Differences in positive predictive value across all subgroups tended to increase at increased cutpoints, especially for the RAPS. These analyses suggest that the RAPS performs favorably compared to those items optimized, in this sample of Hispanic ED patients. Based on comparative item performance in these analyses, the RAPS may hold promise as a useful tool for screening for alcohol dependence, but requires further evaluation as a stand-alone instrument in comparison with other standard screening instruments.

Differences in Family Cohesion, Adaptability, and Environment among Latino Families in Dissimilar Stages of Acculturation

The present study examines the differences among Latino families who are in the low, bicultural, and high acculturation stages on measures of family cohesion, adaptability, and environment. Preliminary results revealed a significant difference in age of migration among the low acculturation and the bicultural and high acculturation groups. Therefore, a multiple analysis of covariance (MANCOVA) to control for age of migration was conducted. The results revealed significant differences among the groups on family cohesion, adaptability, and some indices of family environment. The implications for family counselors follow the recommendations for further research about acculturation’s influence on the Latino family.

Intimate Partner Violence, Acculturation, and Alcohol Consumption Among Hispanic Couples in the United States

The purpose of this article is to report rates of intimate partner violence, acculturation, and alcohol consumption patterns among U.S. Hispanic couples. A probability sample of Hispanic couples in the U.S. household population (N = 527) was interviewed in 1995. Interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers. The response rate was 85%. The rates of male-to-female and female-to-male partner violence (MFPV and FMPV, respectively) were highest in the medium acculturation group, followed by the high acculturation group and the low acculturation group. Multiple logistic regression analyses indicate that couples with at least one medium acculturated couple member were 3 times more likely to experience MFPV than couples with two low acculturated partners. Intimate partner violence among medium acculturated individuals may be the result of the difficulties of negotiating between cultures without the support of a strong social network.

Performance of Screening Instruments for Alcohol Problems in the ER: A Comparison of Mexican- Americans and Mexicans in Mexico*

The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the “best” instrument.

Systemic lupus erythematosus in three ethnic groups: V. Acculturation, health-related attitudes and behaviors, and disease activity in Hispanic patients from the LUMINA Cohort

To assess the relationship between acculturation and clinical, socioeconomic-demographic, and behavioral/psychosocial features in Hispanic patients with systemic lupus erythematosus (SLE) from the LUMINA (Lupus in Minority Populations, Nature versus Nurture) cohort. An empirically derived questionnaire was administered to 67 Mexican American SLE patients participating in a longitudinal study of outcome. This questionnaire inquired about place of birth, upbringing and length of stay in the United States, language (proficiency, usage, and preferences; English/bilingual versus Spanish), type of neighborhood, self-identity, and social interactions. Responses to this questionnaire and an informal interaction with a single bilingual, bicultural Mexican American research assistant were used to generate a score on a 10-cm anchored visual analog scale (VAS) (0 = no acculturation and 10 = maximum acculturation). The responses to the questionnaire were then quantified and scored by a physician who was unaware of the VAS. A composite score was then obtained utilizing 4 of the 6 components of the instrument. The VAS was found to have adequate sensitivity (91%), specificity (88%), and overall predictive value (89%) when the composite score was used as the validity criterion. Therefore, the VAS was used in all subsequent analyses; the median in this VAS separated patients into high and low acculturation groups. The relationship between acculturation and sociodemographic, behavioral/psychosocial (social support, abnormal illness-related behaviors, and helplessness) and clinical variables (disease duration, onset type, number of American College of Rheumatology criteria met, disease activity, and damage) at study entry was then explored. Patients in the low acculturation group had fewer years of education, were less likely to have private health insurance, and had less social support as compared with those in the high acculturation group; they also exhibited less disease activity as determined by the overall physician and patient global assessments of the Systemic Lupus Activity Measure. Abnormal illness-related behaviors and helplessness were not increased in the low acculturation group. Low levels of acculturation were associated with indicators of low socioeconomic status, but also with less disease activity at enrollment into LUMINA; they were, however, not associated with more abnormal illness-related behaviors or with helplessness, as measured in this study. The possible impact of acculturation and of its mediators in the course and outcome of SLE among Hispanic patients needs to be determined longitudinally.