title: Effect of immigration background and country-of-origin contextual factors on adolescent substance use in Spain.
abstract: OBJECTIVE
  The effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use among adolescents with recent immigrant background (ARIBs) are poorly understood. We aimed to assess these effects and identify the main mediating factors in Spain.
  
  
  METHODS
  Participants were 12,432 ARIBs (≥1 foreign-born parent) and 75,511 autochthonous adolescents from pooled 2006-2010 school surveys. Outcomes were prevalence of use of alcohol, tobacco, cannabis, stimulants and sedative-hypnotics. ARIBs were classified by adolescent birthplace (Spain/abroad), whether they had mixed-parents (one Spanish-born and one foreign-born), and country-of-origin characteristics. Adjusted prevalence ratios (aPRs) and percent change expressing disparities in risk were estimated using Poisson regression with robust variance.
  
  
  RESULTS
  Compared to autochthonous adolescents, foreign-born ARIBs without mixed-parents showed significant aPRs <1 for all substances, which generally approached 1 in Spanish-born ARIBs with mixed-parents. The main factors mediating ARIBs' lower risk were less frequent socialization in leisure environments and less association with peers who use such substances. ARIBs' lower risk depended more on country-of-origin characteristics and not having mixed-parents than being foreign-born. Tobacco, cannabis and stimulant use in ARIBs increased with increasing population use of these substances in the country-of-origin. ARIBs from the non-Muslim-regions had a lower risk of using alcohol and higher risk of using sedative-hypnotics than those from the Muslim-region.
  
  
  CONCLUSIONS
  Among ARIBs in Spain, parental transmission of norms and values could influence substance use as much as or more than exposure to the Spanish context. Future research should better assess effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use.
authors.affiliation: Spanish Field Epidemiology Training Program (PEAC), National Epidemiology Center, Carlos III Health Institute, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Sarasa-Renedo
authors.affiliation: National Epidemiology Center, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology Public Health (CIBERESP), Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Sordo
authors.affiliation: Consortium for Biomedical Research in Epidemiology Public Health (CIBERESP), Spain; National School of Public Health, Carlos III Health Institute, Madrid, Spain. Electronic address: jpulido@isciii.es.
authors.forename: José
authors.initials: J
authors.lastname: Pulido
authors.affiliation: Barcelona Public Health Agency (ASPB), Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Guitart
authors.affiliation: BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: González-González
authors.affiliation: Consortium for Biomedical Research in Epidemiology Public Health (CIBERESP), Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Hoyos
authors.affiliation: National Epidemiology Center, Carlos III Health Institute, Madrid, Spain; Consortium for Biomedical Research in Epidemiology Public Health (CIBERESP), Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Bravo
authors.affiliation: National School of Public Health, Carlos III Health Institute, Madrid, Spain.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Barrio
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology*
keywords: Adolescent; Country of origin; Generation; Immigration; Mixed couples; Substance use