Examining External and Internal Acculturative Factors: Cuban-Born Women’s Experience of Well-Being in the U.S.

Abstract

Objective: This study investigates the influence of acculturative stress on the mental well-being of Cuban-born women and Latina immigrants, emphasizing their distinctive experiences. Methods: Utilizing data from the National Latino Asian American Study (NLAAS), a comprehensive nationwide mental health investigation among Latino and Asian Americans, this study examined 264 Cuban women (average age: 58) who migrated to the United States and live in south Florida. The study employed Family Stress Management (FSM) framework and Bekteshi et al.’s Contextual Influence on Acculturative Stress (CIAS) framework to scrutinize the interplay of contextual factors and individual characteristics impacting adolescents’ psychological distress. Results: The findings revealed several noteworthy associations. Higher levels of church attendance, challenges in visiting family overseas, and perceived racial discrimination correlated with elevated stress levels. Furthermore, the age at which individuals immigrated was positively linked to increased stress (b = 0.18; p = 0.04), indicating that older Cuban immigrants experienced greater psychological distress upon their arrival in the United States. Additionally, higher levels of conflict between family and cultural values, as well as intensified religious beliefs, were associated with elevated distress levels. Conclusion: This study underscores the intricate interplay of diverse contextual factors in shaping the mental health and well-being of Cuban-born women. The insights derived from this research have implications for the development of tailored interventions and support systems, aiming to address the unique needs of this population.

1. Introduction

Acculturation is the process in which people from one cultural background meet and adjust to the cultural and social norms of a different culture. This often includes changes in language, behaviors, values, and identity. Acculturation can vary in degree and form, with individuals adopting varying levels of integration, assimilation, separation, or marginalization concerning the new culture and their culture of origin. This concept is particularly relevant in the context of immigrants adjusting to life in a new country, where they navigate the complexities of maintaining their cultural heritage while adapting to the dominant culture of their new environment (Berry 2005). In recent years, an expanding body of research has focused on acculturation’s influence on the mental well-being of Latino immigrants. This research illuminates the intricate cultural and psychological transformation process that unfolds when diverse cultural groups intersect (Berry 2005). While some studies emphasize the positive facets of acculturation for Latino immigrants, such as bolstered social connections, improved socioeconomic integration, and enhanced educational achievements, a parallel body of literature associates acculturation with adverse mental health outcomes, including depression, anxiety, and suicidal ideation (Kim et al. 2021; Klein et al. 2020; Berry and Hou 2016; Torres and Ong 2010). Central to this complex relationship is the concept of acculturative stress, which emerges from efforts to adopt the dominant culture’s beliefs, practices, and values. Acculturative stress, a prevalent issue among immigrants, stems from various challenges encountered during cultural adaptation. This includes the overarching experience of adapting to a new cultural environment and distinct stressors like navigating language barriers, misunderstanding cultural cues, and feeling socially isolated. These factors collectively contribute to the complex experience of acculturative stress, distinguishing it from the general concept of stress due to cultural transition (Urzúa et al. 2021; Bekteshi and Vanhook 2014; Berry 1997). However, the understanding of acculturative stress, especially among Latino immigrants, remains incomplete, emphasizing the need for further investigation.

This study aims to fill a gap in earlier research by focusing on Cuban-born women, frequently neglected in migration studies. These women are part of the Cuban Latino group, representing 3.5% of the U.S. Latino population. Cuban Latinos are distinct because they tend to have higher citizenship, home ownership, and college graduation rates. These traits are often linked with higher income levels compared to other Latino sub-groups (Andrade and Viruell-Fuentes 2011; Pew Hispanic Center 2010). Cuban-born individuals have a unique migration story. Initially coming as refugees, they were welcomed favorably in the U.S. This study focuses on Cuban women because of their distinctive experiences related to culture and psychology during their migration and acculturation. Cuban-born women often face the double challenge of adjusting to a new society while keeping their cultural heritage and family values. This challenge is even more pronounced due to the strong emphasis on family and gender-specific roles in Cuban society (Goodkind et al. 2008). Even with robust support networks and their significant influence in regions such as Miami, Cuban-born individuals encounter challenges in sustaining familial connections, particularly with extended family members. These challenges are exacerbated by the evolving political dynamics between the United States and Cuba (Blizzard and Batalova 2020; Council on Foreign Relations 2023). Consequently, this study sheds light on the confluence of gender, culture, and migration and critically assesses their collective impact on Cuban-born women’s mental health and acculturation processes.

1.1. Literature Review: Contextual Influence on Acculturative Stress among Cuban-Born Women

Family Dynamics: Familismo and Its Role. The existing literature identifies several contextual factors that shape the experiences of acculturative stress and psychological distress among Cuban-born women. Familismo, or the strong ties, loyalty, and connections that bond family members in Latino families (Molina et al. 2013), is a significant contextual factor among Latinos in general, and it influences family structure and relations (Perez 2021; Boswell and Curtis 1984; Gil and Vega 1996; Szapocznik et al. 1978; Szapocznik and Kurtines 1980). Familismo plays a role in both mitigating and exacerbating acculturative stress among Cuban-born women. It serves as a coping mechanism during the cultural transition, providing resources and social support. However, clashes between strong family ties and individualistic values in the U.S. can create challenges (Perez 2021; Gil and Vega 1996). A Cuban-born woman rooted in familismo values close family relationships and traditional roles (Araujo 2020; Szapocznik and Kurtines 1980; Szapocznik and Hernandez 1988). For instance, a Cuban-born woman who strongly values familismo, emphasizing close-knit family bonds and traditional roles, may have played a central role back in Cuba in maintaining and emphasizing close-knit family bonds and traditional roles, often putting family needs above her own. Upon immigrating to the U.S., she encounters a culture that values individualism and personal independence. Her teenage children, adapting to American culture, start seeking more independence, conflicting with her expectations of family interdependence and support. This clash between her familismo values and the individualistic tendencies of her children leads to internal family conflicts, challenging her traditional role and causing acculturative stress (Gil and Vega 1996). Disruptions in family dynamics during cultural transitions can introduce new stressors that affect Cuban-born women’s sense of purpose and belonging in the U.S. (Perez 2021).

Socioeconomic Factors: Impact on Acculturative Stress. The experience of migration and acculturative stress among Cubans is influenced by socioeconomic status. Cuban immigrants who arrived in the U.S. before the 1980s tended to be well-educated and from the upper-middle class, seeking political refuge (Turner et al. 2006; Zsembik and Fennell 2005). However, those who arrived after the 1980s often came from a lower socioeconomic background and faced conditions of poverty (Council on Foreign Relations 2023; Wang et al. 2010). Lower household income and fewer years of education are associated with higher acculturative stress among Cuban immigrants and other Latino groups (Sanchez et al. 2012).

Language Proficiency and Other Contextual Factors. Cuban-born immigrants are predominantly concentrated in South Florida, where they face acculturative stress related to language and racial conflicts common among Latino immigrants (Bekteshi and Vanhook 2014; Gil and Vega 1996; Wang et al. 2010). This makes this geographic area an important one on which to focus with unique historical, community and cultural factors. English language proficiency has a significant impact on acculturative stress, particularly among U.S.-born Cuban young adults who navigate the challenges of cultural and psychosocial negotiations (Wang et al. 2010).

It is important to stress that the experiences of acculturative stress among Cuban-born women are not monolithic and can vary significantly across different age groups and generational cohorts. Women who migrated at different times or at different stages of their lives may encounter unique challenges and stressors. For instance, older Cuban women might face more significant challenges in adapting to new cultural norms and language barriers compared to their younger counterparts. Conversely, younger or more recently arrived women may experience stressors related to identity formation and balancing between cultural preservation and assimilation. This generational difference in the acculturation experience can be attributed to varying levels of exposure to American culture, differing sociopolitical climates during the time of migration, and the evolving nature of the Cuban–American community itself. Therefore, it is crucial to consider these generational nuances when examining the mental health and acculturative stress of Cuban-born women (Blau 2015).

1.2. Theoretical Framework: Guiding the Study

This study incorporates Boss’ Family Stress Management (FSM) framework (Boss 2002) and Bekteshi et al.’s adaptation of FSM to Latina immigrants, known as Contextual Influence on Acculturative Stress (CIAS), to examine the relationships between contextual factors, acculturative stress, and psychological distress among Cuban-born women (Bekteshi and Kang 2020). FSM provides a framework for understanding how families cope with stress, highlighting the role of external and internal contexts in shaping their experiences and mental health. According to FSM, stress levels within families are influenced by external contexts, such as cultural, historical, and economic factors, as well as internal contexts that families can control. It also recognizes that existing coping mechanisms determine whether stress serves as a motivating force or leads to poor mental health outcomes (Boss 2002).

Figure 1 illustrates the concentric circles of external context and internal context. In the external context culture, history, economy, development and heredity factors are shown to envelope the internal context of structural, psychological, and philosophical factors. Within these concentric circles, the relationship between an event and degree of stress experienced from that event is both direct and mediated through both perceptions (A) and resources. Internal context plays a crucial role in shaping how a family copes with stress. For instance, in a family where strong emotional ties and effective communication prevail, stressful situations like job loss are managed more resiliently. Members support each other emotionally and practically, thereby not only overcoming the immediate crisis but also strengthening their relationships for future challenges. In contrast, families plagued by dysfunctional communication or weak emotional connections face heightened tensions under stress. Poor communication can lead to misunderstandings and unmet emotional needs, escalating stress and adversely affecting the family’s core relationships. External factors can either mitigate or exacerbate family stress. A family embedded in a supportive community with robust cultural ties might find external resources and emotional support crucial in times of crises, such as natural disasters. This external aid can lessen the stress burden and positively influence family dynamics. Conversely, a family dealing with economic struggles in a less supportive environment may experience compounded stress, which can strain familial relationships, leading to conflict or emotional disengagement. Such situations underscore the significant impact external factors have on family stress management. Moreover, the way families adapt or maladapt to these internal and external influences provides a deeper understanding of Boss’s framework. Families that adapt well tend to develop resilience, maintain open lines of communication, and seek external support when necessary, emerging stronger from stressors. In contrast, families that respond maladaptively often succumb to negative communication patterns and fail to utilize external support effectively, leading to increased stress and strained relationships. While some perspectives may argue that economic systems are intrinsically shaped by cultural and social relations, Boss’ model distinguishes between economy, history, and culture to comprehensively analyze their distinct influences on family stress in the acculturation process. This approach allows for a more detailed understanding of how each factor, though interrelated, uniquely contributes to the external context affecting families, especially in multicultural settings. By separately examining these factors, the model offers a nuanced insight into the diverse elements shaping family dynamics during acculturation. In summary, Boss’s framework highlights the intricate interplay between internal and external factors and their profound influence on the central aspect of family relationships with the family’s response to these factors determining their overall ability to manage stress (Boss 2002).

Bekteshi and colleagues adapted FSM to address the needs of Latina immigrants (Figure 2) and emphasize the individual and structural contexts that influence acculturative stress among Latinas (Bekteshi and Kang 2020). In line with FSM, this research incorporates Contextual Influence in Acculturative Stress (CIAS) to explore the interactive and individual contextual factors affecting acculturative stress and psychological distress among Cuban-born women. The study categorizes the contexts impacting acculturative stress and psychological distress of Cuban-born women and Latina immigrants into the following categories. Figure 2 mirrors the model presented in Figure 1 and specifies the U.S. external factors in detail and well as culture-specific internal factors:

External context:

• U.S. climate (perceived discrimination, difficulties visiting family abroad, level of contentment with U.S. move, U.S. region of residence, and years in the U.S.).
• Development context (education level, age at immigration, age, marital status, and English skills).
• Economic contexts (financial constraints, employment, and income).
• Cultural contexts (family-culture conflict and gender-based roles); and

Internal context:

(a)

Latino-specific beliefs: familismo

(b)

Church attendance: religiosity.

Building upon the FSM and CIAS models and existing research, this study hypothesizes that acculturative stress and psychological distress are distinct concepts influenced differently by various contexts. This is demonstrated in Figure 2 as a direct relationship that is embedded in both internal and external contextual factors.

2. Methodology

2.1. Data Source and Strategy

This study used data from the National Latino Asian American Study (NLAAS) (Alegria et al. 2004), the first national population-based mental health study of Latino and Asian Americans. NLAAS was designed in coordination with and as part of the Collaborative Psychiatric Epidemiology Studies (CPES), which includes NLAAS, the National Survey of American Life, and the National Comorbidity Survey Replication. This survey was designed to compare the association between immigration factors and mental health services across three major racial and ethnic categories: African American, Asian American, and Latin American. The NLAAS collects extensive information on health and mental health status, behaviors, and health insurance coverage for all age groups. The questionnaire is available in six languages: English, Spanish, Cantonese, Mandarin, Tagalog, and Vietnamese. Trained bilingual interviewers interviewed all the NLAAS participants. The study was approved by three Internal Review Board Committees: the Cambridge Health Alliance, the University of Washington, and the University of Michigan (Alegria et al. 2004). The total sample size of the NLAAS data was 4649, including 2554 Latinos and 2095 Asian Americans. The survey included individuals aged 18 years or older of Latino or Spanish origin who spoke English and Spanish. The survey also provided health-related information to participants (Lewis-Fernández et al. 2009). The study sample for the current analysis consisted of 264 Cuban-born women. South Florida is a focal point of this study due to its historical and ongoing significance as a primary destination for Caribbean and specifically Cuban immigrants. This region has a long-established Cuban community, making it a rich context for exploring the acculturative experiences of Cuban migrants. South Florida’s unique sociocultural environment offers insights into the interplay of community support, cultural preservation, and adaptation challenges faced by Cuban immigrants (Cislo et al. 2010).

2.2. Measures

The two dependent variables used for the current study were acculturative stress and psychological distress. Acculturative stress was measured by adults’ self-rated level of agreement on six statements: (1) I felt guilty about leaving family or friends in the country of origin, (2) I have limited contact with family and friends, (3) I find interaction hard due to difficulty with the English language, (4) I was questioned about my legal status, (5) I think I might be deported if I go to a social or government agency, and (6) I avoid health services due to Immigration and Naturalization Services (INS). Possible scores ranged from 0 to 9, with higher scores indicating a higher levels of acculturative stress. Items were obtained from the Mexican American Prevalence and Service Survey, which measures the experiences of psychosocial stress in Latinos. The scale has been tested repeatedly for appropriateness in general Latinos (Cervantes et al. 1991) and has high internal consistency (Cronbach’s α = 0.88).

The second dependent variable, psychological distress, was measured using Kessler’s Psychological Distress Scale (K10), which consists of 10 items assessing symptoms of depression and anxiety. A validation study completed in Boston using a small convenience sample found evidence that the scales performed well (Furukawa et al. 2003). The K10 is also included in the National Comorbidity Survey Replication (NCS-R) as well as in all national surveys of the World Health Organization (WHO) World Mental Health (WMH) Initiative (Furukawa et al. 2003). Items included responses to the following statements: in the (1) past month I felt depressed, (2) past month I felt hopeless, (3) past month I felt restless/fidgety, and (4) past month I felt tired for no good reason (5). The internal consistency of the scale was high (Cronbach’s α = 0.85).

External context. The first segment of the external context is focused on the U.S. climate—that is, perceived daily and racial discrimination, difficulties visiting family abroad, contentment with the decision to move to the U.S., the U.S. region of residence, and years in the U.S. Perceived discrimination is a two-dimensional construct consisting of perceived racial and daily discrimination. Perceived racial discrimination of adults over 18 is measured by questions such as (1) How often do people dislike you because of your race/ethnicity? (2) Have you seen friends mistreated because of race/ethnicity? (3) How often do people treat you unfairly due to race/ethnicity? Perceived daily discrimination was measured by statements such as: (1) You are treated with less courtesy than other people, (2) You are treated with less respect than other people, (3) You receive poorer service than other people at restaurants or stores, (4) People act as if they think you are not smart, (5) People act as if they are afraid of you, (6) People act as if they think you are dishonest, (7) People act as if you are not as good as they are, (8) You are called names or insulted, and (9) You are threatened or harassed. The items were taken from the Detroit Area Study (DAS) (Williams et al. 1997), and the scales have been used in mental health research. The study reverse-coded response categories such that higher scores reflected a greater frequency of perceived discrimination. The internal consistencies for each scale were high (Cronbach’s α = 0.88 and a = 0.92, respectively).

In assessing difficulties in visiting family abroad, respondents were asked to rate their answers from relatives abroad from not very difficult (1) to very difficult (5). Years in the U.S. are ordinal variables with responses ranging from less than five years (1) to more than 20 years (4). The U.S. region of residence, which initially consisted of four categories—(1) west, (2) east, (3) north, and (4) south—was transformed into four dichotomous variables corresponding to the four regions in the U.S. continent with the decision to move to the U.S. represented by a dichotomous question: Would you decide to move to the U.S.? The responses were either: (1) Yes or (0) No.

Development context. The second segment of the FSM’s external context, developmental context, consists of several variables. These included age (continuous variable with respondents ranging from 18 to 97 to years old) and age at immigration, which was a categorical variable where participants were asked, “How old were you when you first came to this country?” Answer categories included (1) less than 12 years, (2) 13 to 17 years, (3) 18 to 34 years, and (4) older than 34 years. English skills were measured as a scale including questions such as the following: (1) “How well do you speak in English?” (2) “How well do you read English?” (3) “How well do you write in English?” The responses ranged from 1 (poor) to 4 (excellent). Internal consistency was very high for the English skills scale (Cronbach’s α = 0.93). Other variables of the development context include education, an ordinal variable coded as (1) 0–11, (2) 12 years of education, (3) 13–16 years, and (4) more than 16 years of education; and marital status, which was transformed into three dichotomous variables representing the following categories: married/cohabiting, divorced/separated/widowed, or never married.

Financial context. The third segment of the FSM’s external context consists of financial constraints, which was measured with an ordinal variable represented by the following question: “Rate your difficulty in meeting the monthly financial obligations and answers, ranging from (1) not at all difficult to (4) very difficult”. Employment was a dichotomous variable coded as (0) not employed, and (1) fully employed. In addition, the continuous variable household income, referred to as income, was used

Family cultural conflict was measured using five items drawn from a subscale of the Hispanic Stress Inventory (HIS), which measures the cultural and intergenerational conflict between Latina immigrant women and their families (Cervantes et al. 1991). Participants were presented with items such as (1) because of the lack of family unity, you felt lonely and isolated, (2) your personal goals have been in conflict with your family, (3) being close to family interfering with goals, and (4) you argue with family over different customs. Each question about family–culture conflict had three potential response categories: (1) hardly ever or never, (2) sometimes, and (3) often. Higher scores are indicative of higher levels of conflict. The scale’s internal consistency in this population was high (Cronbach’s α = 0.81).

Internal context. The cultural values of familismo and church attendance represent FSM’s internal context. Familismo incorporates opinions of shared family, cultural values, and a general orientation toward the family. The current study incorporated a scale capturing opinions of shared familial and cultural values, a general orientation toward family, family cohesion, and the willingness of family members to spend time with each other. This scale has been used frequently by people of Latin origin (Felíx-Ortiz et al. 1994). It is measured by asking adults to rate their level of agreement with statements such as (1) family members respect each other, (2) the family shares values, (3) things work well as a family, (4) the family trusts and confides with each other, and (5) the family is loyal to the family. The possible scores ranged from 10 to 40. All items were reverse-coded such that higher scores corresponded to higher family cohesion levels. The internal consistency of the scale was high in the current study (Cronbach’s α = 0.80). Church attendance was measured using a question, which probed respondents about how frequently they attended religious services. The response categories ranged from (1) often to (4) never. Responses were reverse-coded, such that higher values reflected higher levels of church attendance.

2.3. Statistical Methods

The study used mediation path analysis in MPLUS (Muthén and Muthén 2005a) to estimate relationships between contextual factors, acculturative stress, and psychological distress among the participants in this study. All ordinal variables with at least four levels were treated as continuous (Muthén and Muthén 2005b). Categorical variables were transformed into binary variables to facilitate the analysis, whereas dichotomous variables were left in their original dichotomous form. Only covariates based on theory (Berry 1997) or the literature on acculturative stress were entered into the model. All regression assumptions, including linearity, homoscedasticity, and multicollinearity, were assessed. Before entering variables into the models, two bivariate statistical tools were used: correlation and analysis of variance. An analysis of the correlation involved an examination of the Pearson correlations to check for the statistical significance of covariates and the two dependent variables.

Multivariate assumptions such as linearity, homoscedasticity, and multicollinearity were assessed while variables with more than 10% of missing data were dropped from the analysis. A specification search (Schumacker and Lomax 2004) permitted the search for a better-fitting model, whereas a modification index (MI) informed our inclusion of specific parameters. MPLUS automatically calculated the indirect effects of the covariates estimated in this study. The comparative fit index (CF), root mean square error of approximation (RMSEA), and standardized root mean residual (SRMR) were used to assess the model fit. The maximum likelihood method (MLR), an estimator robust to non-normality, was employed. Standard errors estimated through MLR are very close to those produced through “bootstrap” methods; however, all the estimated baseline models were cross-validated using the holdover cross-validation technique.

Interactions between various contexts in predicting acculturative stress were estimated using Stata’s Version 18 fitting software (StataCorp 2023). Before testing for interactions, continuous and ordinal variables were treated as continuous and mean-centered, and categorical variables were transformed into dichotomous variables to avoid collinearity. No significant interactions were observed among variables included in the current study.

3. Results

Sample Characteristics

In this sample of 264 Cuban-born women, 71% reported being married, the majority lived in the south (92%), they generally entered the U.S. at an older age (40% older than 35 years), and 34% reported working full time. The majority had a college degree (22%) and reported that visiting the family back home was challenging (56%). Over half of Cuban-born women reported meeting their monthly financial obligations (56%) (

Table 1. Descriptive statistics of contextual factors among Cuban-born women (Categorical).

Contexts	Cuban-Born
	n = 264
Marital Status (%)
Married/Cohabiting	71.2
Divorced/Separated/Widowed	17.0
Never married	11.7
U.S Region of Residence (%)
Northeast	8.0
Midwest
South	92.0
West
Age at Immigration (%)
Less than 12 years	18.2
12–17 years	6.8
18–34	33.7
35+	40.9
Religious Activities (% freq)
Often	45.5
Sometimes	11.0
Rarely	23.9
Never	19.7
Education (%)
0–11 years	33.7
12 years	25.1
13–15 years	19.0
>16 years	22.22
Employment (%)
Full employed	34.2
Not employed	65.8
Years in the U.S. (%)
Born in the U.S.	0
Less than 5	20.1
5–10 years	10.06
11–20 years	11.0
20+	58.0
Has Final Say in Decision (%)
Always	15.5
Sometimes	34.1
Never	9.1
Visiting Family Abroad Difficulties (%)	n = 264
No relatives abroad	8.3
Not at all difficult	11.4
Not very difficult	7.6
Somewhat difficult	16.3
Very difficult	56.1
Difficulties in making monthly bills/Financial constraints (%)
Not at all difficult	15.2
Somewhat difficult	24.6
Not very difficult	33.0
Very difficult	56.1

).

The findings of the study indicate that multiple factors significantly influence the acculturative stress and psychological distress experienced by Cuban-born women (

Table 2. Mediation path analysis of contextual factors, acculturative stress and psychological distress among Cuban-born women.

Contextual Factors	Cuban-Born Women
Psychological Distress	B (Error)
Acculturative stress	0.15 (0.03) *
Age	0.17 (0.02) **
Family-culture conflict	0.28 (0.34) **
Acculturative Stress
Content with decision to move to U.S.	−0.15 (0.13) **
Visiting Family Abroad Difficulties	0.28 (0.06) **
Racial Discrimination	0.26 (0.04) **
Years in the U.S.	−0.22 (0.04) **
Age at immigration	0.18 (0.65) **
English skills	−0.33 (0.03) **
Fit statistics:
X2 = 9.44 DF = 7 p = 0.22 CFI/TLI = 0.98/0.96 RMSEA = 0.04 (0.00/0.05)

Note: p < 0.01 **, p < 0.05 *.

). Enhanced English proficiency (b = −0.33; p = 0.00) and satisfaction with the decision to relocate to the U.S. (b = −0.15, p = 0.00) were linked to reduced levels of acculturative stress. Moreover, the longer Cuban-born women resided in the U.S., the lower their acculturative stress (b = −0.22; p = 0.00). Conversely, higher levels of church attendance (b = 0.38; p = 0.04), difficulties in visiting family abroad (b = 0.28; p = 0.00), and perceived racial discrimination (b = 0.26; p = 0.00) were associated with increased acculturative stress. The age at which individuals immigrated to the U.S. exhibited a positive correlation with acculturative stress (b = 0.18; p = 0.04), suggesting that older Cuban-born women experience greater levels of acculturative stress upon arrival in the U.S. Regarding psychological distress, older age (b = 0.17; p = 0.00) and higher levels of conflict between family and cultural values (b = 0.28; p = −0.00) were associated with increased psychological distress (Table 2).

4. Discussion

This study contributes to our understanding of the contextual influences on acculturative stress and psychological distress among Cuban-born women. The findings highlight several important factors that impact the acculturation process and well-being of this specific group. Proficiency in English emerges as a protective factor, reducing acculturative stress and suggesting that improving English skills can alleviate stress during the acculturation process. On the other hand, higher levels of church attendance, difficulties in visiting family abroad, and perceived racial discrimination are associated with increased acculturative stress. The duration of living in the U.S. and satisfaction with the decision to move also play a role in reducing acculturative stress. Additionally, age at immigration and family–culture conflict influence psychological distress, with older age and greater conflict leading to higher distress levels. Also important is the association between older age at the time of the survey and higher levels of acculturative stress. These findings prompt a consideration of how generational differences might influence the experiences of acculturative stress among Cuban-born women. It is plausible that women who migrated during different periods, under varying sociopolitical climates, have distinct experiences that shape their mental well-being. This factor is particularly relevant considering the dynamic nature of the Cuban immigrant community in the U.S. and the changing sociopolitical relations between the U.S. and Cuba. Future research should aim to disaggregate data by age and time of migration to explore these potential generational differences more comprehensively. Such analysis could provide more nuanced insights into the mental health needs of Cuban-born women across different age groups and migration cohorts, thereby informing more tailored mental health interventions. Moreover, there is a significant relationship between acculturative stress and psychological distress, indicating that higher levels of acculturative stress contribute to greater psychological distress.

These findings underscore the complex interplay of various factors in the acculturation and well-being of Cuban-born women, offering insights for interventions and support systems tailored to their unique needs. Comparing these findings to those of prior studies (Bekteshi and Kang 2020; Bekteshi and Vanhook 2014), this study highlights how the factors impacting the experiences of Cuban-born women differ when compared to Latina immigrants. These findings have significant implications for researchers who treat Latinos as a homogeneous group, emphasizing the need for greater cultural sensitivity and awareness of cultural differences among Latinos. The study reinforces the evidence (Bekteshi and Vanhook 2014; Bekteshi and Kang 2020) that acculturative stress and psychological distress should be examined as separate concepts not only for Latina immigrants but also for Cuban-born women. Our results suggest the importance of further exploring the relationship between acculturative stress and other indicators of poor mental health while considering the impact of various contextual factors. These factors, such as family–culture conflict, familismo, and perceived racial discrimination, may influence acculturative stress and psychological distress differently and in different ways for specific subgroups of Latina immigrants. One possible opportunity to further explore the specific nuances of these relationships and how cultural factors influence well-being would be to examine the experiences of Cuban–American women, including comparing those who are Cuban-born to those who are U.S.-born.

Although not specific to Cuban-born women, studies on Latinas in general suggest that acculturative stress can have different effects on various dimensions of mental health (Wang et al. 2010;). Effective mental health interventions should consider the cultural nuances of different Latino subgroups and attend to the specific dimensions of mental health. Future research should investigate factors beyond acculturative stress that contribute to psychological distress among older Cuban-born women, such as poverty and the lack of social and family support. This aligns with the findings of this study, which indicate that age and family culture conflict predict more psychological distress among Cuban-born women than acculturative stress alone. Previous studies have shown that family–culture conflict challenges all Latino groups when integrating into a new country (Bekteshi and Vanhook 2014; Bekteshi and Kang 2020; Perez 2021; Szapocznik and Kurtines 1980). Given that higher levels of acculturation are associated with lower acculturative stress, it is essential to explore and promote effective acculturation strategies, such as biculturalism and multiculturalism, to enhance the well-being of families and mitigate the negative impact of family–culture conflict. Research consistently indicates that family support and harmonious family relations are positively linked to mental health outcomes among Latinas (Campos et al. 2007; Easter et al. 2007; Bonnin and Brown 2002).

The study also emphasizes increased social discrimination against Latinos in the U.S. While some Cuban-born women may benefit from living in ethnic enclaves like Little Havana in Miami, discrimination remains a significant concern contributing to their acculturative stress (Bekteshi and Vanhook 2014). Future research should explore the relationship between the year of entry into the U.S., discrimination, and mental health among Cuban-born women. Understanding the interplay between the wave of Cuban immigration, available support from the host society, the Cuban enclave, and mental health outcomes has consistently been supported (Bekteshi and Vanhook 2014).

The findings of this study support the need for long-term mental health interventions that address specific contributors to psychological distress, such as family issues between the U.S. and Cuba, experiences of discrimination, and acculturation-related challenges (Bekteshi and Kang 2020). Clients may exhibit hesitancy in seeking help due to past experiences of discrimination, and their interactions with health services can be further influenced by the current social climate. It is important for practitioners to recognize that not all cultural values provide protection against discrimination or negative experiences for Cuban-born women especially considering the dynamics of acculturation (Bekteshi and Kang 2020). When Cuban-born women, who may have high family support, report symptoms of poor mental health, such as anxiety or depression, practitioners should also be cognizant that they may be experiencing discrimination.

Immigration contexts play a significant role in shaping clients’ mental health, and they should be examined within their specific contexts and individually (Bekteshi and Kang 2020). Considering the importance of religious groups in the lives of many Latinos, involving religious communities in outreach services and programs aimed at Cuban-born women can foster rapport building and trust, which are vital components of effective service plans in mental health and community practice at both the micro-level and macro-level. Research can enhance cultural sensitivity by fostering partnerships with community leaders to build trust and increase engagement with Cuban-born women.

Family conflict emerges as a key factor contributing to psychological distress among Cuban-born women. Potential sources of conflict include varying levels of acculturation among family members, shifts in gender roles, and different responses to new cultural expectations (Goodkind et al. 2008). Previous studies have suggested providing services aimed at improving family communication, particularly across generations (Ayon 2014). Additionally, various therapy models could be appropriate for Cuban-born women experiencing family–cultural conflict. A combination of Multicultural Family Therapy and Narrative Therapy may be particularly relevant (Comas-Diaz and Jacobsen 1991). Multicultural Family Therapy recognizes and validates the influence of cultural values, beliefs, and practices on family dynamics. It provides a space to explore the intergenerational and cultural factors contributing to conflict while honoring the strengths and resilience present in the family system. This approach aims to bridge understanding between different cultural perspectives and create space for dialogue and negotiation. Narrative Therapy can be useful in helping individuals and families externalize and reframe the problems they are facing. By examining and reconstructing the dominant cultural narratives at play, Cuban-born women and their families can explore alternative stories that align with their cultural values and identities. Narrative Therapy empowers individuals to challenge oppressive cultural discourses and fosters a sense of agency in shaping their own lives.

Mental health professionals might encounter several challenges as they practice these clinical models, including the following. Cultural Competence: In contemporary mental health practice, the concept of cultural competence has evolved to encompass cultural humility, cultural sensitivity, and cultural consciousness. This shift reflects a deeper understanding of the complexities involved in working with diverse populations. Cultural humility involves an ongoing process of self-reflection and personal critique of cultural biases, emphasizing a lifelong commitment to learning about others’ cultural experiences Cultural sensitivity recognizes and respects differences and similarities between cultures without assigning value judgments, which is crucial for effective communication in a multicultural context (Sue et al. 2009). Cultural consciousness, meanwhile, highlights the importance of being aware of one’s own cultural identity and viewpoints on diversity, thus enabling mental health professionals to better understand the dynamics of power, privilege, and prejudice in therapeutic relationships. By integrating these concepts, mental health professionals can adopt a more nuanced and effective approach, aligning with contemporary understandings of cultural dynamics in therapeutic settings (Azzopardi and McNeill 2016). Power Dynamics: Clients may perceive mental health professionals as having more authority or expertise, which can influence the therapeutic process. Clinicians need to establish a collaborative and egalitarian relationship that respects and values the client’s cultural perspective (Thompson et al. 1999). Language and Communication: Language barriers can pose challenges in therapy when mental health professionals and clients do not share a common language. Accurate translation and interpretation services are crucial to ensure effective communication and understanding between the mental health professional and the client (Thompson et al. 1999). Ethical Considerations: Mental health professionals need to navigate ethical considerations related to confidentiality, informed consent, and cultural norms. Cultural values and expectations may influence clients’ willingness to disclose certain information or involve family members in therapy. Mental health professionals must strike a balance between respecting cultural norms and ensuring the well-being of their clients (Jaldin et al. 2023). Resistance to Change: Clients and families may face resistance or hesitation to challenge cultural norms or make changes within their family systems. Addressing cultural conflict and promoting change may require careful navigation to balance cultural preservation and adaptation.

Mental health professionals who practice culturally appropriate approaches must be mindful of these challenges and work collaboratively with their clients to address them effectively. Ongoing supervision, cultural consultation, and professional development can help mental health professionals enhance their cultural competence and navigate these challenges more effectively (Sue et al. 2009; Thompson et al. 1999).

Limitations

Due to the cross-sectional nature of the data, the temporal ordering among the constructs in all estimated models is based solely on theoretical premises and the literature review. Although the estimated parameters were stabilized through cross-validation, it is essential to note that divergent causal sequences among the contextual constructs and the two outcome variables in this study cannot be definitively delineated. Additionally, it should be acknowledged that the National Latino and Asian American Study (NLAAS) was not originally designed to test the hypothesis of this study, and some variables used to assess contexts not initially intended for the study (e.g., gender-based roles) may be considered a proxy (Driscoll and Torres 2013). Similarly, some of the measures of acculturative stress do not capture all of the complex dimensions of this experience and could be improved upon in future studies. A further development of robust measures would also allow for a more rigorous empirical validation of hypothesized relationships. Furthermore, the NLAAS was conducted over ten years ago, and since then, the Latino population in the U.S. has undergone significant changes that the data may not fully capture (Perez 2021). Factors such as substantial population growth among Latinos and evolving attitudes toward them, particularly in light of ongoing immigration debates, could potentially influence the extent to which Latinos experience discrimination (Driscoll and Torres 2013). Another limitation of this study is its focus primarily on Cubans living in Florida, which may not reflect the experiences of Cubans residing in other parts of the U.S. While the current sample indicates that most Cubans (92%) reported living in Florida, it is worth noting that only approximately 70% of all Cubans in the U.S. reside in Florida (Delgado 2019). Furthermore, an essential data-driven limitation is the omission of race as a variable. The Cuban population is racially diverse, and white Cubans and Afro-Cubans may experience acculturative stress and psychological distress differently, which is partly due to racially motivated discrimination (Gomez and Diaz 2020). It is also important to recognize that racial categories as defined in the United States may vary considerably both in terms of categorizations and lived experiences. Finally, the reliance on older publications in this study poses a limitation, as limited recent research exists on Cuban-born women’s experiences with acculturative stress, potentially not reflecting the current context that influences the acculturation experience and mental health of Cuban-born women.

5. Conclusions

Significant progress has been made in recent years to acknowledge and address the underrepresentation of Cuban-born women in research, however, more effort is needed to enhance their presence. The underrepresentation of Cuban-born women in research can be attributed to various factors. Limited access to resources poses one of the primary challenges faced by Cuban-born women. This includes restricted opportunities for education, inadequate funding, and a lack of extensive research networks (Gomez and Diaz 2020). Language barriers also present a significant obstacle, hindering their understanding of study requirements and effective communication with researchers. Additionally, traditional gender roles, familial responsibilities, and cultural norms related to academic goals contribute to the limited availability of Cuban-born women for research involvement (Torres et al. 2012). These societal factors often prioritize family obligations and discourage active participation in academic endeavors (Driscoll and Torres 2013). Moreover, systemic biases within the research community perpetuate the underrepresentation of Cuban-born women and other marginalized groups. Although these biases are often unconscious, they manifest in study design, recruitment practices, and the allocation of research funding. Addressing these biases requires proactive efforts from both researchers and institutions. Researchers must adopt inclusive recruitment strategies that actively seek out and engage with this population. Collaborating with community organizations that have established connections and trust within the Cuban-born community can facilitate this process. Moreover, providing language support and ensuring culturally sensitive research design will enable Cuban-born women to participate fully and meaningfully (Driscoll and Torres 2013). Ultimately, combating systemic biases within the research community is crucial. Institutions and researchers must acknowledge and address these biases through ongoing education, training, and evaluation of research practices. By actively working toward diversity and inclusivity, researchers can ensure that a broader range of perspectives, including those of Cuban-born women, are represented. This will lead to comprehensive and equitable research outcomes that benefit society as a whole.

This study represents the first attempt to examine the impact of various contextual factors on psychological distress among Cuban-born women in the U.S. The NLAAS data provide a representative sample of Cubans, and exploratory studies have proven valuable in motivating future, more focused research due to the limited existing literature on the subject. It is recommended to conduct smaller and more concentrated studies to investigate further the impact of the contextual factors mentioned on acculturative stress and psychological distress among immigrant groups. The comprehensive analysis presented in this study contributes to our understanding of the influence of environment, cultural values, and acculturation strategies on the psychological distress experienced by Cuban-born women in the U.S. (Driscoll and Torres 2013). With this knowledge, practitioners can better engage with clients with more awareness of and sensitivity to important contextual factors.