Arab American Mental Health in the Post September 11 Era

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An Abstract of

Arab American Mental Health in the Post September 11 Era:

Acculturation, Stress, and Coping

Mona M. Amer

Submitted as partial fulfillment of the requirements for

the Doctor of Philosophy in Psychology

The University of Toledo

May 2005

Persons of Arab (North African/ Middle Eastern) descent have faced unique psychosocial stressors due to the socio-political backlash following the World Trade

Center attacks. These are compounded by traditional acculturation challenges, leading to increased psychological distress. This study satisfies an urgent need to better understand the acculturation and mental health experiences of Arab Americans by comprehensively and rigorously investigating hypotheses introduced in the previous literature.

Participants were 611 Arab Americans from 35 U.S. states who completed a secure Internet form. Variables assessed were: acculturation (Vancouver Index of

Acculturation- Modified Arab Version), acculturative stress (SAFE Acculturation Stress

Scale- Revised; included issues of discrimination and American foreign policy), family functioning (Family Assessment Device- General Functioning Subscale), social support

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(Personal Resource Questionnaire85- Revised), religious coping (Brief Arab Religious

Coping Scale), anxiety (Beck Anxiety Inventory), depression (Center for Epidemiologic

Studies- Depression Scale), and a socio-demographics survey.

Seven research foci were examined. First, 13 socio-demographic indexes hypothesized to relate to acculturation (including SES, generation status, length of residence in the U.S., English vs. Arabic language use, and Arabic TV viewing) were found to relate to American identity in the expected directions, while most indexes did not relate to Arab identity. Second, participants reported significantly higher anxiety and depression compared to normative samples and studies with other ethnic minority groups.

Third, as hypothesized, integrated and assimilated individuals reported less stress, anxiety, and depression compared to those who were separated or marginalized.

Fourth, as hypothesized, acculturation stress correlated with anxiety and depression, and both family functioning and social support related to less stress and less psychological distress. However, religious coping did not correlate with mental health.

Fifth, contrary to the hypotheses, females did not demonstrate greater stress or psychological distress compared to males. Consistent with hypotheses, Christians demonstrated significantly less acculturative stress, anxiety, and depression compared to

Muslims. Finally, structural equation modeling was used to develop a tenable model that explained the complex interactions among SES, acculturation, stress, mental health, and coping resources. Specific and practical recommendations are provided for clinical intervention, community programming and policy planning, and future research.

Dedication

This dissertation is dedicated to my family,

my father mother and sisters,

the coolness of my eyes.

Acknowledgements

All praise and thanks due to Allah, the Compassionate, the Merciful, for blessing me with the strength and guidance to complete this project. Without His endless grace and bounty, none of this would have been possible. He is the Compeller, the Creator, the

All-Knowing, and the All-Wise.

I would like to express my deepest appreciation to Dr. Joseph Hovey, my advisor.

His patient and thoughtful mentorship has helped nurture and shape my interests and scholarship to what it is now. Only with his flexibility, kindness, creativity, and endless support was I able to reach this accomplishment.

Special heartfelt gratitude goes to my dissertation committee members for their invaluable feedback. Thanks to Dr. Paula Dupuy for initiating an internal dialogue of cultural and personal sensitivity that struck a chord with me four years ago and has resonated throughout my work since. Dr. Funk has been my solid reference point amidst the challenges of graduate school, and I appreciate her constant and kind encouragement, consultation, and insight. I thank Dr. Peg Hull Smith for her thoughtful and challenging critiques and her enthusiasm for integrating culture in study. I am moreover appreciative of Dr. Mojisola Tiamiyu’s infectious optimism and thorough critical feedback, as well as her sense of community justice, which was interwoven in the pages of this work.

No amount of thanks could express what I feel for my loving family for their neverending support and prayers. My father continues to be my role model with his kindness, passion for education and scientific inquiry, and boundless motivation and focus. I am grateful for my mother’s love, patience, and encouragement in this difficult

project; she hoisted me up whenever I stumbled or stalled. Hoda, with her wisdom and advice, has been my special companion throughout this process. And Sophi, with her laughter, carried me through the grayest of days.

Sincere appreciation is extended to members of the Greater Toledo Arab community who helped fashion the ideas at the core of this study. Alexander Rezcallah provided important assistance, and I thank him for the countless hours he spent distributing surveys and pondering the results. Thanks also to Nasser El-Okdi and the

Arab Student Union, my lovely friend Sana Jouejati (“Al-Faham”), “Tante” Mahasen

Kassem, Nader Qaimari from the Greater Toledo Association of Arab Americans, Dr.

Sabry Gohara, Dr. Mostafa Ibrahim (Michigan), and Dina Sabry from the Coptic Club for also taking time from their busy schedules to advocate and educate about this study.

I would like to extend my gratitude to Dr. Christine Fox at The University of

Toledo for her ongoing review of my work with the Rasch model. The Yale statistical clinic provided a fertile ground for me to explore the interrelations among the variables in this study using the intriguing G-plus. Thanks also to Dr. Christian Connell at Yale

University for his input and demonstrations with SEM and Amos.

Finally, I would like to express my gratefulness to the larger Arab American community, especially all the participants who took this work seriously enough to complete the study and pass the message on. Moments of kindness from people such as

Marvin Wingfield from the ADC, Souhail Kassabri from the Arab American Community

Center in Cleveland, Rev. Bassam J. Abdallah from the Lutheran ministries in Indiana, and Dr. Mohamed Farrag from ACCESS Dearborn lifted my hopes and gave me the motivation to continue on. All the Arab American individuals, cultural centers,

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professional associations, social service organizations, university clubs, churches, mosques… there are just too many to name and I thank them all. It is my sincere desire that this research serves as a gift to the community in return.

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Table of Contents

Abstract …………………………………………………………………………….. iii

Dedication ………………………………………………………………………….. v

Acknowledgements ………………………………………………………………… vi

Table of Contents ………………………………………………………………….. ix

List of Tables ………………………………………………………………………. xiv

List of Figures ……………………………………………………………………… xvi

I. Introduction ………………………………………………………………………. 1

Acculturation and Mental Health Theory and Research ……………………... 5

Definitions and Models of Acculturation ……………………………… 5

Psychological Adaptation and Acculturative Stress …………………… 17

Acculturation, Family Functioning, and Social Support ………………. 23

Religious Coping and Mental Health of Acculturating Individuals …… 28

Arab American Acculturation and Mental Health …………………………… 32

Definitions and Demographics of “Arabs” and “Arab Americans” …… 33

Acculturation Strategies within a Historical Context ………………….. 38

Acculturation Strategy, Acculturative Stress, and Mental Health …….. 42

The Arab American Family: Stress and Social Support ……………….. 52

Religion and Religious Coping ………………………………………… 60

Definition of Terms ………………………………………………………….. 61

Aims of the Present Study ……………………………………………………. 64

II. Methods …………………………………………………………………………. 68

Participants …………………………………………………………………… 68

Measures ……………………………………………………………………... 82

Vancouver Index of Acculturation- Modified Arab Version (VIA-A) … 82

SAFE Acculturation Stress Scale- Revised (SAFE-R) ………………… 89

McMaster Family Assessment Device- General Functioning Subscale (FAD-GF)……………………………………………………………….. 91

Personal Resource Questionnaire- Part 2- Revised (PRQ85-R) ……….. 92

Brief Arab Religious Coping Scale (BARCS) …………………………. 94

Validity …………………………………………………………… 97

Reliability ………………………………………………………… 100

Category Functioning …………………………………………….. 102

Final Questionnaire ………………………………………………. 104

Beck Anxiety Inventory (BAI) ………………………………………… 104

Center for Epidemiologic Studies- Depression Scale (CES-D) ………... 109

Socio-Demographics Survey …………………………………………… 111

Procedures ……………………………………………………………………. 112

III. Data Analyses ………………………………………………………………….. 120

Rasch Rating Scale Analysis ………………………………………………… 120

Validity ………………………………………………………………… 121

Reliability ………………………………………………………………. 122

Category Functioning Diagnostics ...... 123

Descriptive and Bivariate Statistics ………………………………………….. 125

Structural Equation Modeling ………………………………………………... 126

The Structural Regression Model ……………………………………… 127

Model Specification and Identification ………………………………… 128

Data Preparation and Screening ………………………………………... 128

Model Estimation Procedures ………………………………………….. 131

Estimating Model Fit …………………………………………………... 132

IV. Results …………………………………………………………………………. 136

Descriptive Statistics …………………………………………………………. 136

Research Focus 1: Socio-Demographic Factors Relating to Acculturation ….. 137

Research Focus 2: Mental Health Status Compared to Norms and Other Groups ………………………………………………………………………... 142

Research Focus 3: Acculturative Strategy, Stress, and Mental Health ………. 147

Research Focus 4: Relationships among Stress, Coping, and Mental Health ... 149

Research Focus 5: Gender Differences in Stress and Mental Health ………… 150

Research Focus 6: Christian-Muslim Differences in Acculturation and Mental Health ………………………………………………………………… 151

Research Focus 7. Structural Model of Acculturation, Coping, and Mental Health ………………………………………………………………………… 153

Specification and Identification of the Hypothesized Model ………….. 153

Data Preparation and Screening ………………………………………... 156

Evaluation of Model Fit ………………………………………………... 165

Model Respecification …………………………………………………. 165

Final Model …………………………………………………………….. 168

V. Discussion ………………………………………………………………………. 173

Research Focus 1: Socio-Demographic Factors Relating to Acculturation ….. 173

Research Focus 2: Mental Health Status Compared to Norms and Other Groups ………………………………………………………………………... 178

Research Focus 3: Acculturative Strategy, Stress, and Mental Health ………. 180

Research Focus 4: Relationships among Stress, Coping, and Mental Health ... 181

Research Focus 5: Gender Differences in Stress and Mental Health ………… 184

Research Focus 6: Christian-Muslim Differences in Acculturation and Mental Health ………………………………………………………………... 185

Research Focus 7: Structural Model of Acculturation, Coping, and Mental Health ………………………………………………………………………… 187

Clinical Implications …………………………………………………………. 190

Community Implications …………………………………………………….. 196

Strengths and Limitations of the Present Study ……………………………… 199

Recommendations for Future Research ……………………………………… 204

References ………………………………………………………………………….. 211

Appendix A. Vancouver Index of Acculturation (Ryder et al., 2000) ……………... 242

Appendix B. Pilot Questionnaires for the Present Study …………………………... 243

Appendix C. Web site Questionnaires for the Present Study …………………….... 249

Appendix D. SAFE Acculturation Stress Scale (Mena et al., 1987) ………………. 268

Appendix E. BARCS: Initial 62 Pilot Items Ordered by Logit Measure ………….. 270

Appendix F. BARCS: Piloted Items Removed and Reason for the Removal ……... 273

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Appendix G. BARCS: Revised 28 Pilot Items Ordered by Logit Measure ……….. 275

Appendix H. BARCS: Revised 18 Pilot Items Ordered by Logit Measure ……….. 277

Appendix I. Example E-mail Invitation for the Present Study …………………….. 278

Appendix J. Summary of Responses to Arab Acculturative Strategy Scale ……….. 279

Appendix K. BAI Descriptive Statistics for Select Studies with Different Ethnic Groups ……………………………………………………………………………… 281

Appendix L. CES-D Descriptive Statistics for Select Studies with Different Ethnic Groups ……………………………………………………………………………… 282

Appendix M. Estimated Covariance Matrix for SEM Variables …………………... 284

Appendix N. Estimated Correlation Matrix for SEM Variables …………………… 285

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List of Tables

Table 2.1. Basic Demographic Characteristics of Participants ……………………… 69

Table 2.2. Socio-Economic Characteristics of Participants and Their Families …... 70

Table 2.3. Participants’ Location of Residence (N= 611) ……………………………. 73

Table 2.4. Participants’ Generational Status …………………………………………… 74

Table 2.5. Generational Status of "Other" or Mixed Categories …………………….. 76

Table 2.6. Participants’ Location of Ancestry ………………………………………….. 78

Table 2.7. Location of Participants’ Extended Family ………………………………… 79

Table 2.8. Participants’ Visitations to the Arab World ………………………………... 80

Table 2.9. Language Spoken in Participants’ Households ……………………………. 81

Table 2.10. Frequency of Watching Arabic TV Channels …………………………….. 81

Table 2.11. Category Functioning of the VIA-A Arab Subscale ……………………… 85

Table 2.12. Category Functioning of the VIA-A American Subscale ………………... 87

Table 2.13. BARCS: Largest Standardized Residual Correlations to Identify Dependent Items …………………………………………………………………………….. 98

Table 2.14. BARCS: Largest Standardized Residual Correlations to Identify Dependent Items …………………………………………………………………………….. 99

Table 2.15. Category Functioning of the 15-Item BARCS …………………………….. 103

Table 2.16. Descriptive Statistics for BAI Items (n= 601) …………………………….. 107

Table 2.17. Comparison of Correlations for BAI-20 and BAI-21 ……………………. 108

Table 4.1. Summary of Participant Responses on Research Measures ……………… 137

Table 4.2. Correlations Between Socio-demographic Variables and Acculturation . 138

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Table 4.3. BAI Descriptive Statistics for Current Study and Normative Studies ….. 144

Table 4.4. CES-D Descriptive Statistics for Current Study and Normative Study….. 146

Table 4.5. Correlations between Cultural Identities and Mental Health ……………. 147

Table 4.6. Stress and Mental Health Scores Based on Acculturation Strategy …….. 149

Table 4.7. Correlations among Stress, Coping, and Mental Health (n= 609) ……… 149

Table 4.8. Stress and Mental Health Scores Based on Gender ………………………. 151

Table 4.9. Acculturation and Mental Health Scores Based on Religious Affiliation . 152

Table 4.10. Original Descriptive Characteristics of Observed Variables ………….. 158

Table 4.11. Final Descriptive Characteristics of Observed Variables ……………… 164

Table 4.12. Summary of Parameter Estimates for Covariances in Final Model …… 170

Table 4.13. Summary of Parameter Estimates for Coefficients in Final Model ……. 170

List of Figures

Figure 1.1. Linear Model Proposed by Szapocznik and Colleagues ………………. 9

Figure 1.2. John Berry’s Bidimensional Acculturation Model ……………………. 12

Figure 1.3. Bourhis and Colleagues’ Interactive Acculturation Model ……………. 14

Figure 2.1. Probability Curves for VIA-A Arab Subscale ………………………… 86

Figure 2.2. Probability Curves for VIA-A American Subscale ……………………. 88

Figure 2.3. Person-Item Map for the 15-Item BARCS …………………………….. 101

Figure 2.4. Probability Curves for the 15-Item BARCS …………………………... 103

Figure 4.1. Hypothesized Model of Arab American Acculturation, Coping, and Mental Health ………………………………………………………………………. 154

Figure 4.2. Histograms for VIA-A Arab Scores Before and After Transformation .. 160

Figure 4.3. Histograms for Length of Stay in U.S. Before and After Transformation ……………………………………………………………………... 160

Figure 4.4. Histogram for Frequency of Arabic TV Viewing ……………………... 161

Figure 4.5. Histogram for Annual Family Income in Dollars ……………………... 162

Figure 4.6. Histograms for Education Before and After Collapsed Categories …… 162

Figure 4.7. Histograms for BAI Scores Before and After Transformation ………... 163

Figure 4.8. Standardized Parameter Estimates for Hypothesized Model ………….. 167

Figure 4.9. Final Model with Standardized Parameter Estimates ………………… 169

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Chapter 1

Introduction

In May 2003, a 46-year-old Arab American woman named Anissa Khoder suffered an anxiety attack and fainted during a court hearing after the judge implied that she was a terrorist. Mrs. Khoder, a non-practicing Muslim who immigrated from

Lebanon at the age of 32, attended the hearing in Tarrytown, New York, to contest two parking tickets she had received. Seventy-nine year old Justice William Crosbie reportedly countered her request with a comment that if she financially supported terrorists, then she should not be unwilling to pay the tickets. In response, Mrs. Khoder, who identifies herself as “American,” celebrates Christmas, and does not listen to Arabic music, experienced an anxiety attack in which she was unable to speak. She then fainted and an ambulance was called (Bandler, 2003).

Mrs. Khoder’s story is not singular. Experiences of targeted prejudice and discrimination against Arab Americans subsequent to September 11, 2001 have not been uncommon. Although anti-Arab discrimination and hate crimes have fluctuated over the past 20 years parallel to American involvement in Middle East conflicts, a dramatic increase in the frequency and severity of such events after the World Trade Center attacks is undeniable. For example, the Federal Bureau of Investigation (FBI) reported that anti-

Muslim crimes increased by 17% during 2001. The cities of Los Angeles and Chicago both reported a 15% increase in Anti-Muslim and Anti-Arab crimes such as verbal

1 2 threats, vandalism, vehicular assaults, and even murders. In addition to harassment and forced isolation by their fellow citizens, governmental statements and policies have added further stressors for persons of Arab ethnic background. Examples include the FBI interrogation of over 5,000 Middle Eastern men, the detention of hundreds of Arab

Americans without notification of a specific crime committed, the Immigration and

Naturalization Service’s fingerprinting and registration of Arab immigrants, and tighter immigration laws (Singh, 2002).

Considering the salient acculturative stressors that Arab Americans have been facing in the U.S., in addition to immigration stressors such as war trauma, political exile, economic instability, and loss of extended family support, it is not surprising to discover significant mental health complaints and increased service utilization within this population. For example, in 1989 Laffrey, Meleis, Lipson, Solomon, and Omidian conducted a health needs assessment among Arab immigrants in Northern California.

Based on a combination of data-gathering techniques (e.g., community forums, key informants, government health data, a survey), the authors contended that Arab

Americans are at risk for mental health problems due to acculturative stressors and trauma. Moreover, two of the top five health problems endorsed by participants were emotional problems (17%) and social or family stress (13%). Abudabbeh and Nydell

(1993) reported a critical need for mental health practitioners to attend to the psychological concerns of Arab Americans after the Gulf War. Individuals who sought help were often refugees suffering posttraumatic stress disorder or Arab students and second generation Arab Americans who experienced anxiety, fear, and guilt. Other presenting complaints identified by the authors included identity confusion, cultural

3 agoraphobia, intergenerational conflict, parenting difficulties, physical abuse, and loss of the extended family support system.

Mental health clinicians and researchers have provided anecdotal evidence that

Arab American mental health problems and service utilization have increased since the

World Trade Center tragedy (“Stress-Related Ailments,” 2003). Mosque imams

(religious leaders) have reported an increasing need to counsel Arab congregants as a result of discrimination since September 11 (Ali, Milstein, & Marzouk, 2005). With respect to service utilization, in a recent mental health needs assessment conducted in

Toledo, Ohio, 32.5% of the 157 Arab American respondents indicated that they or a person close to them had sought professional mental health assistance (Amer et al, 2003).

In another community study also conducted in Toledo, 10.4% of 240 Muslims of Arab ethnic background admitted to receiving professional psychological services during the two years prior to the study (Khan, 2003). Similarly, in a study of 285 Arab Muslims in

Greater Columbus, Ohio, 9.6% admitted to seeking formal mental health services during the previous three years (Aloud, 2004). These results are remarkable when contrasted with indications that Arab Americans are reluctant to seek professional help. Within the

Arab American community there is an unwillingness to admit to psychological distress, and visiting a mental health provider may be viewed as disloyalty to group honor or as a sign of shame and weakness. These barriers are compounded by mistrust towards both mainstream and Arab professionals (Abudabbeh & Nydell, 1993; Aloud, 2004; Nassar-

McMillan & Hakim-Larson, 2003; Salari, 2002).

Despite the apparent increase in mental health concerns and professional service utilization among Arab Americans, research on this population has remained stagnant and

4 limited (Nassar-McMillan & Hakim-Larson, 2003). Such paucity of research only further demonstrates the marginalized nature of this population (Salari, 2002). Only a handful of articles in total have been published using Arab American samples, primarily written by professionals from related fields such as nursing and anthropology. These studies have employed personal anecdote, case study, survey, interview, and small-sample correlation techniques. In all of the studies that used measures, the measures had not been evaluated for reliability and validity prior to the study. Moreover, although many of these studies presented detailed descriptions and theories regarding Arab American acculturative factors and mental health, large-scale hypothesis testing has not been conducted. As a result of the minimal academic literature, mental health providers often depend on the media for resources. Media-based information is often inaccurate, and clinicians may therefore be biased or find it difficult to understand the presenting problems of their Arab

American clients. As a result, they may implement therapeutic techniques that are irrelevant, insensitive, or even harmful (Abudabbeh, 1997; Al-Krenawi & Graham, 2000;

Budman, Lipson, & Meleis, 1992).

The present study serves to fill a serious gap in the Arab American mental health literature by examining the accurateness of many of the previously-proposed theories regarding acculturation and mental health. Rigorous measure development, larger sample attainment, hypothesis-testing, and complex modeling approaches were used. In addition to stimulating further research with this population, this study presents timely benefits for clinicians who can use the results to inform their practice in a culturally-sensitive manner.

The results of this study may also help Arab American cultural centers and organizations develop policies promoting better mental health that are consistent with research

5 evidence. For example, current conflicting theories on ideal acculturative strategies are demonstrated by the contrast between centers that promote Arab ethnic identity and others that encourage patriotism, assimilation, and devalued ethnic identity.

The following sections in this Introduction outline the existing literature on the impact of acculturation factors on mental health. The history of acculturation theory is detailed, followed by a summary of the emerging acculturative stress data. The roles that family functioning, social support, and religious coping play in the acculturation process are briefly discussed. Next, the historical and socio-demographic characteristics of Arabs in America are reviewed, in addition to studies regarding Arab acculturation strategies.

The existing literature on Arab American acculturation stress and mental health are then expounded, including the intersections of family, social support, and religion. Finally, the current research objectives are presented.

Acculturation and Mental Health Theory and Research

The theory of acculturation has had a significant impact on social sciences since the early 1900’s when it was first conceptualized by anthropologists. Acculturation constructs have been an integral component of the examination and measurement of several phenomena characteristic of the 20th century, including colonization, international migration, budding minority groups in multicultural societies, and even economic globalization (Castro, 2003). Although its birth was in the field of anthropology, acculturation research has become a vital topic in the field of psychology, in particular the relatively new discipline of cross-cultural psychology (Berry, 2003).

Definitions and Models of Acculturation. The term “acculturation” was first introduced in 1936 by anthropologists Redfield, Linton, and Herskovits. They defined

6 acculturation as the “phenomena which results when groups of individuals having different cultures come into continuous first-hand contact with subsequent changes in the original culture patterns of either or both groups” (p. 149). The Social Sciences Research

Council proposed a more refined definition in 1954:

Acculturation may be defined as cultural change that is initiated by the

conjunction of two or more autonomous cultural systems…. Its dynamics can be

seen as the selective adaptation of value systems, the process of integration and

differentiation, the generation of developmental sequences, and the operation of

role determinants and personality factors. (p. 974)

These early definitions of acculturation highlighted the interactive nature of cultural exposure when groups are involved in long-term contact with one another.

Changes may occur when one (or both) group adopts beliefs, values, or behavioral customs from the other. These changes may affect the group’s social, political, and economic systems. Although this early definition of acculturation did not emphasize the dominance of one group over the other, a shared assumption among anthropologists at that time was that although acculturation is an exchange process, acculturation would be more significant in favor of the more contributing and powerful dominant or host culture.

In other words, acculturating groups would transition towards less native and traditional beliefs and customs, thereby becoming more developed, functional, and successful.

During this process, the acculturating newcomer group would internalize (or assimilate into) the adopted host culture (Castro, 2003; Trimble, 2002).

In 1967 Graves proposed a significant addition to acculturation theory: the distinction between acculturation and psychological acculturation. He noted that

7 acculturation as researched by anthropologists consists of the acculturation process at a population or societal level. In other words, acculturation referred to the above- mentioned changes in a group’s value system and cultural practices after exposure to a more dominant group. Psychological acculturation, on the other hand, referred to the intra-individual processes whereby a single person changes his or her attitudes, beliefs, and behaviors after exposure to an alternative culture. Included in this theory was a hypothesized interactive relationship between acculturation at the individual and group levels. Theorists further postulated that the psychological acculturative process can be either positive or negative. Positive psychological adaptation took place when there was a good match between the person and the new culture and the acculturation process led to a clear identity, strong self esteem, and positive mental health. Negative adaptation referred to the anomie, identity confusion, and anxiety experienced by some acculturating individuals (Castro, 2003; Graves, 1967).

As acculturation theory began to emphasize the psychological acculturation process, particularly among sociologists and psychologists, several acculturation paradigms were introduced. Gordon (1978) presented a more in-depth analysis of the linear assimilation model. He discussed the process by which immigrants and minority group members acculturate to the host or mainstream culture, emphasizing seven subprocesses. The first subprocess is cultural assimilation, in which the person changes his or her cultural patterns to match those of the host society. The second is structural assimilation, through which the person becomes engaged in mainstream societal networks and institutions. Intermarriage with persons from the host group is the third assimilation subprocess. Fourth, the person begins to identify as a member of the new

8 culture, also known as identification assimilation. A fifth subprocess was attitude receptional assimilation, or lack of intergroup prejudice, while the sixth was behavioral receptional assimilation, in which there is an absence of intergroup discrimination. The final subprocess introduced was civic assimilation, in which there is no intergroup conflict or power struggle. According to Gordon, cultural assimilation is the first acculturative event, and structural assimilation is pivotal to the process because it is immediately followed by the other subprocesses. In other words, as members of the group become involved in mainstream culture, they will eventually intermarry and over generations dissolve into the framework of the host society. Based on Gordon’s model it was assumed that the key factor influencing the acculturative process was length of residence in the host culture. The entire process was conceptualized as a time-based continuum in which the person first presents with strong traditional ethnic culture and finally adopts the host culture, with a period of biculturalism at the midpoint. This acculturation model produced the first impetus in psychological acculturation research

(Castro, 2003; Gordon, 1978).

Assimilation theory gave rise to a more specific unidimensional model: the linear model introduced by Szapocznik, Scopetta, Kurtines, and Aranalde (1978). These authors proposed that acculturation (or assimilation) is a function of the length of time a person resides or interacts with the host culture, with different rates of assimilation depending on age and sex (see Figure 1.1). According to the theory, younger persons will acculturate at rates faster than their parents and at rates faster than persons who immigrated at an older age. Additionally, males will acculturate faster than females. Furthermore, the authors distinguished between cultural acquisition of behaviors (e.g., traditions, customs, habits)

9 and adoption of basic cultural values, with the former occurring earlier and at a faster rate than the latter.

Male Children

Female

Male Parents Acculturation Female

Length of Time

Figure 1.1. Linear Model Proposed by Szapocznik and Colleagues1

1 From “Acculturation and Psychological Adaptation,” by V.S. Castro, 2003, Westport, CN: Greenwood.

There have been several criticisms of unidimensional acculturation paradigms.

The early concept of acculturation assumed that acculturation was a linear process in which the more traditional group would gradually lose its customs while adopting the values and behaviors of the host culture in a nonreversible manner. Therefore, the terms

“acculturation” and “assimilation” were often used interchangeably. However, contemporary theorists argue that acculturation is not a nonreversible process, and that there isn’t a conceptual or definite end point to the acculturative process at which one group has completely assimilated into the other. Additionally, acculturating groups may internalize specific aspects of another group’s culture consistent with their own worldview or belief system, but they may not necessarily adopt the host culture in its entirety. Another criticism is that despite claims to the otherwise, the acculturation

10 process is not always positive, and sometimes the adoption of another group’s more contemporary practices can lead to conflict, disruption, and stress (Trimble, 2002).

Finally, the linear model does not account for significant changes in the host culture that result from the interactive presence of the immigrant group even when the immigrant group becomes absorbed by the dominant culture (Bourhis, Moïse, Perreault, & Senécal,

1997).

Arguments against the assimilation model on an individual level paralleled criticisms of the model at the group level. With respect to research evidence, studies have found that adoption of mainstream values and behaviors does indeed increase with time spent in the host society. After immigrants establish residence in the new culture, individuals from each successive generation demonstrate higher levels of mainstream identity and host cultural practices. However, there has been no support for the suggestion that the traditional culture is completely diminished in the process, and oftentimes several aspects of the traditional culture (e.g., family structure) are retained throughout the acculturative process. Men and younger persons have been found to assimilate at a faster rate than women and older persons; however, this phenomenon has only been found in relation to cultural behaviors and not values. In conclusion, the acculturative process is too complex to be accounted for by the linear assimilation model, and ethnic identity and mainstream identity have not been found to be completely mutually exclusive (Castro, 2003).

In response to some of the shortcomings of the linear model, several researchers have proposed bidimensional or multidimensional models of acculturation. These models are based on the conviction that a person’s ethnic identity or identification with

11 traditional culture falls on a separate continuum from that person’s adoption of mainstream identity and culture. One such model is the Acculturation-Biculturalism

Model that was proposed by Szapocznik, Kurtines, and Fernández (1980). This model is different from the linear model proposed earlier by Szapocznik and colleagues (1978) in that it accounts for situations in which acculturating individuals are exposed to two cultures: the culture of origin and the mainstream host culture. In such a bicultural environment, individuals develop the skills needed to interact with both cultures within the framework of two separate but related processes: adoption of host culture and retention of ethnic culture. As with previous unidimensional theories, the adoption of host culture is viewed as a linear function of the length of time that the person has resided or interacted with the host culture. The process of retaining or losing the original culture, on the other hand, depends on a variety of factors such as amount and type of continued exposure to original cultural traditions and community support from others of the same cultural background (Szapocznick et al., 1980).

Perhaps the most wellknown two-dimensional acculturation model, however, is the model that was proposed by John Berry (1980, 1984; see Figure 1.2). Berry also maintained that retaining the traditional culture falls on a separate continuum from acquiring the new host culture. He hypothesized that when individuals are exposed to the host culture- for example after immigrating- they are confronted with two questions they must answer. The first question is, “Are cultural identity and customs of value, and to be retained?” The second question is, “Are positive relations with the larger society of value, and to be sought?” If the person answers “no” to the first question and “yes” to the second question, he or she will abandon or renounce traditional cultural values and

12 behaviors and acquire the host culture. This is otherwise known as assimilation. If a person answers “yes” to the first question and “no” to the second, then he or she has decided to retain the culture of origin and refrain from adopting aspects of the mainstream culture. The person is thus selecting separation (or segregation). Other individuals may find value in both adopting the new culture and retaining the old, which is called integration. Integration is the outcome of responding in the affirmative to both questions. Finally, some individuals may choose the option of marginalization (or, deculturalization, disengagement) from both the traditional and host cultures (answering

“no” to both questions).

Question 1. “Are cultural identity and customs of value, and to be retained?” Yes No Question 2. “Are positive Yes relations with the larger Integration Assimilation society of value, and to be No Separation Marginalization sought?”

Figure 1.2. John Berry’s Bidimensional Acculturation Model1

1 Adapted from Berry, 1984, p. 12.

The four acculturation options that Berry proposed- assimilation, separation, integration, and marginalization- are referred to as acculturation strategies to emphasize the decision-making component of the process. The model incorporates both individual and group levels of analysis. For example, a cultural group might elect as a whole to separate from the host culture even though one or more individuals from that same group may choose to follow an alternative acculturation mode such as integration. The model also theoretically accounts for the influences of the host society in influencing the person

13 or group acculturation strategy. For example, newcomer groups may be forced to separate from the host culture because the host society purposefully ostracizes them, while in other countries assimilation may be the most endorsed state policy (Castro, 2003).

Despite its widespread popularity, several criticisms have been associated with

Berry’s model. Some theorists have argued that the model does not distinguish between attitudes and behaviors, and that retention of traditional culture is related more to attitudes regarding the ethnic culture whereas adoption of the host culture is related to acquiring mainstream behavioral practices. Another criticism has been that the model does not adequately address the nature of the marginalization category, which can represent either a distressful condition of anomie or a positive individualistic stance

(Bourhis et al., 1997). Although Berry does not discount the influences of the host culture on impacting the person’s acculturation strategy (e.g., Berry, 2001), these influences are not emphasized or truly accounted for in the original model, in which the strategies are defined based primarily on the person’s choice in answering the key acculturative questions. Thus, researchers have criticized Berry’s model for not addressing the significant impact of intergroup relations on acculturation style (Castro, 2003).

To more fully account for the impact of intergroup relations on a person’s acculturation strategy, Bourhis and colleagues (1997) introduced the Interactive

Acculturation Model (IAM; Figure 1.3). This model takes into account three acculturative processes: (1) the acculturating individuals’ strategies based on their cultural identification, (2) the host culture’s attitudes towards the new individuals’ acculturation, and (3) the outcomes resulting from the interactive relationship between the first two factors. The interaction between the individual’s desired acculturative

14 strategy and the host culture’s attitudes towards the individual’s group of origin will lead to one of three outcomes: consensual, problematic, or conflictual. For example, if the person or minority group selects an assimilation acculturation strategy and the host culture’s policies promote assimilation, then the outcome will be a consensual process.

However, if the individual attempts to assimilate but the host or majority group prefers that person’s group to be separated from the host culture, the outcome will be conflictual.

Immigrant Community Host Community Integration Assimilation Separation Anomie Individualism

Integration Consensual Problematic Conflictual Problematic Problematic

Assimilation Problematic Consensual Conflictual Problematic Problematic

Segregation Conflictual Conflictual Conflictual Conflictual Conflictual

Exclusion Conflictual Conflictual Conflictual Conflictual Conflictual

Individualism Problematic Problematic Problematic Problematic Consensual

Figure 1.3. Bourhis and Colleagues’ Interactive Acculturation Model1

1From Bourhis et al., 1997, p.382.

According to Bourhis and colleagues (1997), the host culture’s preference for a particular acculturation strategy is based on two factors. The first factor is the integration ideology endorsed by the state; in other words, the belief system and resultant governmental policies that the host society promotes. For example, some countries may encourage immigrants to assimilate into the host culture whereas other states may forcibly segregate or exclude the minority individuals (e.g., refusal to provide citizenship status). The second influencing factor on the host or majority culture’s attitudes is the

“vitality” of the immigrant group. Groups with high vitality are characterized by high status (i.e., social prestige and acceptance), stronger demographic variables (e.g., larger numbers), and greater institutional support (e.g., representation and decision-making power in education, businesses, government, or media). These high-vitality groups have more power in selecting their desired acculturative strategies whereas low-vitality groups are more likely to be excluded by the host culture (Bourhis et al., 1997). Because the

IAM is a relatively new model, lack of empirical support is its main criticism (Castro,

2003).

In general, multidimensional models of acculturation have gained more recognition and support in recent years. However, regardless of the model used, researchers have agreed that several variables significantly impact the acculturative process. At the group level, the demographic (e.g., overpopulation), political (e.g., war), and economic (e.g., poverty) contexts of the culture of origin may influence the group’s acculturative strategy in the new homeland. The acculturating group’s vitality and changes in its economic, social, and cultural features in the host society may also impact acculturation strategy. Additionally, the host society may influence the newcomers’ strategy based on its integration ideologies, prejudice, or discrimination (Castro, 2003).

On an individual level, socio-demographic factors appear to play a significant role in the acculturative process. For example, younger age, male sex, shared language with the host culture, and higher education has each been associated with greater integration or assimilation. In his Acculturation Model, Schumann (1986) argued that acquisition of the host language is the significant determinant of acculturation level. Other factors influencing the individual’s acculturative process include perceived discrimination,

16 perceived in-group status, the demographic density of the group, and the person’s intentions regarding selection of acculturative strategy. The acculturating person’s physical and mental health, as well as coping skills, may also play a role, as may the person’s choice (i.e., voluntary or involuntary) in interacting with the host society

(Castro, 2003).

Researchers have identified five types of acculturating groups based on three factors: (1) the extent to which association with the host culture was voluntary, (2) mobility of the acculturating group, and (3) residential permanence. Refugees involuntarily move to the host society. Asylum seekers involuntarily live in the dominant culture, but their presence is not permanent. Sojourners are temporary visitors to the new culture and their presence is highly voluntary (e.g., temporarily residing in another country to further one’s education). Another group that voluntarily moves to the host culture is that of immigrants, and their presence is permanent. Unlike asylum seekers, sojourners, refugees, and immigrants who are all mobile and have migrated, indigenous people are sedentary and their interaction with the host culture is involuntary (e.g., the host country colonizes the land of the indigenous people). Finally, ethnic groups refer to subgroups of the society in which members share the same cultural and racial heritage.

Although some of these ethnic groups may be long established, such as African

Americans in the U.S., the groups continue to face the dynamics of acculturating and psychologically adapting to the majority culture (Castro, 2003).

Persons who plan to reside permanently in the host culture are divided into generational levels; later generations are associated with greater acculturation, adoption of the host culture, and abandonment of the cultural heritage. Immigrants are considered

17 first generation because they represent the first generation from their family to immigrate. Children of immigrants who are born in the new culture are considered second generation. These children’s children are termed third, fourth, etc. generations.

Persons who immigrate with their parents as children comprise a unique group because their acculturation experiences fall somewhere between those of adult immigrants and the second-generation. Some researchers have labeled this group the “1.5 generation” (or,

“one-and-a-half generation”), a term that was coined by Rubén Rumbaut in the 1970’s and introduced earlier as the “half-second generation” in the early 1900’s by Thomas and

Znaniecki (Rumbaut, 1994; Rumbaut, 2004; Rumbaut & Ima, 1988). Use of the term 1.5 generation has been inconsistent, with researchers defining it as children who immigrated before the age of 10 (e.g., Hill, & Johnson, 2004), before the ages of 12 or 13 (e.g.,

Allensworth, 1997; Wildsmith, Gutmann, & Gratton, 2003), before age 15 (e.g., Bean,

Swicegood, & Berg, 2000), before age 18 (e.g., Kim, Brenner, & Liang, 2003), between ages 5 and 12 (e.g., Huer, Saenz, & Doan, 2001), between ages 6 and 17 (Poch, 2003), and between ages 11 and 18 (Remennick, 2003). Others have suggested even more specific terms such as 1.25 or 1.75 generations to refer to child immigrants of specific age subgroups (Rumbaut, 2004).

Psychological Adaptation and Acculturative Stress. A substantial portion of the acculturation literature has focused on the psychological adaptation of acculturating individuals. Psychological adaptation refers to general well-being characterized by a clear sense of personal identity, strong self-esteem, high quality of life, and positive mental health. Persons with positive psychological adjustment in the new culture have the tendency to be sensitive to the values, beliefs, and behaviors characteristic of the

18 dominant culture, and they tend to possess strong coping strategies and communication skills that make it easier for them to interact in the new culture. Psychological adaptation is often associated with sociocultural adaptation, or the person’s ability to successfully cope with everyday events and demands in the new culture. Sociocultural adaptation may be characterized as developing friendships, establishing social networks, and becoming productive in terms of educational or employment objectives (Berry, 2003; Castro, 2003).

Theorists have suggested that psychological adaptation depends on the person’s psychological adjustment or “fit” to the traditional as well as host cultures. In other words, if a person’s acculturative mode is similar to the acculturative strategy desired of them (or forced upon them) by the host culture, then there will be a good fit between the individual and the host culture, and positive psychological outcomes are predicted. On the other hand, intergroup conflict, and subsequently intrapersonal distress, will occur when there is discordance between the traditional and host cultures. For example, a person who intends to integrate but finds pressures to assimilate will likely experience poor adjustment to the majority culture, as will a person who attempts to assimilate but is excluded and segregated by host society policies. Other factors influencing successful adaptation include the acculturative phase (e.g., recent immigration or later generation status) and the person’s resources both prior to and during the acculturation process.

Resources may include an active (problem-solving) coping style, higher education, and social support (Berry, 2001; Bourhis et al., 1997; Castro, 2003).

Psychological adaptation has been hypothesized to have a direct relationship with the person’s acculturation level or strategy, although research has provided inconsistent support for this assertion. According to unidimensional or linear theorists, the longer a

19 person is exposed to the majority culture, the more he or she will adopt the mainstream culture and demonstrate better adjustment. In other words, greater assimilation is believed to be predictive of better mental health for immigrants and other acculturating individuals. Research on the validity of these assumptions has not supplied consistent evidence, partly due to methodological flaws. Because proponents of the linear model maintained that ethnic identity and mainstream identity are mutually exclusive, measurement tools assessing assimilation may not have been sensitive to the impact of concurrent ethnic identity on psychological adjustment (Castro, 2003).

Advocates of the bidimensional model, particularly those who support John

Berry’s (1984) model have also linked acculturative strategy with psychological adjustment. Researchers have found that the integration strategy is predictive of best mental health, perhaps because it is associated with social support and resources from both ethnic and mainstream cultures. Integrated persons may experience pride, self- esteem, and competence as a member of both groups. Integration is also not typically associated with intergroup conflict; rather, the individual selects the positive or functional aspects of the host culture that he or she would like to adopt while still retaining useful values from the traditional culture. On the other hand, marginalization has been underscored as the strategy most linked to negative mental health. Persons who are marginalized have been found to have weak identity and poor social support.

Marginalization has also been associated with dysfunctional family relationships and substance abuse (Berry, 2003; Castro, 2003; LaFromboise, Coleman, & Gerton, 1993;

Phinney, Horenczyk, Liebkind, & Vedder, 2001).

Assimilation and separation have been found to be associated with intermediate levels of psychological adaptation. Assimilation is associated with negative attitudes towards one’s own group, which may instigate retribution and anger from that group. On the other hand, it has been viewed as a positive mode of cultural adaptation. People who are separated may enjoy social support and ethnic pride associated with their group, leading to greater self-confidence and self-esteem. Separation is also associated with the least amount of change from pre-acculturation values and behaviors. However, this isolation from mainstream society may further sustain negative stereotypes and discrimination against their group, which in turn may make it more difficult for these persons to effectively interact and cope in the new society (Berry, 2003; Castro, 2003).

While psychological adaptation is the outcome for some acculturating individuals, for others the outcome is poor adjustment and psychological distress. The concept acculturative stress was developed in reference to the distress experienced by individuals when the demands or stressors imposed on them during the acculturative process are too significant to overcome. Researchers have suggested that acculturative stress is directly related to a person’s acculturative strategy: integration is associated with lower levels of acculturative stress, marginalization is related to the highest levels of acculturative stress, and separation and assimilation fall in between. Separation has been found to be associated with greater stress than assimilation (Berry, 2003; Bourhis et al., 1997).

Acculturative stress is usually associated with a poor fit between the person’s acculturative mode and the attitudes towards the person from the host culture. For example, acculturative stress would be expected to be greater for persons whose immigration was involuntary, for those who are not received positively or who are

21 rejected by the mainstream society, and for those who experience greater discordance between their traditional culture and the host society. Some writers have described a phenomenon called “culture shock” in referring to the stressors immigrants experience due to significant changes in their surroundings in the host society (Padilla, 1985).

Factors that can intensify acculturative stress include learning new languages, norms, customs, and laws. Other singular stressors that acculturating individuals are exposed to include prejudice and discrimination (Castro, 2003; Organista, Organista, & Kurasaki,

2003). With respect to gender differences, researchers have hypothesized that immigrant women tend to experience significantly higher levels of acculturative stress and depression compared to their male counterparts due to a “double burden” or “role overload.” This hypothesis states that as immigrant women become employed, stressors from employment are compounded by pressures to continue their primary role in homemaking and parenting (Dion & Dion, 2001).

Acculturative stress (and consequently mental health) appears to be related to the time frame of the acculturation process or the timing of the exposure to the acculturative stressors. Acculturative stress and subsequently psychological problems is more intense during initial exposure to the new culture and with persistent difficulties in adapting to the new culture. Examples of persistent acculturative stressors for an immigrant to the

United States are continued difficulties in learning the English language and difficulties obtaining employment, both of which have been found to be associated with higher scores on psychological symptom checklist scales. Experiences of pre-migration stressors such as exposure to war, torture, rape, robberies, or extreme poverty are associated with chronic posttraumatic stress, anxiety, and depression symptoms. These psychological

22 symptoms may persist and intensify the effects of post-migration stressors such as loss of extended family support (Organista et al., 2003). Moreover, persons who immigrate at a later age experience greater levels of stress compared to second and later generation individuals (Padilla, Alvarez, & Lindholm, 1986).

Researchers have used acculturation stress as an alternative model for studying the effects of acculturation on mental health. Hovey and King (1997), for example, introduced a model that accounts for the role of acculturative stress on mental health outcomes among immigrants. They proposed that higher levels of acculturative stress may lead to depression and suicidal ideation. Additionally, other factors such as social support, extended family support, socio-economic status, pre-migration factors (e.g., psychological adjustment), post-migration factors (e.g., use of the host language, knowledge of the new culture), motivation for migrating, expectations for the future, and religiosity may buffer against levels of distress. Liebkind (1996) proposed another model of acculturative stress in which she specified four classes of predictors of acculturative stress: pre-migration experiences (e.g., trauma), social context of the ethnic community

(e.g., population density), post-migration experiences (e.g., discrimination), and acculturation attitude (e.g., homesickness, adoption of majority culture). These factors are hypothesized to influence acculturative stress. Additionally, in her study both gender and generational status had significant influences on these factors (i.e., later generation persons and males experienced less problems related to these predictors).

For many contemporary researchers, acculturation stress is a more essential concept than acculturation strategy per se. They argue that despite theoretical contentions, oftentimes acculturation levels are not directly predictive of acculturative

23 stress due to a wide variety of individual differences, and therefore acculturative stress should be measured as a separate construct (Hovey, 2000). Research has found that persons with high acculturative stress tend to present with mental health symptoms such as identity confusion, feelings of alienation, somatic complaints, anxiety, and depression

(Castro, 2003). For example, acculturative stress has been found to predict depression and suicidal ideation among Mexican immigrants (Hovey, 2000). Another study of 674

Cuban-American and 211 Nicaraguan-American adolescents and their parents found that the first-generation parents experienced significantly more acculturative stressors than their children, and that acculturation stress was related to lower adolescent self-esteem, increased parent-child conflicts, and decreased family cohesion (Gil & Vega, 1996).

Acculturation, Family Functioning, and Social Support. The interaction between family relationships and the acculturative process has not received adequate analysis in the literature compared to other aspects of the acculturative process (Chun & Akutsu,

2003). However, some researchers have attempted to explore the relationship between family processes and acculturation, particularly as acculturation relates to general family functioning, family leadership, marital relationships, parent-child relationships, and the family life cycle. In terms of general family functioning, the family’s role in buffering against acculturative stressors was espoused by Hovey and King (1996). They reported that families with lower levels of family functioning tended to experience greater amounts of acculturative stress and subsequently higher levels of depression. On the other hand, some researchers have argued that poor family functioning is often an outcome of acculturative stressors such as pre-migration trauma and stressors, and that

24 family problems may increase over time or with greater assimilation (Chun & Akutsu,

2003).

The family’s leadership and decision-making hierarchy is a key factor in the acculturation process. Parental leaders who are flexible and supportive of their children can help promote psychological adaptation. However, disagreements regarding family leadership ensuing from the acculturative process can lead to conflict and greater intra- and inter-personal distress. For example, younger persons in the family who have developed greater cultural facility or sociocultural adaptation (e.g., better English language skills) may gain greater power and leadership in the family structure, thereby upsetting the traditional parental leadership status. Additionally, movement from a traditional extended family model to a nuclear family more consistent with the host culture may lead to conflicts with extended family members (e.g., grandparents, mothers- in-law) who previously were in positions of control. For example, within Asian American immigrant families tension may occur between the parents’ traditional values in obedience to authority, deference to elders, and filial obligation and the new values of their American-born children who have adopted more egalitarian and individualistic orientations (Chun & Akutsu, 2003; Santisteban & Mitrani, 2003).

Marital relationships are also often tested during acculturation. This is typically related to the different roles, duties, and expectations of spouses encouraged in the ethnic and host cultures (Dion & Dion, 2001). For example, a woman from a traditional patriarchal culture that promotes homemaking duties who chooses (or is forced) to obtain employment in the new culture may experience greater amounts of family conflict, particularly if her spouse does not agree with her new role (Santisteban & Mitrani, 2003).

In such cases the wife may develop greater independence and self confidence while the husband may experience lower self-esteem. Substance abuse and domestic violence have been identified as negative strategies used by husbands to cope with such acculturative stress (Chun & Akutsu, 2003).

With respect to parent-child relationships, the intergenerational culture gap- or differences in acculturative levels between parents and their children- is often a central difficulty associated with the acculturative process. Bonding between parents and their children may be affected. In acculturating families that demonstrate stronger bonding the children may have an easier time selecting positive peer influences. On the other hand, bonding may be more difficult within acculturating families, particularly due to communication difficulties when children speak the host language and parents continue to speak the language of their culture of origin. Differences in life experiences between parents and children may also lead to less bonding (Santisteban & Mitrani, 2003).

Related to the nature of parent-child relationships is that of the family life cycle and related developmental stages. For example, different cultures may encourage different ages at which children begin assuming greater levels of family responsibilities, become independent from their parents, and develop long-term romantic relationships.

Different cultures may also prescribe different procedures for caring for the parents as the parents grow older and are less able to care for themselves. Acculturating individuals may experience psychological distress when trying to decide which roles to follow: traditional ones or those of the new culture. Additionally, within acculturating families, differences in life cycle expectations between parents and children or between the

26 traditional belief system and expectations of the host culture can lead to greater family tensions (Padilla et al., 1985; Santisteban & Mitrani, 2003).

Notwithstanding the theories regarding the association between acculturation and family relationships, conflicting evidence has been provided by researchers. For example, in their review of research on Latino families in America, Chun and Akutsu

(2003) reported that some studies have revealed that greater levels of acculturation

(assimilation) are associated with lower family commitment and support, and consequently greater tension and stress. However, other studies have discovered that greater acculturation is associated with increased help-seeking from extended family members, greater family cohesion, and familial interdependence. Still other studies have found no relationship between acculturation and family commitment. Contradictory evidence was also found in research on parent-child bonding within Latino families.

Some researchers described the acculturative process to be associated with greater frequency and intensity of family conflicts, whereas others reported that the quality and attachment of parent-child relationships were not significantly related to acculturation.

According to Chun and Akutsu, much of the conflicting results can be attributed to difficulties with measurement of acculturation constructs.

The role of family relationships within the framework of the acculturation paradigm continues to be in need of further exploration, especially in regards to the directionality of the relationship between family functioning and acculturative stress. For example, many researchers and theorists (e.g., Chun & Akutsu, 2003; Padilla et al., 1985;

Santisteban & Mitrani, 2003) have focused on the impact that acculturative processes have on altering a family’s structure and on imposing greater stressors and tensions on

27 the family. On the other hand, some researchers and theorists (e.g., Hovey & King, 1996;

Santisteban & Mitrani, 2003) have emphasized the role that positive family functioning plays in buffering or reducing acculturative stress and helping family members successfully cope with the acculturative process.

Just as positive family functioning may provide sources of support for acculturating individuals, other sources of social support have also been shown to interact with the acculturation process and acculturative stress. The 1980’s and 1990’s witnessed a phenomenal increase in research on the relationship between social support and mental health. Despite this increase, theoretical disagreements remain regarding the definition of social support. Social support generally refers to positive interactions and contacts between a person and his or her surrounding family, community, and society. It is a reciprocal relationship between individuals within a social network in which one person intends to provide resources or empathy to another person who receives the support.

Some researchers have distinguished between social networks and social supports, arguing that the former refers to the actual relationships or connections a person has to other people whereas the latter relates to the support item that is exchanged within the network (Mutran, Reed, & Sudha, 2002). Similarly, a distinction has been made between actual number of social networks and perceived social support (e.g., Hovey & Magaña,

2000). Support can include both tangible (e.g., finances) and intangible (e.g., encouragement) components (Heitzmann & Kaplan, 1988).

Only a small portion of social support literature has focused on minority or acculturating groups, and that literature is not consistent. The majority of articles assessing social support within the context of acculturation theory have reported

28 buffering or mediating effects of social support on outcome variables such as mental health. For example, Hovey and Magaña (2000) reported that lower levels of perceived social support among Mexican immigrant farmworkers were associated with higher levels of anxiety and depression. The role of social support in buffering against acculturative stress and consequently mediating psychological symptoms has been demonstrated in studies of acculturating individuals (Lee, Koeske, & Sales, 2004;

Oppedal, Roysamb, & Sam, 2004; Shen & Takeuchi, 2001; Yeh & Inose, 2003).

However, these studies are recent, and the impact of social support on the acculturative process has not been sufficiently examined. Some authors have reported interestingly converse results. For example, Chun and Akutsu (2003) cited research findings in which

Vietnamese and Cambodian families who demonstrated greater social networking also demonstrated greater family conflict, perhaps due to the increased pressures and responsibilities associated with involvement in the networks. It is possible that these contradictory results relate to differences in the operational definitions of social support.

Religious Coping and Mental Health of Acculturating Individuals. As with family functioning and social support, the question of whether religion has a positive or negative impact on mental health has been a long-standing debate among psychologists and psychiatrists. Mental health professionals have traditionally eschewed the topic of patient religiosity, and they have been reluctant to systematically study the effects of religion on mental health. However, despite this bias against religion, hundreds of published studies over the past few decades have reported moderate to strong positive effects of religiosity on mental health; the minority of literature points to negative effects of religion on health

(Levin & Chatters, 1998; Siegel, Anderman, & Schrimshaw, 2001).

For example, persons who have mental illness have been found to be less religious than those without mental illness, and persons who are religious have been found to demonstrate better well-being (Levin & Chatters, 1998). Well-being as defined as morale, life satisfaction, congruence with life goals, positive affect, and prosocial behaviors has been found to be significantly associated with religion (Plante & Sharma,

2001). Although research results are often mixed primarily due to measurement errors and psychometric limitations, studies have essentially documented that religious affiliation (e.g., Catholicism and Islam) and intrinsic religiosity are associated with less depression and lower suicide rates (Koenig, McCullough, & Larson, 2001; Plante &

Sharma, 2001). For the most part religious affiliation and religiosity have been found to have a significant impact on reducing psychological distress, depression, drug and alcohol use, martial dissatisfaction, and delinquent behavior. These salutary effects on mental health have been especially salient for the elderly and for persons with chronic physical illness (Levin & Chatters, 1998), as well as for persons experiencing recent stressful life events (Smith, McCullough, & Poll, 2003).

Researchers have proposed several explanations for how religion impacts emotional well-being: religion promotes and offers social cohesiveness and social support networks, it forbids or prevents health-compromising behaviors (e.g., smoking and drinking), it provides a sense of coherence and understanding of the world, it provides psychological resources such as optimism, self-esteem, and mastery, and it exposes the person to positive emotions such as love, warmth, forgiveness, and empowerment

(George, 2003; Levin & Chatters, 1998; Oleckno & Blacconiere, 1991; Siegel et al.,

2001). Religiosity may be associated with other psychosocial factors associated with

30 positive well-being. For example, religious persons are more likely to have stable and intact families and are less likely to separate or divorce. They are more likely to volunteer, participate in activities, and contribute to social and community life. They are also more likely to be involved with the social networks of their congregation. Since positive family functioning, involvement in activities, and social support are all related to better mental health, it stands to reason that persons who are religious will demonstrate higher levels of life satisfaction (Koenig et al., 2001). Finally, even biological explanations have been theorized; for example, religious activity may boost the immune system and reduce stress-related cortisol levels (Goerge, 2003).

Five models have been introduced to specify the effect that religion has on mental health. Proponents of the suppressor model argue that significant stressors lead to increases in religious and other types of coping behaviors, which in turn reduces the impact of the initial stressors on mental health. The distress-deterrent model, on the other hand, hypothesizes that religion and poor health (or stress) are not related, and that both independently influence mental health in a counterbalancing manner. According to the prevention model, religious involvement and other psychosocial mediators have indirect and direct effects on shielding the person from developing physical, and consequently psychological, problems. The moderator model suggests that religion modifies the effects of health or stress factors, which in term determines the mental health outcome. Finally, many researchers contend that physical health problems and stressors suppress or reduce religious involvement while simultaneously increasing negative psychosocial effects on the person, thereby producing negative mental health outcome. This fifth hypothesis is known as the health effects model (Levin & Chatters, 1998).

Other researchers have chosen to focus on the construct of religious coping rather than religious involvement per se. These researchers argue that religion can be used as an effective coping resource for individuals, particularly during times of stress. Moreover, religious coping has been found to be a significantly better predictor of mental health outcomes than simple religious affiliation or orientation. Religious coping has been demonstrated to have moderating, mediating, deterring, and buffering effects on stress.

As with the literature on religious affiliation, religious coping strategies such as prayer have been reported to be significantly more effective for particular groups including females and African Americans, as well as for persons who are widowed, poorer, and less educated (e.g., Pargament, 1997; Pargament & Brant, 1998; Pargament et al., 1990).

Similar to the literature on religious involvement, the positive or negative effects of religious coping have been a topic of controversy. However, Pargament and Brant

(1998) attempted to resolve this controversy by enumerating several types of helpful and harmful religious coping styles based on previous outcome studies. They wrote that helpful religious coping strategies include gaining spiritual support from God, collaborating with God to solve a problem, obtaining congregational support, and attributing the stressful situation to positive causes (e.g., love from God). Types of religious coping associated with poorer outcomes include dissatisfaction with the congregation, discontent with God, feelings of abandonment, and framing the stressor negatively (e.g., as a punishment from God). Coping styles that have provided mixed results in the literature are using rituals in times of crisis, deferring the stressor to God’s care, and directly solving problems independently from God.

The interaction of religion or religious coping with the acculturative process has received scant attention at best in the literature. Some acculturation researchers have indicated that religious involvement is associated with better mental health among acculturating individuals and that religion is an essential cultural and social institution for immigrants (Gong, Takeuchi, Agbayani-Siewert, & Tacata, 2003). For example, Ai,

Peterson, and Huang (2003) reported that religious and spiritual activities may aid refugees in coping with pre-migration trauma and post-migration stressors. They studied

149 Muslims from Bosnia and Kosovo currently residing in Michigan and Washington and found that the refugees used more positive than negative religious coping strategies.

Participants who demonstrated positive coping styles also experienced higher levels of optimism. More severe posttraumatic trauma was related to negative coping. Other studies have linked religiosity to lower rates of alcohol abuse and psychological symptoms among immigrant Asian groups in the U.S. (Gong et al., 2003). Similarly,

Hovey and Magaña (2000) reported that Mexican immigrant farmworkers with lower levels of religiosity were more likely to experience anxiety and depression.

Arab American Acculturation and Mental Health

Much of the theory and literature on acculturation and mental health has been based on research with the four nationally recognized minority groups: African

Americans, Asian Americans, Latin Americans, and Native Americans. Research on

Arab American acculturation, on the other hand, has taken a back seat despite Arab presence in the U.S. since the late 1800’s and despite an Arab American population size that is larger than the combined population of Native American, Eskimo, and Aleut

33 peoples in the United States. Arab Americans are not an officially recognized minority in the United States (Abudabbeh, 1997; Poyrazli, 2002).

Definitions and Demographics of “Arabs” and “Arab Americans.” When studying the Arab American population in the U.S., it is important to define the members that compose this group. However, the definition or even the existence of an “Arab” ethnicity or identity has been a topic of great controversy. In fact, some authors and historians believe that the concept of being an “Arab” was unimportant prior to the spread of Arab nationalism in response to Ottoman and European colonialism in the early 1900’s. The concept of a united Arab identity was expounded and promoted during the time when countries in the Middle East were fighting for their independence from the colonial powers. This movement was spearheaded by leaders such as Egyptian President Abdel-

Nasser and other Arab nationalists, a large percentage of whom were Christian activists

(Abudabbeh, 1997; Ammar, 2000; Timimi, 1995).

Currently, one of the most commonly-accepted methods of classifying a person as

“Arab” is family heritage in one of the 22 member states of the League of Arab States.

These include five countries lining the northern coast of Africa (Mauritania, Morocco,

Algeria, Libya, Tunisia, Egypt), four eastern African countries (Djibouti, Somalia, Sudan,

Comoros Islands), and several west Asian states (Syria, Lebanon, Jordon, Palestine, Iraq,

Kuwait, Oman, Qatar, Bahrain, Saudi Arabia, Yemen, United Arab Emirates). Contrary to common belief, neither Iran nor Turkey is considered an Arab country. Additionally, despite their shared Semitic background with Arabs, Israeli Jews are generally not considered Arab. Furthermore, although Palestine is not a recognized sovereign country by many Western states, the Arab world does view it as a nation.

According to Abudabbeh (1996, 1997), “the Arab Nation” is generally thought to refer to lands that are populated by individuals who speak Arabic and who relate to the nomadic tribes of Arabia through familial descent or Arab values of human excellence and beauty. This is the main reason why adjacent countries such as Iran, Turkey, and

Israel are not considered Arab. Although different Arabic dialects exist, a standard classical Arabic is shared among all Arabs, and pride in the complexity, rhyme, and rhythm of this language is a key cultural value. Arabic is the fourth most widely spoken language worldwide. Apart from Arabic, the Islamic faith is also considered to be a marker of the Arab world as it is the majority religion in all the Arab countries except

Lebanon, in which about half of the population is Christian (Abudabbeh, 1996, 1997;

Abudabbeh & Nydell, 1993; Timimi, 1995). Shared Arab cultural traditions include particular foods, music, art, literature, festive occasions, and political histories (Keck,

1989; Maloof, 1981). Other values central to Arab culture include the importance of marriage and family (Abudabbeh, 1996) and the importance of maintaining family honor

(sharaf al-aila) and family reputation (somaat alaila) (Hattar-Pollara & Meleis, 1995a).

Despite shared cultural traditions, Arabs remain a heterogeneous and diverse group. Arab countries may differ in Arabic dialect, additional spoken languages, political systems, religious affiliations, and cultural practices. For example, the majority of Saudi

Arabians are Muslims who speak Arabic. Moroccans, on the other hand, are likely to speak a mixture of Arabic and French. Yemeni women tend to dress conservatively in long garments and headscarves, whereas it is not uncommon to see a woman wearing more revealing clothing in the streets of Lebanon. About 14 million Arabs are Christian

(Abudabbeh, 1997), there are significant percentages of Arab Jews who live in Tunisia,

35 and about 5% of Bahrainis are Hindu (Erickson & Al-Timimi, 2001). Indeed, Arabs do not necessarily share the same ancestral lineages.

The Arab American community includes persons who have immigrated to the

United States from the Arab world as well as these immigrants’ children and later generation descendants. Because of their roots in different religions, countries of origins, and histories, it is difficult to make sweeping generalizations about the Arab American population (Abudabbeh, 1997). Arab Americans were described as “a multicultural multiracial, and multiethnic mosaic population” by Abudabbeh and Nydell (1993, p.

262). Even physical appearances may be varied- some Arab Americans have white skin and blue eyes whereas others may have black skin and black eyes (El-Badry, 1994).

Additionally, many persons who would typically be classified as Arab Americans, such as Chaldean Americans, may not identify as a member of this group. Chaldeans are predominantly Roman Catholics from the northern part of Iraq who comprise less than

1% of the Iraqi population. The Chaldean-American population grew dramatically from about 1,500 in the early 1960’s to about 100,000 in 1998. In addition to (or instead of)

Arabic, Chaldeans speak a modern version of Aramaic (Dallo & James, 2000).

In addition to the challenges associated with defining the members of the Arab

American population, it is also currently difficult to obtain reliable estimates of the number of Arab Americans residing in the U.S. Prior to 1899, immigrants from the

Middle East were recorded in the same category as the Asian Turkish by both the United

States Bureau of Immigration and Naturalization and the Bureau of the Census (Naff,

1994). This is because at the time these immigrants had come from lands possessed by the Ottoman Empire. In 1899, separate categories for Syrians and Palestinians were

36 created by the Bureau of Immigration; however, other Arabs continued to be included in the category “Turkey in Asia” by the Bureau of Census in 1910 (Naff, 1985, p.109).

These early attempts at classifying Arab immigrants were often crude and contradictory.

Some Arab immigrants were even forced to return to their homeland because the immigration officials at Ellis Island had difficulty determining their race based on their skin color and the shape of their noses (Ammar, 2000)! In each subsequent census different categories– as well as their definitions– changed, and thus demographic tracking or comparisons throughout the years is difficult (Naff, 1994).

Results of the 1990 Census significantly undercounted the Arab American population. Several explanations for this miscalculation included: language barriers, respondents’ mistrust of authorities, respondents’ reluctance to identify themselves as

Arab due to fear of stigma, and poor incentives which led to a low response rate.

Moreover, an “Arab American” category was not included in the short forms while the long forms included ethnic categories such as “Middle East” which includes non-Arabs

(Naff, 1985; Schopmeyer, 2000). Arab Americans of mixed ancestry were also likely to be overlooked in the 1990 Census results (Schopmeyer, 2000).

For the 2000 Census the Arab American Institute and the American-Arab Anti

Discrimination Committee collaborated with the Census Bureau in an attempt to determine reliable estimates of the Arab American population (“Generations of Arab,” n.d.). Promotional Arabic language materials were used in effort to increase response rate

(Samhan, 2001). The 2000 Census reported that there are 1,189,731 Americans of Arab decent living in the United States (de la Cruz & Brittingham, 2003). However, community polling and academic research has determined that the Arab American

37 population numbers nearly 3 million (Abudabbeh, 1996, 1997; Samhan, 2001) or more than 3.5 million (Arab American Institute, 2003). Arab Americans live in all 50 states

(Samhan, 2001). One third of Arab Americans live in California, Michigan, and New

York. The top six metropolitan areas of Arab concentration are Detroit-Dearborn, Los

Angeles, New York, Chicago, Washington, D.C., and Northeastern New Jersey (Arab

American Institute Foundation, n.d.). According to Zogby polling and community estimates, the Detroit-Dearborn Arab American population exceeds 400,000, Los

Angeles exceeds 300,000, and there are more than 225,000 Arab Americans in the New

York City metropolitan area (“Arab American Population,” 2005).

The largest Arab American group is Lebanese, followed by Syrian, Palestinian, and Egyptian (Arab American Institute Foundation, 2002a). However, the Sudanese immigrants are the fastest-growing Arab group, and immigrants from Saudi Arabia,

Qatar, United Arab Emirates, and Yemen increased fourfold between the years of 1982 to

1992. Compared to the rest of the American population, Arab Americans tend to be younger, richer, and more educated. They are more likely to be entrepreneurs or to own businesses, and the majority has U.S. citizenship (El-Badry, 1994; Samhan, 2001; Zogby,

1990). About two-thirds were born in the United States (Erickson & Al-Timimi, 2001).

Because the earliest Arab immigrants to the United States were Christian, it is not surprising that approximately one-half to two-thirds of Arab Americans today are of the

Christian faith (El-Badry, 1994; Samhan, 2001); recent polling results determined that

Arab American Muslims comprise just 24% of the population (Arab American Institute

Foundation, 2002a).

Acculturation Strategies within a Historical Context. Arab immigration to the

United States occurred in three waves, each with distinct acculturative characteristics.

Arabs began immigrating to the United States in large numbers beginning in 1875. The majority were Christians from Syria and Lebanon who worked as farmers and peddlers, primarily in the Northeastern United States. Arabs from the first immigration wave were mostly Roman Catholic or Eastern Orthodox Christian, and they readily assimilated into

American culture. They identified as “White,” anglicized their names, and acquired the

English language. This flow of immigrants was interrupted during and after World War I:

Public concern regarding immigrants led to the Quota Act and Johnson-Reed Act of 1924 which reduced the influx of Middle Eastern immigrants. Consequently, between the years of 1925 and 1948 Arab immigration to the United States was virtually curtailed

(Abudabbeh & Nydell, 1993; Abu-Laban & Suleiman, 1989; Ammar, 2000; El-Badry,

1994; Naff, 1985, 1994).

After World War II American immigration policies changed, and the second wave of immigration took place as a result of political and economic unrest in the Middle East.

The majority of these immigrants were Palestinian refugees who were displaced following the establishment of the Israeli state in 1948, Egyptians whose land was confiscated by the Nasserist regime, Syrians escaping revolutionary leadership, and Iraqi royalty fleeing the establishment of a republic government. Other motives for immigration included the desire for better education or greater career opportunities. A large portion of these Arabs was well-educated; they spoke fluent English and worked in professional occupations (Abudabbeh, 1996; Abu-Laban & Suleiman, 1989; El-Badry,

1994; Naff, 1985, 1994). The second wave differed from the first in that they included a

39 larger portion of Muslims and women. These new immigrants were more willing to identify as “Arab.” Unlike the first immigration group which was voluntary, the second group included persons who were refugees or whose choice to immigrate was not entirely voluntary (Naber, 2000).

The third wave of immigration began in the 1960’s after the Immigration Act of

1965 that ended the quota system favoring European immigrants. These immigrants were mostly Muslims with even higher educational backgrounds than the previous immigrants, although they also included large groups of Muslims of lower socio-economic and educational levels. These Arab immigrants settled across a wider geographical area, including the West coast. The 1990’s saw a rapid and unprecedented growth of immigrants from North African and Arabian Gulf countries (Abudabbeh, 1996; Abu-

Laban & Suleiman, 1989; El-Badry, 1994; Naff, 1985, 1994). In addition to providing more diversity to the Arab American community, this third wave brought with it increased levels of Arab nationalism, increased criticism of American policy, and decreased interest in engaging in American civic life (Naber, 2000).

With respect to the current influx of Arabs to the United States, precise numbers have not been recorded. However, evidence suggests that the flow of immigration from

Arab countries has been significantly reduced since September 11, 2001. Many Arab

Americans who traditionally traveled back and forth between the Arab and American worlds have decided to reside indefinitely in their Arab country of origin (Howell &

Shryock, 2003). New immigration legislation has led to restricted admissions to persons of Arab descent. For those who have been granted permission to enter the United States, registration (i.e., background screening, fingerprinting, photographing, etc.) with the

Immigration and Naturalization Service is mandatory within one month of arrival and every year thereafter (Arab American Institute, 2002). Additionally, hundreds of student visas have been placed on “indefinite hold” due to lengthy clearance procedures. Students affected include those who were returning to the U.S. to continue their education and those who were planning to apply for permanent residency. Additionally, from approximately 10,000 Arab students who were enrolled in American institutions in 2001,

20% returned to their homeland after September 11 due to intimidation and fears. Efforts are currently underway in the Middle East to encourage Arabs to instead immigrate to other English-speaking countries such as Australia, Canada, and the United Kingdom

(Arab American Institute, n.d., 2002).

Striking acculturative differences amongst persons from the three immigration waves are noticeable to this day. For example, Ammar (2000) found that strategies of acculturation among Arab immigrants in a Midwestern American community were directly related to the three immigration waves. She found that immigrants from the late

1800’s readily assimilated into American culture, becoming politically active and religiously influential in the community. Their present-day descendents consist of primarily Lebanese doctors, lawyers, and political leaders. The mostly Palestinian Arabs who immigrated during the second wave (1948-1966) remain strongly attached to their cultural heritage and traditions and resist the adoption of American values and behaviors.

They are active in Arab organizations, and most do not have college degrees. The third group of immigrants (post 1967) are integrated in their professional lives but are socially separated from American culture. Other writers (e.g., Abudabbeh 1996; Naff, 1985) have described similar patterns of acculturation for the three immigrant waves.

Abraham (1989) emphasized the choice that Arab Americans have in regards to acculturative strategies and he illustrated how the level of discrimination experienced by each individual depends on the level of adherence and identification with Arab culture.

For example, he described a process of “ethnic denial” whereby some Arab Americans consciously deny or de-emphasize their Arabic and Islamic heritage– even to the extent of falsely claiming to be of European descent– in an effort to prevent discrimination and ease entrance into mainstream culture. Abraham described a second process of “ethnic integration” in which Arab Americans choose to highlight similarities between American and Arab cultures in an effort to integrate the two. They also demand political and social recognition from mainstream institutions. This strategy is utilized mostly by middle-class

Arab Americans, in particular American-born second and third generation Lebanese and

Syrians. A third acculturative strategy that Arab Americans, in particular recent immigrants from poor or working-class families, consciously choose to follow is called

“ethnic isolation.” These groups tend to establish isolated ethnic communities within the

United States in which cultural traditions are emphasized and adoption of mainstream culture is discouraged.

In recent years, the acculturative strategy of “complete” separation has become a viable alternative for Arab Americans. Ahmed (2003) described a contemporary phenomenon of Arab Americans who live in isolated ethnic communities, speak Arabic at home and at work, and continuously watch Arabic T.V. This phenomenon has been supported by a documented increase in Arabic print, radio, and television media; by the early 1990’s there were about seven Arabic TV stations broadcasting just in the Detroit-

Dearborn area alone (El-Badry, 1994). The Arab Americans Ahmed described are

42 virtually residing in the Arab world while physically residing in the United States. They are isolated from mainstream society and may vicariously experience the same stressors, traumas, and challenges that Arabs living in the Middle East experience.

Acculturation Strategy, Acculturative Stress, and Mental Health. Acculturation is a challenging and difficult process for Arab Americans, perhaps even more challenging than for persons of other ethnic backgrounds. Arab Americans may be more likely than other ethnic group members to describe feelings of alienation from the host culture, and the process of developing a self-identity is complex and conflictual (Faragallah, Schumm,

& Webb, 1997; Ghanem-Ybarra, 2003). Some writers have enumerated the socio- demographic variables that influence acculturation strategy and acculturative stress, and acculturative influences on mental health. The bulk of current literature emphasizes the forced separation of Arab Americans from the dominant culture. Stressors that increase such isolation include stereotypes and discrimination from the media and mainstream population, governmental policies that target persons of Arab descent, Arab invisibility in mainstream institutions, and even negative attitudes held by mental health professionals who are faced with the task of alleviating the psychological impact of these stressors.

Other acculturative stressors such as communication barriers, unemployment, and pre- immigration trauma may influence the psychological well-being of Arab Americans. In a study of 91 Arab American college students, Amin (2001) found that ethnic identity was related to emotional adjustment and sense of ethnic comfort, and assimilation was related to academic adjustment and life satisfaction. Contrary to acculturation theories, however, participants who endorsed a separation strategy reported better psychological health than those who were assimilated or marginalized.

Researchers have reported specific socio-demographic factors that influence acculturative strategies among Arab Americans. For example, Tavakoliyazdi (as cited in

Faragallah et al., 1997) found that Arabs who immigrated at a younger age tended to be more flexible regarding the adoption of American culture, as were those who spent longer intervals between visits to their native homeland. The role of generational status was highlighted by Ajrouch (2000); in an interview of 20 Lebanese American adolescents in

Dearborn, Michigan, clear distinctions were made between first-generation immigrants who spoke poor English and the second-generation individuals who had adopted many mainstream cultural practices. Faragallah and colleagues (1997) found that acculturation increased with age of immigration, length of residence, and time since previous visit to homeland. These three factors were associated with fewer adherences to traditional cultural norms such as gender role orientation. In another study by Meleis, Lipson, and

Paul (1992), results of structured interviews with 88 Middle Eastern immigrants indicated that time since immigration was positively correlated with both perceived ethnic identity as well as adoption of American cultural, social, and family values.

Perhaps the factor that has influenced Arab American acculturation strategy and stress most is that of discrimination and rejection from the host culture. Several writers have argued that discrimination is a key factor in furthering isolation or marginalization of present-day Arab immigrants (Ammar, 2000; Faragallah et al., 1997; Hattar-Pollara &

Meleis, 1995b). However, anti-Arab sentiment is not a novel phenomenon. Even prior to the Crusades, Europeans held derogatory ideas regarding Arabs, and such views perpetuated throughout the Middle Ages and into the early 1900’s when the majority of

Arab countries were colonized by European states. Americans attained these negative

44 biases from the Europeans (Erickson & Al-Timimi, 2001). Unlike racism towards other ethnic groups, anti-Arab racism is widely tolerated by mainstream American society

(Abraham, 1994), and common stereotypes of Arabs are that they are lazy, dirty, cruel, treacherous, bloodthirsty, oil-rich, barbarian, terrorist, sex crazed, and cruel to women

(Abraham, 1994; Suleiman, 1999). Arab women are believed to be veiled, submissive, helpless, and oppressed (Ammar, 2000).

Anti-Arab biases and stereotypes are widespread throughout different types of

American media, including educational textbooks, political analyses, novels, movies, and mainstream television, print, and radio press (Erickson & Al-Timimi, 2001). For example, television stations in the Arab world have provided more comprehensive and accurate information regarding the 2003 American strikes at Iraq than American media which, relying on governmental contributions and a strive to display patriotism, have barely shown the blood, horror, and destruction experienced by Iraqi citizens

(Poniewozik, Ghosh, Radwan, & Turgut, 2003). In his book Reel Bad Arabs: How

Hollywood Vilifies a People, Jack Shaheen (2001) provided a meticulous review of over

900 films produced by Hollywood from 1896 to 2001 and documented a pervasive and consistent bias towards distorting, vilifying, and dehumanizing the Arab peoples. Many media biases have been propagated by the United States government, which hopes to bolster American public support for foreign policies in the Middle East (Erickson & Al-

Timimi, 2001). For example, the Department of Defense has provided finances and equipment assistance to over 14 films that depict Americans killing Arabs, including

Rules of Engagement which is the only Hollywood war film that has showed American soldiers killing (Yemeni) women and children (Shaheen, 2003). Other causes of the

45 support for such mass negative misinformation include fear and anger experienced by members of the dominant American culture in response to terrorist acts committed by small numbers of Arabs, simple lack of accurate informational resources, and lack of an influential Arab lobby in the fields of media and politics (Erickson & Al-Timimi, 2001;

Shaheen, 2001).

Acts of anti-Arab racism and discrimination by fellow American citizens have been stimulated by media hysteria in association with the political atmosphere of

American foreign policy (Ammar, 2000; Suleiman, 1999). For example, threats and violence against Arabs in the United States such as vandalism, bombings, verbal and physical attacks, and even murders heightened after the Arab-Israeli war in 1967 (Abu-

Laban & Suleiman, 1989), during the Iran hostage crisis in 1978 (Singh, 2002), during the U.S. bombing of Libya in 1986 (Abraham, 1994), during the Gulf War in the early

1990’s (Abraham, 1994), and after the World Trade Center attacks on September 11,

2001 (American Arab Anti Discrimination Committee, 2001a, 2001b). As a result of the anti-Arab bias, more than 300 hate crimes against Arab Americans took place in response to the Oklahoma City bombing although Arabs were not involved in this event (Shaheen,

2003). Human Rights Watch published a detailed report of post-September 11 violence towards Arabs, Muslims, and persons who are mistaken to be Arab or Muslims (Singh,

2002). The report stated, “Unlike previous hate crime waves, however, the September 11 backlash distinguished itself by its ferocity and extent” (pp. 14-15). Muslim women wearing headscarves and Sikhs wearing turbans were disproportionately targeted. In addition to criminal assaults, Arab Americans have reported other types of discrimination such as sudden termination of employment and prevention from boarding airplane flights.

One-third of all Arab Americans reported having ever been a victim of ethnic-based discrimination. One-fifth experienced such discrimination after September 11, and 20% reported discrimination against their children or family members (Arab American

Institute Foundation, 2002b). A 2003 survey of 1,106 Arabs and Chaldeans in Detroit reported that 15% had a “bad experience” relating to the Anti-Arab backlash (Baker et al., n.d.). Muslim Arab Americans have experienced greater discrimination and alienation than their Christian counterparts (Arab American Institute Foundation, 2002b; Baker et al., n.d.). In another sample of 108 Arab Americans in central Florida, 53% reported having been treated unfairly by strangers, 47% reported engaging in an argument regarding something racist that was done to them, and 46% reported being called racist names within the past year (Moradi & Hasan, 2004).

Anti-Arab discrimination has not been limited to a personal level, however. State- sponsored agencies have also placed pressures on Americans of Arab decent. For example, systematic documentation has identified that police throughout the U.S. consistently discriminate against Arab Americans. Policies by the American government during the Gulf War such as interrogations by FBI agents led Arab Americans to worry that they would be placed in internment camps similar to the Japanese in World War II

(Ammar, 2000). Policies after September 11, 2001 such as the passage of the Patriot Act have further abridged Arab American freedoms. For example, over 1,200 individuals have been detained without ever being charged with a crime, thousands of Middle

Eastern men have been interrogated, and hundreds have been deported on minor visa violations. Substantial numbers of people have been arrested without sufficient evidence; for example, persons who were sending money to relatives in the Middle East. Charity

47 and social organizations have had their finances arbitrarily frozen without sufficient proof that they are supporting terrorists. Racial profiling has led to a reluctance of Arab

Americans to take air flights to and from their country of origin, and as a result many

Arab American families find themselves increasingly divided. The war in Iraq further intensified such stressors; for example, 11,000 Iraqi Americans have been interrogated by the government (Howell & Shryock, 2003).

Despite efforts by the Arab American Institute and American-Arab Anti

Discrimination Committee to combat the discrimination and stressors Arab Americans face from the mainstream community and from the government, these pressures are appearing to increase. For many Arab Americans, the proposed Patriot Act II is substantially more terrifying to them than the idea of being housed in internment camps; they believe that with the new policies they will be essentially under “house arrest” with every aspect of their personal and professional lives monitored. The government will have the power to arrest persons without due process and even deport them to their country of origin for further interrogation (Howell & Shryock, 2003). Arab Americans, especially recent immigrants, are becoming increasingly dissatisfied with American foreign policy as well (Erickson & Al-Timimi, 2001). These include American policies towards the Palestinian-Israeli conflict and towards the war in Iraq.

Thus, the World Trade Center bombings provided a catalyst in intensifying the acculturative stressors and related mental health concerns that Arab Americans face.

Howell and Shryock (2003) described how almost overnight the Arab community which had once been viewed as a vibrant, productive, and integral part of the Detroit socio- economic landscape was transformed into the “Other.” Arab Americans in Detroit have

48 found themselves suddenly on the defensive, having others constantly question their motives, plans, beliefs, and patriotism. In their quest to prove their commitment to the

United States and distance themselves from the stereotype of the terrorists, they have often felt the need to denounce the very culture and religion that they were raised in, stirring a great deal of psychological distress regarding their personal identities. They have felt pressures to constantly apologize for the attacks and to curtail any type of political activism that may brandish them as traitors. In response to these changes, Arab

Americans have become vigilant and afraid; many have put a halt to their life goals. In addition to feeling forcibly alienated, anxious, and chronically worried, Arab Americans additionally feel guilty and hopeless.

Psychological symptoms resulting from increasing acculturative stressors were similarly conveyed in a report published by the Arab American Institute one year after the World Trade Center attacks. The report described the “double pain of mourning an attack on their country and simultaneously having to defend themselves” that Arab

Americans experienced (Arab American Institute, 2002, p.1). The report described how for Arab Americans the grief, anxiety, and trauma experienced by all Americans in response to the attacks were compounded by additional psychological distress as a result of the anti-Arab backlash. Similarly, a Washington Post article printed in August of 2002 underscored the fear, anxiety, anger, confusion, hopelessness, and guilt experienced by

Arab Americans in Dearborn, Los Angeles, and Seattle. These emotions were in response to harassment, discrimination, national and international governmental policies, and ostracism from the mainstream American population (Pierre, 2002). A recent study of

108 young adult Arab Americans in Florida found that perceived discrimination events

49 related positively to psychological distress, and sense of personal control mediated that relationship (Moradi & Hasan, 2004)

In addition to overt discrimination, a related but strangely paradoxical phenomenon that furthers the isolation of Arab Americans from the mainstream population includes their virtual invisibility in mainstream institutions. For example, schools in the United States do not provide culturally sensitive information about Arab groups and the Arab culture, and Arab American students often feel excluded from their curriculums. Increased efforts by teachers and administrators need to be made to counteract or correct misconceptions about Arab Americans and to seriously prevent ethnically-motivated bullying (Schwartz, 1999). Advanced academia also often does not recognize Arab Americans; for example, the paucity of literature and research on Arab

Americans in the health fields is remarkable (Erickson & Al-Timimi, 2001). Despite increased racial profiling by the police, police academy training curriculums do not include modules for interacting with Arab Americans. On the other hand, culturally sensitive information about interacting with persons of other ethnic backgrounds (e.g.,

African Americans, Latin Americans, Native Americans, Asian Americans) is often included (Ammar, 2000). Even more striking, however, is how the racial and ethnic classifications of the U.S. government have “structured the social and historical invisibility of Arab Americans” (Naber, 2000, 38). Because Arab Americans are categorized as “White,” “Caucasian,” or “other,” they have not emerged as a distinct group in American society.

In addition to individual, federal, and institutional discrimination, another source of long-standing acculturative stress for Arab Americans, including second generation

50 individuals, is the task of negotiating two conflicting and often contradictory identities.

Unlike other immigrants (e.g., those from Europe) who often find similarities between their traditional culture and American culture, for Arabs the cultural differences are sometimes momentous. For example, mainstream American culture is significantly more liberal and individualistic, and many Arab Americans struggle with the question of how to live in America while retaining values of family, community, and honor (Abudabbeh

& Nydell, 1993). This conceptual and behavioral divergence between American individualism and Arab collectivism was demonstrated by Buda and Elsayed-Elkhouly

(1998) in their cross-cultural study of American and Arab business executives.

In addition to discrimination and related societal pressures, Arab Americans experience other acculturative stressors. Pre-immigration trauma can lead to anxiety, depression, and posttraumatic stress disorder (Ahmed, 2003). Jamil and colleagues

(2002) reported that in a retrospective study of 375 client medical records, Iraqi refugees and immigrants presented with significantly higher levels of posttraumatic stress disorder compared to non-Iraqis. Development of the disorder was related to their exposure to trauma during the Gulf War. Stressors during immigration such as loss of extended family support further places this group at risk for mental health problems (Laffrey et al.,

1989). Upon arriving to the United States, Arab immigrants, especially educated professionals, often expect that they will easily find employment. Inability to find adequate employment may lead to poor self-esteem and a reduction in social status for

Arab men who believe strongly in providing for their families (Budman et al., 1992).

They may refuse to apply for welfare, which is seen as a source of embarrassment or shame. Poor English language skills or a noticeable accent may lead to greater stressors.

Moreover, Arab American women may face unique stressors when they attempt to participate in American society. They often do not have the education or skills needed to obtain a job, and in contrast to family-run businesses in their homeland, they may feel uncomfortable working in a factory or industry setting that places them in close proximity to male workers (Aswad, 1994).

Because of acculturation stressors including discrimination, Arab Americans are at-risk for mental health problems. However, even mental health services themselves can also be a source of stress for Arab Americans. Oftentimes mental health providers share the same misconceptions about the Arab culture that are being propagated in mainstream media. The tendencies to overpathologize Arab American clients and to give incorrect diagnoses have been described by many authors. For example, reviews of medical charts have revealed that mainstream professionals are significantly more likely to characterize their Arab American clients as noncompliant, unwilling to access services, difficult to care for, overly anxious, and vague in their symptom presentation (Erickson & Al-

Timimi, 2001). Due to cultural insensitivity, traditional therapeutic techniques are oftentimes not applicable to the Arab American culture and may even be inadequate or harmful (Abudabbeh, 1997; Al-Krenawi & Graham, 2000; Budman et al., 1992).

Moreover, mental health practitioners may have negative beliefs and emotions towards

Arab Americans that may negatively impact their clients. Therapists may have difficulty empathizing with persons of Arab background and may experience feelings of hostility or superiority towards their clients (Erickson & Al-Timimi, 2001).

In a particularly illustrative case study of the interaction among acculturative stressors and mental health services, Budman and colleagues (1992) related the story of a

17-year-old Iraqi American male named “Omar” who was hospitalized in a psychiatric inpatient unit due to social withdrawal, phobic anxiety, and disturbance of sleep and appetite. After an initial misdiagnosis of schizophrenia due to the staff’s misunderstanding of cultural behaviors, Omar was diagnosed with depression and anxiety. An Arab American cultural consultant was invited as co-therapist to his main therapist, and family therapy was conducted. As therapy progressed it became clear that

Omar’s symptoms were directly related to acculturative stressors. Omar had experienced the stressors of living in Baghdad during the Iraq-Iran War, as well as the culture shock of moving to the United States. Post-immigration difficulties included financial difficulties, tension related to the modification of traditional family members’ roles and interpersonal dynamics, and diffusion of family goals.

The Arab American Family: Stress and Social Support. For traditional Christian and Muslim Arabs, the family is a crucial aspect of their ethnic and individual identities.

Arabs consider the family to be the basic unit of society and the main source of honor and shame for each individual. Due to strong values of interconnectedness, Arab individuals may engage in self-sacrifice for the sake of the family’s needs, and any event that relates to one person is also considered to affect the remaining family members. This is related to strong beliefs in loyalty and protection of the group. On the other hand, Arab families are also hospitable to strangers and visitors. Respect for older persons is a typically emphasized family value, and therefore decisions are often deferred to parents and the elderly. Arabs additionally value large families and the extended family; oftentimes extended family members are intricately involved in a family’s daily activities, and paternal uncles in particular are granted special respect. Religious identity is also central

53 to the Arab family (Abudabbeh, 1996, 1997; Abudabbeh & Nydell, 1993; Abu-Laban &

Suleiman, 1989; Abu-Saad, 1984).

Traditional Arab families are patriarchal with delineated gender roles. Men are primarily responsible for financial affairs and have the highest authority and decision- making responsibilities in the family. Women are primarily responsible for maintaining household duties and childrearing, and they are provided with honor and respect. Pre- marital relations are effectively taboo as sexual purity is a source of family honor.

Marriage is therefore considered a celebrated religious occasion and an essential rite of passage. Most spouses meet their partners through their family or parents’ social networks. Divorce is frowned upon by Muslims and forbidden by most Arab Christian denominations. Children are expected to maintain their cultural heritage and to reside with their families of origin until marriage. They are generally treated indulgently; however, they are expected to obey their parents and care for them in their old age

(Abudabbeh, 1996, 1997; Abudabbeh & Nydell, 1993; Abu-Laban & Suleiman, 1989;

Abu-Saad, 1984; Read, 2004).

The degree to which Arab American families retain the above-mentioned Arab family characteristics depends on their level of acculturation (Ammar, 2000; Faragallah et al., 1997). However, strong family values continue to remain an essential value to Arab immigrants to the United States (Ajrouch, 2000). As Abudabbeh (1997) stated:

There are today many signs of strain on the Arab family system due to factors such as

industrialization, urbanization, war and conflict, and Westernization. Despite these

pressures, the family remains the individual’s main system of emotional and concrete

support throughout the Arab world and for Arabs living elsewhere. (pp. 118-119)

The role of family in buffering acculturative stressors was briefly highlighted in a few studies. For example, Hattar-Pollara and Meleis (1995a) wrote that Jordanian

American women consciously provided support, praise, and nurturance to help prevent their adolescent children from developing delinquent or culturally inappropriate behaviors. The mothers often helped their children recognize their personal uniqueness and learn the importance of their cultural values. Because the teens faced acculturative pressures from peers to assimilate, the mothers responded by increasing opportunities for family activities and support such as church participating. Another study found that for

Lebanese adolescents in an ethnic Arab community in Dearborn, social support from family relations was a vital factor in the development of ethnic identity (Ajrouch, 2000).

On the other hand, research in Arab American communities has linked acculturation processes to decreased general family functioning, increased marital dissatisfaction, and increased parent-child conflict. For example, using a survey of 47

Arab immigrants, Laffrey and colleagues (1989) found that the five most frequently reported health-related problems for Arab Americans were family stress, adjustment to

American life, management of acute illness, coping with adolescents, and marital stress.

Using a sample of 39 Arab immigrants to the United States, Faragallah and colleagues

(1997) found that longer duration from homeland and immigration at an older age were related to higher levels of family dissatisfaction as measured by the Kansas Marital,

Parental, and Family Life Satisfaction Scales. They also found that parental satisfaction declined with longer duration of residence. On the other hand, they did not find a significant correlation between discrimination and level of family satisfaction.

According to Arab American literature, marital tensions and conflict may be viewed as a consequence of the acculturative process. For example, tension can arise when spouses seek different acculturative strategies. For example, Aswad (1994) described the ideological conflicts that were raised between Arab men and their wives in

Southend Dearborn when the wives desired employment. Based on 40 interviews with

Yemeni and Lebanese women, the author reported a male belief system characterized by the insistence that only men should be employed. Aswad suggested that this power and control over their wives’ behaviors provided the men with status and honor. Abudabbeh

(1997) used several case studies to illustrate how marital relationships may be disrupted among Arab Americans. She explained that when Arab American wives attempt to negotiate their traditional role and adopt American values and norms, marital conflict may ensue. This conflict may escalate into cases of domestic violence in situations in which there is minimal support from the extended family and the husband has financial pressures in addition to the stress of attempting to maintain Arab traditions. These cases may be referred to law enforcement agencies or mainstream mental health professionals.

Kulwicki and Miller (1999) stated that as in other minority groups, “domestic violence may be a serious health problem among women of Arab ancestry” (p. 200), and they cited examples of “honor” murders in this population.

A second key area of family strain is that of parent-child conflict, particularly when second generation children adopt American cultural practices, resist their parents’ authoritarian style, and demand more freedom and independence (Abudabbeh, 1997;

Abudabbeh & Nydell, 1993). Parents may find it difficult to teach their children Arab values and behaviors in the face of influences from the host society on their children

(Maloof, 1981). Because roles are identified at birth and individualized identity is limited, adolescence in Arab countries is relatively early, brief, and characterized by minor changes in mood. Arab immigrant parents may therefore be unprepared to cope with the turbulent and stormy parent-adolescent conflict that is more prevalent in

American society, and they may have difficulty accepting their child’s self-centeredness, acting out, or nonconformist behaviors (Budman et al., 1992). This conflict may be heightened when the children have higher education than their parents or when daughters seek marriage with an individual from outside the group (Abudabbeh & Nydell, 1993).

Adolescents in these circumstances may experience paranoid and depressive anxiety, guilt, as well as identity confusion regarding the Western and Arab worlds (Timimi,

1995).

Mothers are especially vulnerable to experiencing distress as a result of their teenage children’s behaviors because for Arab women support, respect, and advocacy from their children is often a source of power and prestige (Meleis, 1991). Additionally, in traditional Arab families sons often develop strong supportive bonds with their mothers, and this special relationship may not be present for boys that have been influenced by mainstream culture (Budman et al., 1992). Because Arab American mothers are entrusted with the role of transmitting the cultural heritage and protecting their children’s shame and honor, they may experience significant amounts of distress during the childrearing years. Hattar-Pollara and Meleis (1995a) conducted interviews with 30 Jordanian immigrant women in California and reported that these women experience significant levels of anxiety and fear regarding the well-being of their children. The mothers worried that their children would adopt mainstream adolescent

57 behaviors such as dating, disrespect to elders, self-centeredness, and independence. To counteract such acquisition of dominant culture, the mothers utilized coping strategies such as increasing censorship, restricting social activities, and scolding the children when the children did not provide proper respect or deference for their fathers and elders. Such strategies provided constant worry for the mothers who were simultaneously trying to help their children integrate in mainstream society.

In some cases parent-child conflict may escalate to the point of intervention from legal authorities, for example in cases that are considered child abuse or when rebellious children abuse drugs or commit crimes (Abudabbeh, 1997). Kulwicki and Miller (1999) stated that acculturative stressors such as poverty and social isolation in addition to aspects of Arab culture such as male authority, use of corporal punishment, and values of honor and shame might lead to harmful parent-child behaviors. They reported that in an unpublished teen health survey submitted to the Michigan Department of Health, of 362

Arab Americans, 12.2% admitted to experiencing physical abuse at home, and 17.7% experienced emotional or verbal abuse (p. 202).

Additionally, there may be gender distinctions in acculturative stressors and strategies. For example, a survey and follow-up interview with 52 eighth-grade Arab immigrants to Canada found that in comparison to boys, girls’ motivation to learn

English was significantly more influenced by the desire to integrate in Canadian society and adopt Canadian cultural behaviors. The study also noted that while mothers encouraged their daughters to integrate in Canadian society in an effort to obtain more freedom and career opportunities, fathers resisted such changes and attempted to restrict the women’s autonomy (Abu-Rabia, 1997). In another study, Abu-Ali and Reisen (1999)

58 suggested that Muslim adolescent girls experience contradictory information regarding appropriate gender roles from their American and ethnic environments. They found that in a sample of 96 high-school students (over three fourths of whom identified their origin as Middle Eastern or Arab), those who had lived in the United States for longer periods of time obtained higher masculinity scores on the Bem Sex Role Inventory. The authors also found that femininity was significantly predicted by ethnic identity (as measured by the Multigroup Ethnic Identity Measure) and religiosity (as measured by a nine-item

Islamic religiosity scale).

Meleis (1991) argued that Arab American women are at-risk for physical and mental health problems as a result of the need to negotiate vivid differences between

American and Arab culture in addition to an increase in their role responsibilities. She presented an example of Arab women in California who struggled to maintain their ethnic heritage and traditions, preserve family relations, and provide optimum care for their children. Hattar-Pollara and Meleis (1995b) conducted interviews with 30 Jordanian women who had immigrated to the greater Los Angeles area an average of 13.5 years prior to the interviews. The authors found that the women experienced “a sense of burden and of role overload” (p. 537) because their traditional responsibilities of childrearing, managing the house, preserving familial kinship relations, and retaining cultural traditions were more difficult in the United States. This was attributed to struggles such as a language barrier, societal hostility, their children’s peer pressure to adopt American behaviors, disruption of the extended family system, and the necessity to learn new skills such as driving, shopping, financial management, and even employment. In response to these acculturative stressors and isolation from mainstream society, the Jordanian

American women developed a strong ethnic identity and organized a religious and ethnic social network to re-create an environment similar to that of their home country.

Because of the central role family plays in Arab culture, kinship and social networks are often intertwined for Arab Americans. For example, family members and relatives, followed by spouses or partners, are the major sources of social support for

Arab Americans whereas friends are the major support source for mainstream Americans.

When extended family members have not immigrated to the U.S., Arabs may attempt to develop networks with persons from the same ethnic-country background (e.g.,

Egyptians). However, despite their efforts to re-create social networks with remaining family members or at places of worship, Arab Americans may experience low levels of social support (May, 1992).

For example, in a survey research of 73 Arab American immigrant parents from six counties, scores on indicators of numbers in social network, duration of relationships, frequency of contact, reception of emotional support, reception of tangible support, and total functioning of the social network were significantly lower than scores reported for the normative adult sample. This was attributed to the geographical distance between respondents and their support system. Using the Norbeck Social Support Questionnaire, the author learned that the Arab immigrants had lost an important member of their family in the past year and that they identified 26% of their network to live outside of the U.S.

(May, 1992). Hattar-Pollara and Meleis (1995b) also reported disruption of social networks and loss of social support among Arab American women; the authors described how the women attempted to recreate an ethnic social support system through establishing religious parishes and developing social activities at church.

Religion and Religious Coping. The topics of Arab American religious affiliation, religiosity, and religious coping have been introduced by researchers. Some authors

(Faragallah et al., 1997; Schumm, 1995) have argued that Christian Arabs have an easier time acculturating to American society in comparison to Muslim Arabs. They explained that this may be due to severed ties with their homeland as a result of having experienced religious persecution or war and because Christians share the same religious beliefs as the majority American culture. For example, Schumm (1995) postulated that willingness to have one’s children serve in the U.S. military may be used as an indicator of acculturation. Using a nonrandom survey of 35 Arab immigrants, he found that Christian

Arabs were more likely to support their children’s service and that this support significantly correlated with indicators of acculturation such as identification with U.S. culture and participation in American cultural practices. In a nonrandom survey of 39 immigrant Arabs, most of who were married fathers, Faragallah et al. (1997) found that

Arab Americans, especially Muslims, felt isolated from American society and hopeless regarding a possible future of considering the American land to be their home. The authors found that compared to Christian Arabs, Muslim Arabs retained more traditional family roles, maintained their cultural traditions which are highly intertwined with religious values, were exposed to greater discrimination within American society, and experienced less satisfaction with life in the United States.

Religion may serve as sources of prevention and coping for both Christian and

Muslim Arab Americans. For example, Abudabbeh and Hamid (2001) reported that from

2,000 Arab clients who sought services from the NAIM Foundation in Washington, D.C., only five presented with substance use problems. They suggested that affiliation to the

Islamic religion- which prohibits alcohol- is the main factor in preventing substance abuse and related psychological problems. They reported that another organization which services Christians and Muslim Arabs also found substance abuse problems to be rare.

Religious networks or social networks at places of worship can provide a source of support for acculturating Arab Americans. Oftentimes these networks substitute the role of the extended family and are the outcome of the immigrants’ attempt to recreate a world of familiarity (Hattar-Pollara & Meleis, 1995b; Maloof, 1981).

Definition of Terms

1.5 generation (or, one-and-a-half generation): In this study, a term that denotes

individuals who immigrated to the United States as children before the age of 18.

Acculturation: An interactive process between two groups in which one or both groups

adopts beliefs, norms, and traditions from the other; or, an individual’s process of

cultural change (e.g., in values, attitudes, and behaviors) that results from

extended exposure to another, usually more dominant, culture.

Acculturation strategy (or, acculturative strategy): A person’s acculturation preference or

level of adopted acculturation modality (e.g., assimilation, marginalization,

separation, or integration).

Acculturation stress (or, acculturative stress): Stress that results from the difficulties and

challenges associated with the acculturation process.

Arab: Of or pertaining to the Arab world. For this study, the Arab world is defined as the

22 member states of the Arab League, namely: Algeria, Bahrain, Comoros,

Djibouti, Egypt, Iraq, Kuwait, Jordan, Lebanon, Libya, Mauritania, Morocco,

Oman, Palestine, Qatar, Saudi Arabia, Somalia, Syria, Sudan, Tunisia, United

Arab Emirates, and Yemen. Arabs share a common Arabic language, but are

diverse in terms of dialects, history, religion, and cultural practices.

Arab American: A person of Arab descent who is a resident of the United States.

Assimilation: A process whereby a person replaces his or her native ethnic culture/

customs with the new or mainstream culture/ customs.

Asylum seeker: A person who involuntarily seeks temporary residence in the host

culture, typically as a result of political exile or persecution from the country of

origin.

Biculturalism: The midpoint of the unipolar assimilation continuum in which the

acculturating person demonstrates characteristics of both the culture of origin and

new culture. May also be used to refer to “integration.”

Culture: The values, beliefs, norms, symbols, behaviors, and historical traditions shared

by a group of people.

Dominant culture: See “host culture.”

Early immigrant: A person who immigrated to the United States from their homeland at a

young age; for example, below the age of six years old.

Ethnic group: A group of persons who share a common cultural heritage and are believed

to have common ancestry.

Ethnic identity: The component of a person’s self-concept that derives from knowledge

of membership in a particular group, and the emotional significance related to that

group membership. The cognitive, affective, and moral dimensions of ethnic

identity that influence a person’s worldview.

First generation: A term used to refer to individuals who are the first from their families

of origin to immigrate to the United States.

Host culture: The dominant, majority, or mainstream culture that a person is acculturating

to; in this study, the American culture. The host culture is typically more

advanced in terms of technology, worldwide political power, and economic

wealth.

Immigrant: A foreign-born individual who voluntarily leaves his/ her country of origin

and has been admitted to reside permanently in a new host country (in this study,

the U.S.) as a lawful permanent resident

Immigration: Relocation to another country to become a permanent resident there.

Indigenous peoples: Peoples who have a historical presence in a geographical area prior

to invasions, conquests, colonialism, or settlement by another group.

Integration: An acculturative process of maintaining the values and culture of one’s

ethnic group while simultaneously establishing relationships with, and becoming

a full participant in, the new mainstream society.

Mainstream culture: See “Host culture.”

Marginalization (or, alienation): An acculturative strategy of rejecting both native

culture/ customs and mainstream culture/ customs.

Psychological acculturation: At an individual level, an individual’s process of cultural

change (e.g., in values, attitudes, and behaviors) that results from extended

exposure to another, usually more dominant, culture.

Psychological adaptation: General well-being and positive mental health experienced by

acculturating individuals as an outcome of adjusting to the new society without

serious acculturative stress effects.

Refugee: A person who is involuntarily displaced from his or her residence of origin due

to war, persecution or genocide (religious, political, or ethnic), natural disasters,

or occupation by a foreign group.

Second generation: A term used to refer to individuals who were born and raised in the

United States but whose parents were born in the Arab world.

Separation (also, isolation, segregation): An acculturative strategy of maintaining one’s

native culture and customs while rejecting the mainstream or new culture and

customs.

Sociocultural adaptation: The acculturating person’s ability to successfully cope with the

demands of a new culture, particularly in the areas of social networks or

employment.

Sojourner: A foreign-born individual who voluntarily leaves his/her country of origin and

has been admitted to reside temporarily in a new host country, typically with the

aim of completing a personal goal (e.g., educational, employment).

Aims of the Present Study

As discussed above, previous scholars have introduced theories and empirical data regarding the associations among socio-demographic, acculturation, and acculturative stress factors for Arab Americans. However, hypothesized interactions among these variables have not been confirmed with more systematic large-sample research, and the impact of these variables on mental health has not been adequately

65 explored. Furthermore, one of the methodological shortcomings of acculturation research in general has been its reliance on simple tests of association between acculturation status and mental health, without the use of more integrated and sophisticated modeling techniques that could better explain the data (Shen & Tekeuchi, 2001).

The purpose of this research was to satisfy a vital need in Arab American acculturation literature by examining the hypotheses introduced in previous studies with the use of rigorous sampling, measurement, and data analysis techniques. The project also aimed to introduce a tenable model of Arab American acculturation that clarifies the complex interactions of acculturation processes, mental health factors, and support variables. Based on theories and findings from acculturation research and the Arab

American literature described earlier, seven research areas for this study were developed.

The first research focus of this study examined socio-demographic indexes that were expected to influence acculturation strategy and ethnic identity. It was hypothesized that higher income, higher education, later generation status, immigration by choice, earlier age of immigration, longer time of residence in the U.S., possessing American citizenship, not possessing Arab country citizenship, fewer visits to the Arab world, less recent visitations to the Arab world, greater English (versus Arabic) language use, less frequent Arabic TV viewing, and self-identification as an “American” would each be positively associated with adoption of American cultural identity (heretofore called

“American identity”). Conversely, it was hypothesized that these factors would be associated with lower levels of Arab ethnic identity (heretofore called “Arab identity”).

Assessment of Arab American mental health was the second research focus. Due to the current anti-Arab socio-political environment and mounting acculturative stressors

66 since September 11, it was hypothesized that Arab Americans would report significantly higher levels of anxiety and depression compared to normative data from the mainstream population. However, it was hypothesized that levels of anxiety and depression would be comparable to other ethnic minority groups that similarly suffer acculturation stressors such as immigration trauma and discrimination.

The third research focus of this study tackled the question of acculturative strategy and mental health. Consistent with acculturation theory, it was hypothesized that respondents who were integrated, assimilated, or who have adopted greater levels of mainstream American culture would report lower levels of acculturative stress and better mental health as defined by anxiety and depression. On the other hand, Arab ethnic identity and identification with the separation or marginalization acculturation strategies were hypothesized to be positively associated with stress, anxiety, and depression.

Fourth, relationships were anticipated among acculturative stress, mental health, and coping variables. It was hypothesized that greater acculturative stress would be related to higher levels of anxiety and depression. Coping resources such as family functioning, social support, and religious coping were hypothesized to relate to less acculturative stress, anxiety, and depression.

Gender differences were assessed in the fifth study area. It was hypothesized that

Arab American females would report higher levels of acculturative stress, anxiety, and depression compared to males.

The sixth research focus examined religious differences in acculturation and mental health. As discussed previously, Muslim Arab Americans are more likely to face discrimination and forced isolation from American society than Christian Arab

Americans. It was therefore hypothesized that Christian respondents would demonstrate greater mainstream American identity, less Arab ethnic identity, less acculturative stress, and better mental health profiles (i.e., less anxiety, depression) compared to Muslims.

In contrast to the six initial hypothesis-testing research areas, the seventh focus of this study was exploratory and aimed to generate a tenable structural model of acculturation and mental health for Arab Americans. Acculturation, American cultural identity, and higher socio-economic status were expected to predict less acculturative stress, while Arab ethnic identity was expected to predict greater stress. Serving as a mediating variable between acculturation and mental health, acculturative stress was expected to predict anxiety and depression. The coping resources of family functioning, social support, and religious coping were expected to have direct effects on reducing anxiety and depression in addition to indirect effects on these mental health outcomes by impacting acculturative stress.

Chapter 2

Methods

Participants

Participants were 611 Arab Americans residing in the United States who completed a set of questionnaires hosted on a form-based Web site. The Web site contained measures assessing acculturation, acculturative stress, family functioning, social support, religious coping, anxiety, and depression. Additionally, a 25-item socio- demographics survey was included. Basic demographic characteristics of the sample are listed in Table 2.1. A total of 59.9% (n= 366) were female and 36.7% (n= 224) were male. Ages ranged from 18 to 81 with a mean age of 29.32 (SD= 11.09). About half

(53.2%, n= 325) were single, and nearly one-third (31.1%, n= 190) were married. The majority (69.2%, n= 423) were Muslim, and the second-largest religious affiliation was

Christianity (21.6%, n= 132). Participants were provided the option of describing their specific religious denomination. From the Muslim respondents, 252 reported that they were Sunni, and 31 stated that they were Shi`aa. Christian denominations included

Catholic, Greek Orthodox, Antiochian Orthodox, Maronite, and Coptic.

Socio-economic characteristics of the sample are listed in Table 2.2. For the most part participants were well-educated. About one-fourth (26.4%, n= 161) had completed some college classes, and nearly two-thirds had completed either a bachelors degree or equivalent (27.8%, n= 170) or a post-graduate degree (30.4%, n= 186). Participants’

68 69

Table 2.1 Basic Demographic Characteristics of Participants Demographic characteristic n Percent

Sex

Male 224 36.7

Female 366 59.9

Missing data 21 3.4

Marital status

Single 325 53.2

Married 190 31.1

Separated 5 0.8

Divorced 30 4.9

Widowed 4 0.7

Domestic partnership 2 0.3

Other: “engaged” 28 4.6

Other 6 1.0

Missing data 21 3.4

Religious affiliation

None/ atheist 23 3.8

Druze 6 1.0

Christian 132 21.6

Muslim 423 69.2

Other 6 1.0

Missing data 21 3.4

Total 611 100.0

Table 2.2 Socio-Economic Characteristics of Participants and Their Families Demographic characteristic n Percent

Highest educational level completed

Elementary or middle school 2 0.3

High school degree 36 5.9

College classes, no degree 161 26.4

Associates degree or equivalent 33 5.4

Bachelors degree or equivalent 170 27.8

Masters degree or equivalent 116 19.0

Doctoral degree or equivalent 70 11.5

Other 2 0.3

Missing data 21 3.4

Father’s educational level

No education 25 4.1

Elementary school 38 6.2

Junior high or middle school 46 7.5

High school degree 102 16.7

Associates degree or equivalent 31 5.1

Bachelors degree or equivalent 130 21.3

Masters degree or equivalent 84 13.7

Doctoral degree or equivalent 124 20.3

Other 9 1.5

Missing data 22 3.6

Demographic characteristic n Percent

Mother’s educational level

No education 37 6.1

Elementary school 39 6.4

Junior high or middle school 70 11.5

High school degree 156 25.5

Associates degree or equivalent 73 11.9

Bachelors degree or equivalent 129 21.1

Masters degree or equivalent 49 8.0

Doctoral degree or equivalent 35 5.7

Other 2 0.3

Missing data 21 3.4

Annual family income before taxes (USD)

Less than 15,000 53 8.7

15,000 - 24,999 49 8.0

25,000 - 34,999 45 7.4

35,000 - 49,999 46 7.5

50,000 - 74,999 98 16.0

75,000 - 99,999 84 13.7

100,000 - 149,999 82 13.4

Over 150,000 66 10.8

Unsure 67 11.0

Missing data 21 2.4

Total 611 100.0

72 fathers similarly had high levels of educational attainment: 55.3% (n= 338) had obtained a bachelors degree or higher, and 16.7% (n= 102) had a high school degree. Mothers’ education was comparatively lower: 34.9% (n= 213) had obtained a bachelors degree or higher, and 25.5% (n= 156) had a high school degree. Annual family income ranged from less than $15,000 (8.7%, n= 53) to more than $150,000 (10.8%, n= 66), with more than half of the sample (54.0%, n= 330) listing an annual income of more than $50,000.

Study respondents resided in 34 states and the District of Columbia. The largest subgroups were from Ohio (19.0%, n= 116), Michigan (15.9%, n= 97), and California

(11.6%, n= 71). Table 2.3 lists the participants’ locations of residence.

Generational status of participants (determined by age of immigration and family history in the U.S.) is listed in Table 2.4. A total of 8.7% (n= 53) were sojourners who had arrived to the U.S. as adults and plan to return to their native homeland. Among sojourners, age of arrival to the U.S. ranged from 16 to 35, with a mean arrival age of

23.17 (SD= 5.48). Length of stay in the U.S. ranged from one year to 17 years with a mean stay of 4.17 (SD= 2.77). The majority (81.1%, n= 43) had come to the U.S. for voluntary reasons- for example, for educational or economic pursuits- and a minority

(17.0%, n= 9) had come for a mixture of voluntary and involuntary (i.e., economic or political crisis in homeland) reasons. The majority (75.5%, n= 40) had a temporary visa such as a work or study visa. The rest either had the Green Card (13.2%, n= 7) or U.S. citizenship (9.4%, n= 5), and one respondent had refugee/ asylum status. Most sojourners

(90.6%, n= 48) carried a valid passport from an Arab country.

Table 2.3 Participants’ Location of Residence (N= 611) State n Percent State n Percent

Alabama 6 1.0 Mississippi 2 0.3

Arizona 7 1.1 Nebraska 2 0.3

Arkansas 2 0.3 New Jersey 25 4.1

California 71 11.6 New York 37 6.1

Colorado 3 0.5 North Carolina 12 2.0

Connecticut 4 0.7 North Dakota 1 0.2

Florida 20 3.3 Ohio 116 19.0

Georgia 3 0.5 Oklahoma 2 0.3

Illinois 25 4.1 Oregon 2 0.3

Indiana 5 0.8 Pennsylvania 13 2.1

Iowa 1 0.2 Rhode Island 1 0.2

Kansas 2 0.3 Tennessee 3 0.5

Kentucky 4 0.7 Texas 32 5.2

Louisiana 1 0.2 Utah 1 0.2

Maryland 16 2.6 Virginia 26 4.3

Massachusetts 33 5.4 Wisconsin 3 0.5

Michigan 97 15.9 Washington, D.C. 7 1.1

Minnesota 5 0.8 Missing data 21 3.4

Table 2.4 Participants’ Generational Status Generational Status n Percent

Sojourner 53 8.7

First-generation immigrant 112 18.3

One-and-half generation 100 16.4

Second generation 221 36.2

Third and later generation 43 7.0

Other/ mixed generational status 60 9.8

Missing data 22 3.6

Total 611 100.0

A total of 18.3% (n= 112) of the participants were first-generation immigrants.

These individuals were born and raised in an Arab state, immigrated to the U.S. as adults, and planned to remain in the U.S. indefinitely. Age of arrival to the U.S. was 18 to 42 with a mean arrival age of 24.96 (SD= 5.41). Length of stay in the U.S. ranged from one year to 46 years with a mean stay of 16.31 (SD= 10.93). The majority (75.0%, n= 84) immigrated for voluntary reasons, while 21.4% (n= 24) immigrated for mixed voluntary and involuntary reasons. More than half of the immigrants (58.0%, n= 65) had obtained

U.S. citizenship, while 24.1% (n= 27) had the Green Card and 13.4% (n= 15) had temporary visas. Four participants were involuntary immigrants with refugee/ asylum status. The majority of immigrants (83.9%, n= 94) carried a passport from an Arab state.

The “one-and-a-half” or 1.5 generation participants were those who were children when they emigrated with their families from the Arab world to the U.S. Exactly 100 participants (16.4%) fell in this category. Age of immigration ranged from one to 17 with

75 a mean age of 7.41 (SD= 5.37). Length of stay in the U.S. ranged from 2 to 48 years with a mean stay of 19.49 (SD= 8.65). The majority of these child immigrants (85.0%, n= 85) had obtained American citizenship, while 12% (n= 12) had Green Card status. The majority (70.0%, n= 70) carried a passport from an Arab state.

U.S.-born second generation participants comprised the largest subgroup in this study (36.2%, n= 221). These were persons whose parents emigrated to the U.S. from the

Arab world. Respondents’ current age ranged from 18 to 81 with a mean age of 25.11

(SD= 8.11). All participants had U.S. citizenship with the exception of one participant who declined to answer. A total of 41.2% (n= 91) additionally carried a passport from an

Arab state.

Third and later generation participants comprised 7.0% (n= 43) of the sample.

These were persons who were born in the U.S. and had grandparents, great-grandparents, etc. who had immigrated to the U.S. Current age ranged from 18 to 70 with a mean age of

29.88 (SD= 13.68). All participants had US citizenship with the exception of two participants who declined to answer. A minority (18.6%, n= 8) additionally carried a passport from an Arab state.

Nearly 10% of the sample (n= 60) did not fall in any of the above-mentioned generation status categories (see Table 2.5). From these, 8.3% (n= 5) were born in the

U.S. prior to moving to the Arab world as young children and returning to the U.S. as older children. Ten percent (n= 6) were born in the U.S prior to moving to the Arab world as children and returning to the U.S. as adults. Another 15% (n= 9) indicated that that their grandparents had immigrated to the U.S., but their parents returned to the Arab world where the participant was born and raised. The participant then immigrated to the

Table 2.5 Generational Status of "Other" or Mixed Categories Percent total sample Description of generational history n Percent (n= 611)

Undecided whether staying in or leaving the U.S. 3 5.0 0.5

Born in U.S., moved to Arab state, returned to US as a 5 8.3 0.8 child

Born in U.S., moved to Arab state, returned to US as an 6 10.0 1.0 adult

Grandparents immigrated to U.S., parents returned to 6 10.0 1.0 Arab state, respondent moved to U.S. as a child

Grandparents immigrated to U.S., parents returned to 3 5.0 0.5 Arab state, respondent moved to U.S. as an adult

Born in non-Arab state, moved to U.S. as a child 14 23.3 2.3

Born in non-Arab state, moved to U.S. as an adult 6 10.0 1.0

Born and/ or raised in the U.S., now self-identified as a 7 11.7 1.1 sojourner planning to return to Arab state

Child immigrant 3 5.0 0.5

Other 7 11.7 1.1

Total 60 100.0 9.8

U.S. as children (with their parents) or as adults (with or without their parents). Another group were those who were born in a non-Arab country and who then immigrated to the

U.S. as children with their parents (23.3%, n= 14). Another 10% (n= 6) were born and raised in non-Arab countries before immigrating to the U.S. as adults. Non-Arab birth locations were: Brazil, Canada, France, Germany, Greece, United Kingdom, and

Venezuela. Another subgroup (11.7%, n= 7) were participants who were U.S.-born or

77 child immigrants to the U.S. who now consider themselves to be “sojourners” intending to return to the Arab world. Three participants were uncertain whether they planned to return to the Arab world or remain in the U.S. Finally, three participants were child immigrants; i.e., they immigrated without their parents for academic advancement or marriage prior to the age of 18.

Participants’ ancestries were from a variety of Arab states (see Table 2.6). The largest subgroups in the sample were Palestinian (24.1%, n= 147), Egyptian (19.5%, n=

119), Lebanese (15.7%, n= 96), Syrian (6.7%, n= 41), and Iraqi (4.9%, n= 30). A total of

14.7% (n= 90) of respondents were from households in which each parent came from a different Arab country. The most common parental combinations were Lebanese-Syrian,

Lebanese-Palestinian, and Palestinian-Syrian. From those of mixed heritages, a total of

5.2% (n= 32) had at least one parent from a Northern African state (i.e., Algeria, Libya,

Tunisia, Morocco) and a total of 2.9% (n= 18) had at least one parent from the “Persian

Gulf” (i.e., Bahrain, Kuwait, Oman, Saudi Arabia, United Arab Emirates, and Qatar).

Familiarity and engagement with the Arab world differed among participants. A total of 46.3% (n= 283) were born in an Arab state, while the rest were born in the U.S.

(46.2%, n= 282) or in Canada, South America, Europe, or Asia (3.8% n= 23).

The extended family of 42.4% (n= 259) of the participants resided mostly in the

Arab world, while 26.5% (n= 162) indicated that their extended family was divided almost equally between the Arab world and the U.S. A total of 21.9% (n= 134) indicated that their extended family resided mostly in the U.S. Location of extended family is listed in Table 2.7.

Table 2.6 Participants’ Location of Ancestry Percent total Arab state n Percent sample (n=611)

Parents with shared backgrounds

Algeria 8 1.6 1.3

Bahrain 1 0.2 0.2

Egypt 119 23.9 19.5

Iraq 30 6.0 4.9

Kuwait 1 0.2 0.2

Jordan 15 3.0 2.5

Lebanon 96 19.3 15.7

Libya 8 1.6 1.3

Morocco 9 1.8 1.5

Palestine 147 29.5 24.1

Saudi Arabia 5 1.0 0.8

Somalia 1 0.2 0.2

Syria 41 8.2 6.7

Sudan 2 0.4 0.3

Tunisia 1 0.2 0.2

Yemen 9 1.8 1.5

More than one Arab state 3 .6 0.5

Other 2 0.4 0.3

Total 498 100 81.5

Parents from different Arab states 90 -- 14.7

Missing data 23 -- 3.8

Total sample 611 -- 100.0

Table 2.7 Location of Participants’ Extended Family Location n Percent

Mostly in the U.S., in the same city as participant 59 9.7

Mostly in the U.S., in other cities 75 12.3

About half in the U.S. and half in the Arab world 162 26.5

About half in the U.S. and half in non-Arab states 11 1.8

Mostly in the Arab world 259 42.4

Mostly in non-Arab states 10 1.6

Another combination 14 2.3

Missing data 21 3.4

Total 611 100.0

A total of 42.4% (n= 259) of participants indicated that they visit the Arab world on a regular basis, 39.9% (n= 244) have visited one to six times in their lives, and 7.9% have never visited (n= 48). More than two-thirds of the participants had visited an Arab state within the past 5 years (68.6%, n= 419), one-fifth (21.8%, n= 133) visited 5 or more years ago, and 6.2% (n= 38) have never visited the Arab world (see Table 2.8).

As listed in Table 2.9, language spoken at home varied from only English (8.2%, n= 50) to Arabic and English about equally (39.0%, n= 238), to only Arabic (8.5%, n=

52). Other language combinations included French or other languages.

Table 2.8 Participants’ Visitations to the Arab World

Response n Percent

Frequency of visitations over lifetime

Never 48 7.9

Once or twice 104 17.0

Three to six times 140 22.9

Regularly 259 42.4

Other: Lived there before but don't visit 12 2.0

Other: Lived there before and visited recently 12 2.0

Other frequency 13 2.1

Missing data 23 3.8

Total 611 100.0

Timing of most recent visitation

Never 38 6.2

More than 20 years ago 13 2.1

10 years to 20 years ago 54 8.8

5 years to 10 years ago 66 10.8

2 years to 5 years ago 184 30.1

1 year to 2 years ago 133 21.8

During the past 12 months 102 16.7

Missing data 21 3.4

Total 611 100.00

Table 2.9 Language Spoken in Participants’ Households Response n Percent

Only English 50 8.2

Mostly English 125 20.5

English & Arabic about equally 238 39.0

Mostly Arabic 110 18.0

Only Arabic 52 8.5

Another language combination 14 2.3

Missing data 22 3.6

Total 611 100.0

As listed in Table 2.10, Frequency of watching Arabic TV was distributed relatively evenly among participants (see Table 2.10).

Table 2.10 Frequency of Watching Arabic TV Channels Response n Percent

Never 99 16.2

Once in a while (every few months) 168 27.5

Sometimes (about every couple of weeks to monthly) 118 19.3

Often (about once a week or more) 109 17.8

Always (almost every day, or every day) 95 15.5

Missing data 22 3.6

Total 611 100.0

Measures

Vancouver Index of Acculturation- Modified Arab Version (VIA-A)

The majority of acculturation scales to date have been developed based on a unidimensional model of assimilation, with higher scores indicating adoption of the host culture, lower scores indicating retention of traditional culture, and intermediate scores suggestive of biculturalism. Other measures have attempted to operationalize a categorical paradigm of acculturation consistent with Berry’s (1984) bidimensional model, with an attempt to classify respondents as assimilated, integrated, separated, or marginalized. Although theoretically the categories should be mutually exclusive, studies using these measures have often found significant intercorrelations among the scales. On the other hand, a bidimensional measurement of acculturation is more consistent with the actual experience of acculturating individuals, and it also provides richer information for researchers (Ryder, Alden, & Paulhus, 2000). The Vancouver Index of Acculturation

(Ryder et al., 2000; see Appendix A) was developed in an attempt to address these challenges. An orthogonal relationship between ethnic and mainstream identities is assumed, and there are two subscales that independently assess these two identities. The questionnaire assesses components of culture including values, behaviors, and traditions as well as comfort with a spouse, friend, or co-worker from the ethnic or mainstream cultures. Because the subscales are identical in content and scoring, intraindividual comparisons of ethnic and mainstream identities can be made (Ryder et al., 2000).

The VIA consists of 20 statements rated on a 9-point Likert-type scale ranging from 1= “strongly disagree” to 9= “strongly agree,” with a midpoint of 5= “neutral/ depends.” Points 2, 4, 6, and 8 are not anchored. Ten of the 20 statements reflect

83 identification with the person’s heritage culture, and the 10 others are matching statements assessing identification with North American culture. The questionnaire alternates between cultural heritage and mainstream questions. A final cultural heritage score is based on the mean score of the 10 items assessing cultural heritage, with scores closer to 9.0 indicating greater ethnic identity. The North American culture score is calculated in the same manner using the 10 North American items (Ryder et al., 2000).

Ryder and colleagues (2000) reported Cronbach’s alphas ranging from .91 to .92 for the Heritage subscale and alphas ranging from .85 to .89 for the Mainstream subscale.

To assess for orthogonality, the two subscales were correlated, revealing intercorrelations of -.18, -.13, and -.01 for their Chinese, East Asian, and non-Asian ethnic minority samples, respectively.

With respect to validity, each subscale correlated as expected with indexes that are associated with increased adoption of mainstream culture, including generational status, English use, percentage of time lived and educated in an English-speaking country, and intention to remain living in the mainstream culture. Also consistent with expectations, the Heritage subscale yielded a correlation of -.57 with the Suinn-Lew

Asian Self-Identity Acculturation (SL-ASIA) Scale, while the Mainstream domain correlated .60 with the SL-ASIA. Higher scores on the SL-ASIA represent greater acculturation and less ethnic identity. Scores on the Heritage subscale for the Chinese and

South Asian samples correlated significantly with a measure of interdependent self- construal, whereas the Mainstream subscale was associated with greater independent self- identity. Moreover, the Mainstream domain was related to lower levels of interpersonal problems and social anxiety (Ryder et al., 2000).

The VIA has not been utilized in many studies, and the current study is the first time it was used with the Arab American population. To modify the questionnaire so that it was more culturally relevant, the term “heritage culture” was substituted with “Arab culture” or “Arab ethnic background.” Sentences were also adjusted for clarity. For example, the item “15. I believe in the values of my heritage culture” was altered to “15.

I believe in Arab values,” which rendered the statement even more comparable to its mainstream alternative of “16. I believe in mainstream North American values.” In addition, the final two statements reflecting friendships were changed from “I am interested in having friends who are…” to “I have friends who are…” to emphasize current rather than desired acculturation levels.

Additionally, the VIA-Arab (or, VIA-A) rating scale was shortened to seven choices with specific anchors: 1= “strongly disagree,” 2= “disagree,” 3= “slightly disagree,” 4= “neutral/ depends,” 5= “slightly agree,” 6= “agree,” and 7= “strongly agree.” Similar rating scale reduction was recommend by Amer (2002) based on findings that the majority of Arab Americans in her sample tended to select the polar ends of rating scales, rendering middle categories of minimal utility. This is consistent with previous observations that Arabs may have difficulty distinguishing subtle choice levels and have a propensity to select extreme-most choices (Bilal, Kristof, & el-Islam, 1987).

The modified VIA-A was piloted on a sample of 76 Arab Americans in the

Toledo, Ohio area (see Appendix B, p. 244). Surveys were distributed by hand at mosques and churches that are known to have large Arab congregations, as well as at The

University of Toledo. Please see “BARCS” for further detail regarding the pilot procedures. Respondents’ ages ranged from 18 to 70, with a mean age of 30.0 (SD=

12.7). A total of 42.1% (n= 32) were Christian, and 57.9% (n= 44) were Muslim. The majority had Egyptian (32.4%, n=22), Lebanese (38.2%, n= 26), Palestinian (17.6%, n=

12), or Syrian (8.8%, n= 6) heritages. Cronbach’s alphas were .80 for the Arab subscale and .84 for the American subscale.

Table 2.11

Category Functioning of the VIA-A Arab Subscale Observed Category Infit Outfit Step Category label count measure MNSQ MNSQ calibration Step S.E. 1- strongly disagree 10 (-1.80) 1.38 3.50 None

2- disagree 9 -0.97 1.48 2.24 .05 .35

3- slightly disagree 14 -0.54 0.68 0.45 -0.31 .26

4- neutral/ depends 68 -0.19 0.95 0.86 -1.25 .20

5- slightly agree 88 0.24 1.04 1.07 0.32 .12

6- agree 253 1.00 1.16 0.90 -0.13 .10

7- strongly agree 285 (2.58) 0.91 0.95 1.31 .09

To assess the effectiveness of the proposed 7-point rating scale, the Rasch Rating

Scale Model (Wright & Masters, 1982) was utilized. A summary of the response category functioning for the Arab subscale is presented in Table 2.11. Small observed counts for the “slightly disagree,” “disagree,” and “strongly disagree” categories may be reflective of the high levels of Arab ethic identity experienced by the pilot sample. Because surveys were distributed at Arab mosques and churches, and among college students who are identified to have Arab backgrounds, this is not surprising. The category measures increased monotonically, indicating that participants with higher levels of Arab identity

86 tended to endorse the higher-level categories. However, the thresholds (step calibrations) did not increase monotonically across the rating scale, and the magnitudes of the differences between the category thresholds were minimal. This indicates that difficulty levels estimated for choosing one category over another were disordered and that the psychological distance between one category over another was not distinct. Additionally, both the “disagree” and “strongly disagree” categories yielded outfit mean-square scores greater than 2, indicating that they may be providing misinformation to the data.

CATEGORY PROBABILITIES: MODES - Step measures at intersections P ++------+------+------+------+------++ R 1.0 + + O | | B | | A |111 77| B .8 + 11 777 + I | 11 777 | L | 11 777 | I | 1 77 | T .6 + 11 77 + Y | 1 77 | .5 + 1 77 + O | 1 6666666*7 | F .4 + 1 666 77 6666 + | 1 66 77 666 | R | 1 444444 66 7 666 | E | 4* 6*44 77 6666 | S .2 + 222222*4 1 **5555**5**5 6666 + P | 2222222 44 222*** 77*44 5555 66| O |22 ***333********3777 444 55555 | N | 333***** 555**66 77*****333 444444 555555555 | S .0 +**************7777777 1*********************************+ E ++------+------+------+------+------++ -2 -1 0 1 2 3 PERSON [MINUS] ITEM MEASURE

Figure 2.1. Probability Curves for VIA-A Arab Subscale

A visual representation of the category functioning is presented in Figure 2.1. The probability curves were not distinct and orderly, indicating poor category functioning. A score of “0” (“strongly disagree”) was the most probable score for a person whose ability

87 level was one logit lower than the difficulty of the item, and “6” (“agree”) was the most probable score for a person whose ability was one logit higher than the given item difficulty. Categories “1,” “6,” and “7” were the most probable categories for the majority of the continuum, and category “4” was most probable for a small section of the variable. Categories “2,” “3,” and “5” were never the most probable categories, and therefore they did not add distinct data.

Table 2.12

Category Functioning of the VIA-A American Subscale Observed Category Infit Outfit Step Category label count measure MNSQ MNSQ calibration Step S.E. 1- strongly disagree 51 (-2.26) 1.08 1.10 none

2- disagree 56 -1.14 1.09 1.39 -0.77 .17

3- slightly disagree 53 -0.58 0.93 0.80 -0.32 .13

4- neutral/ depends 114 -0.14 0.89 0.76 -0.83 .12

5- slightly agree 122 0.36 .91 0.97 0.23 .10

6- agree 214 1.19 1.02 0.92 0.14 .09

7- strongly agree 149 (2.82) 1.27 1.11 1.55 .11

A summary of the response category functioning for the American subscale is presented in Table 2.12. A satisfactory number of persons endorsed each category. The category measures increased monotonically as expected, and outfit mean square scores were within acceptable limits. Thus, the categories functioned as expected in that respondents with higher levels of American identity tended to endorse the higher-level categories in a predictable fashion. On the other hand, the thresholds (step calibrations)

88 did not increase monotonically across the rating scale as desired, and the magnitudes of the differences between the category thresholds were minimal. This indicates that difficulties estimated for choosing one category over another were disordered and that the psychological distance between categories was not distinct.

CATEGORY PROBABILITIES: MODES - Step measures at intersections P ++------+------+------+------+------+------++ R 1.0 + + O | | B |11 | A | 1111 | B .8 + 111 77+ I | 11 77 | L | 11 777 | I | 1 7 | T .6 + 11 77 + Y | 1 77 | .5 + 1 77 + O | 1 6666666* | F .4 + 1 666 77 666 + | 11 66 7 666 | R | 2222222* 4444 6 77 66 | E | 2222 **44 5***5555 77 666 | S .2 + 222 4**** 556 44 *55 666+ P | 22222 33**3 1**** ** 5555 | O |222 333344 5556*12*33*77 444 5555 | N | 33333*4444 5555666 ****2*333 444444 5555555 | S .0 +***********************777777 111**************************+ E ++------+------+------+------+------+------++ -3 -2 -1 0 1 2 3 PERSON [MINUS] ITEM MEASURE

Figure 2.2. Probability Curves for VIA-A American Subscale

A visual representation of the category functioning is presented in Figure 2.2. A score of “1” (“strongly disagree”) was the most probable score for a person whose ability was one logit lower than the difficulty of the item, and “6” (“agree”) was the most probable score for a person whose ability was one logit higher than the given item difficulty. Categories “1,” “6,” and “7” were the most probable categories for the majority of the continuum, and category “4” was most probable for a small section of the

89 variable. Categories “2,” “3,” and “5” were never the most probable categories, and therefore they did not add distinct data.

Based on the Rasch rating scale diagnostics, the rating scale was shortened even further for the final study. Categories “3” and “5” were removed, and the final scale consisted of 1= “strongly disagree,” 2= “disagree,” 3= “neutral/ depends,” 4= “agree,” and 5= “strongly agree.” Thus, the total mean score on each subscale ranged from 1.0 to

5.0. The final modified Arab version of the VIA can be found in Appendix C (p. 250).

Cronbach’s alphas for this sample were .88 for the Arab subscale and .82 for the

American subscale.

SAFE Acculturation Stress Scale- Revised (SAFE-R)

The Social, Attitudinal, Familial, and Environmental (SAFE) Acculturation Stress

Scale (Mena, Padilla, & Maldonado, 1987; see Appendix D) was designed to assess negative stressors experienced by both immigrant and later-generation individuals as they acculturate to the host culture. Respondents are asked to rate the extent to which they perceive 24 items to be stressful in their lives on a 6-point scale ranging from 0= “have not experienced” to 5= “extremely stressful.”

Cronbach’s alpha for the SAFE has been found to be .89 in previous studies

(Fuertes & Westbrook, 1996; Mena et al., 1987). Convergent validity was demonstrated by Mena and colleagues with low to moderate correlations between the SAFE and stressfulness ratings of respondents’ answers to open-ended questions regarding their life in America. Significant differences were found between the scores of immigrants and second-generation students, with immigrants reporting more stress.

The utility of the SAFE scale in assessing Arab American acculturative stress was examined by Amer (2002). Rasch rating scale analysis (Wright & Masters, 1982) revealed strong person reliability (.86) and excellent item reliability (.97); however, the items were found to effectively differentiate persons into only two levels of acculturative stress because the respondents generally experienced low levels of stress. Construct validity was demonstrated by strong fit statistics and a meaningful hierarchy of the scale with items reflecting greater alienation and hopelessness indicating greater stress.

The current sample included recent immigrants who likely present with higher levels of acculturative stress than the second-generation participants in Amer’s (2002) sample. Therefore, it was expected that the SAFE scale would be useful in differentiating among varying levels of acculturative stress within the sample. However, to further increase the suitability of this measure for Arab Americans, four additional items were added in this study reflecting the following culturally-specific stressors: discomfort with media portrayal of the person’s ethnic group (“25. It bothers me when the media portrays a negative image of Arabs and Arab Americans”), experience with discrimination that has hindered personal goals (“26. Discrimination because of my ethnic background has hindered my ability to reach short-term or long-term personal goals.”), and discomfort with the governmental policies towards the ethnic group (“27. It bothers me that current governmental policies and laws unfairly target against persons of my ethnic background;”

“28. The international policies of the U.S. toward Arab countries bother me.”).

Additionally, per Amer’s (2002) suggestions based on response category functioning diagnostics, the current measure included four response choices: 0= “not at all stressful/ have not experienced,” 1= “a little stressful,” 2= “moderately stressful,” and

3= “very stressful.” Possible total scores on the SAFE-R ranged from zero to 84, with higher scores indicating greater acculturative stress. Cronbach’s alpha for this sample was

.89. The SAFE-R can be found in Appendix C (p. 251).

McMaster Family Assessment Device- General Functioning Subscale (FAD-GF)

The Family Assessment Device (Epstein, Baldwin, & Bishop, 1983) has been described as “perhaps one of the oldest and most researched family functioning projects”

(Sawin, Harrigan, & Woog, 1995, p.6). The FAD General Functioning subscale (FAD-

GF; see Appendix C, p. 253) is a subscale of the FAD consisting of 12 statements that assess problem solving, communication, roles, affective responses, affective involvement, and behavioral control. The statements are rated on a 4-point Likert scale:

1= “strongly disagree,” 2= “disagree,” 3= “agree,” and 4= “strongly agree.” Six of the items are reverse-scored. The respondent’s total score is then divided by 12 to produce a family functioning index ranging from 1 to 4, with higher numbers indicating greater family distress (Epstein et al., 1983; Messer & Reiss, 2000).

Cronbach’s alpha in Epstein and colleagues’ (1983) study was .92. One week test- retest reliability in a non-clinical sample was .71 (Epstein et al., 1983; Miller, Epstein,

Bishop, & Keitner, 1985). A later study using a larger sample of nonclinical (n= 627), psychiatric (n= 1,138), and medical (n= 298) participants reported coefficient alphas ranging from .83 to .86 (Kabacoff, Miller, Bishop, Epstein, & Keitner, 1990). The FAD-

GF demonstrated only a weak correlation with social desirability as measured by the

Marlowe-Crowne Social Desirability Scale (-.14; Miller et al., 1985).

With respect to validity, the FAD-GF was found to be effective at discriminating between nonclinical and clinical samples (p < .0001), and a caseness score of 2.0 was

92 suggested by the authors (Miller et al., 1985). The FAD-GF has also been found to correlate as expected with the principal component of the FAD long form (Kabacoff et al., 1990), the Family Unit Inventory’s Integration (-.75) and Coping (-.48) subscales and the FACES-II Adaptability (-.61) and Cohesion (-.50) subscales. FAD-GF scores were also found to be consistent with independent clinicians’ ratings of family dysfunction based on in-depth interviews (Epstein et al., 1983; Miller et al., 1985).

An Arabic translated version of the FAD-GF demonstrated satisfactory internal consistency reliability (.82) and test-retest reliability (.66; Al-Krenawi, Graham, &

Slonim-Nevo, 2002; Al-Krenawi, Slonim-Nevo, Maymon, & Al-Krenawi, 2001). The

FAD-GF was also piloted on a sample of 120 second-generation Arab Americans (Amer,

2002). Rasch statistics yielded satisfactory person reliability (.84) and item reliability

(.90). Strong construct validity was demonstrated by a theoretically meaningful unitary construct characterized by increasing levels of emotional alienation and interpersonal conflict. All items contributed meaningful and distinct information to the scale. Also, rating scale diagnostics revealed an ideal pattern of participant responses to the four category choices. However, the scale did not sufficiently differentiate among participants due to about half of the sample endorsing only negligible levels of family distress.

However, in the current study a wider variety of family functioning was expected as a result of greater socio-demographic diversity. Cronbach’s alpha for this sample was .86.

Personal Resource Questionnaire- Part 2- Revised (PRQ85-R)

The Personal Resource Questionnaire (PRQ), which was initially developed by

Brandt and Weinert in 1981, assesses the multidimensional characteristics of social support. The original Personal Resource Questionnaire (PRQ81) was slightly modified in

1982 (PRQ82) and again in 1985 (PRQ85). The current version- PRQ85- includes two sections. In the first section respondents are asked to describe their experiences and satisfaction in response to descriptions of 10 life situations that may necessitate social support. The second part (PRQ85- Part 2) consists of 25 items rated on a 7-point Likert- type scale ranging from 1= “strongly disagree” to 7= “strongly agree.” To prevent response set, five items are reverse-scored. The final score is based on a tally of the response selections, and this total score ranges from 25 to 175 with higher scores indicating greater levels of perceived social support (Lindsey, 1997; Weinert, 1987).

Strong reliability statistics have been reported for the PRQ- Part 2. Internal consistency coefficients have ranged from .87 to .93. Item-scale correlations have ranged from .29 to .70 (Weinert, 1987). Hunter (1998) cited an unpublished study that did not find a significant correlation between the PRQ- Part 2 and the Marlowe-Crowne Social

Desirability Scale.

In evidence of construct validity, Weinert (1987) reported that the PRQ82-Part 2 correlated as expected with the Beck Depression Inventory (r= -.33) and Trait Anxiety

Scale (r= -.39). A correlation of -.31 between the PRQ85- Part 2 and the Profile of Mood

States demonstrated discriminant validity (Weinert & Tilden, 1990). Convergent validity was evidenced by correlations of .53 and .58 (two samples) with the Cost and Reciprocity

Index, a measure that assesses social support, reciprocity, social cost, and conflict.

Consistent with expectations, the PRQ85- Part 2 moreover correlated with the Family

APGAR tool and the Dyadic Adjustment Scale (.37 to .55) (Weinert & Tilden, 1990).

The PRQ85- Part 2 has not been widely used with Arab or Arab American participants, although Suwaileh (1996) used an Arabic version of the questionnaire for

94 her dissertation sample of 60 Bahraini adults. She reported a reliability coefficient of .88.

Additionally, the PRQ85- Part 2 has been translated into several languages and has been found to be reliable and valid in studies with other ethnic groups, providing support for its cross-cultural utility. For example, it has been used in studies with African American teenagers (Cosey & Bechtel, 2001), African American and Latino American adults

(Banks, 1999/2003), Mexican immigrants to the United States (Hovey, 1999; Hovey &

Magaña, 2000), Dominican Americans (Orshan, 1999), Puerto Rican Americans (Orshan,

1996), Navajo women (Higgins & Dicharry, 1991), and Koreans and Korean Americans

(Han, Kim, & Weinert, 2002) to name a few.

For the present study a total social support index was attained using the 25-item

PRQ85- Part 2. However, rather than using the original 7-point rating scale, the questionnaire was revised to include a more culturally-sensitive 5-choice scale: 1=

“strongly disagree,” 2= “disagree,” 3= “neutral,” 4= “agree,” and 5= “strongly agree.”

This was based on previous evidence that Arabs and Arab Americans tend to endorse extreme-most categories and that shorter rating scales provide more accurate data (see discussions in Amer, 2002 and Bilal et al., 1987). Possible scores on this revised version

(PRQ85-R; see Appendix C, p. 254) ranged from 25 to 125, with higher scores indicating greater social support. Cronbach’s alpha for this study was .91.

Brief Arab Religious Coping Scale (BARCS)

To date there have been no published studies with Arab or Arab American samples that include a measure of religious coping. The most commonly used religious coping questionnaires contain questions that are not culturally-sensitive to Muslim or

Arab participants. For example, the Religious Coping Activities Scale (Pargament et al.,

1990) includes a statement relating to confession of sins, which is a primarily Christian concept, as well as items that may be culturally taboo to express (e.g., anger towards

God, questioning faith, asking God why the stressful event happened). Similarly, the

Religious Problem-Solving Scale (Pargament et al., 1988) contains a subscale of collaborative coping in which God is conceptually placed on the same level as the respondent (e.g., “Together, God and I put my plans into actions.”) which is a concept that is foreign to most Arabs. Moreover, most of the published measures are lengthy and are therefore not suitable for studies such as the present one in which multiple other measures are administered.

For the above-mentioned reasons a brief religious coping scale was developed for this study. First, a total of 62 potential items describing religious coping behaviors were piloted (see Appendix B, p. 245). Respondents were asked to rate the frequency with which they had utilized these coping practices when they previously experienced stressors or a problem on a 5-point Likert-type scale: 0= “not used at all/ does not apply,”

1= “used sometimes,” 2= “used often,” 3= “used very often,” and 4= “used always.”

Most of the 62 items were borrowed from or based on the two longest and most comprehensive religious coping scales: the Ways of Religious Coping Scale (Boudreaux,

Catz, Ryan, Melendez, & Brantley, 1995) and the RCOPE (Pargament, Koenig, & Perez,

2000). The Ways of Religious Coping Scale consists of 40 items that assess the respondent’s frequency of internal (private, such as praying) and external (social, such as seeking support from clergy) religious coping behaviors (Boudreaux et al., 1995). The

RCOPE contains 115 statements reflecting a wide variety of different coping behaviors that fall into five categories: (1) coping to find meaning, (2) coping to gain control, (3)

96 coping to gain comfort and closeness to God, (4) coping to gain intimacy with others and closeness to God, and (5) coping to achieve a life transformation (Pargament et al., 2000).

Additional items were added based on knowledge of Arab religious coping practices. All items were worded to include both Christian and Islamic references, and to reflect cultural sensitivity. For example, Arabic words such as du`aa (supplication), surat

(Qur’anic verse), and halaqa (religious learning gathering) were included.

Informed consent and study procedures were reviewed and approved by The

University of Toledo Institutional Review Board. The pilot survey was distributed by non-random convenience sampling in the Greater Toledo, Ohio area. Emphasis was placed on obtaining data from participants of varying levels of religiosity; for example, by distributing the questionnaire to religious leaders and non-practicing individuals.

Additionally, input from both Christian and Muslim Arab American respondents was desired to ensure reliability and validity for both subgroups. The survey was distributed to frequent attendees of mosques (Islamic Center of Greater Toledo, Perrysburg and

Masjid Saad Foundation, Toledo) and churches (St. George Coptic Orthodox Church,

Waterville and St. Elias Antiochian Orthodox Church, Sylvania). Leaders of the

University of Toledo Arab Student Union and Coptic Club distributed the questionnaire at the University and among their family and friends. The pilot study (which also included a revised version of VIA-A; see discussion of VIA-A above) took approximately 15 minutes to complete. Participants were encouraged to provide feedback regarding the piloted BARCS items.

A total of 76 individuals participated in the BARCS pilot study. Respondents’ ages ranged from 18 to 70, with a mean age of 30.0 (SD= 12.7). A total of 42.1% (n= 32)

97 were Christian, and 57.9% (n= 44) were Muslim. The possible total score range was 0-

248. Supporting the varied levels of religious coping among respondents, the actual score range was 10-240, with a mean total score of 152.67 (SD= 49.75).

Validity. The Rasch Rating Scale Model (Wright & Masters, 1982) was used to examine the psychometric properties of the 62 pilot items in order to select the most effective ones. The construct of “religious coping” was conceptualized as religiously- based actions a person may take to reduce stress or to cope with a problem. Items reflecting low levels of this construct would measure coping behaviors that are shared by many persons in a population, even those who are not actively religious, and would take little effort to engage in. These could include, for example, simply remembering God or supplicating to God for help. These items would be “easy” to endorse on a measure.

Items reflecting high levels of the construct would be coping behaviors used by more religious individuals that necessitate greater religious commitment and effort, such as visiting a religious institution, attending or teaching a religious class, or meeting with a religious leader. Such items would be “difficult” to endorse on a measure.

The mean of the 62-item pilot scale’s infit mean square scores was 1.01, with a mean standard deviation of .38. Therefore, items with infit mean square scores above

1.39 were removed. The same procedure was used to remove items with outfit mean square scores above the mean outfit score plus mean standard deviation (1.05 + .47=

1.52). Twelve items were removed (See Appendix E). To identify item pairs that were redundant, the largest standardized residual correlations were identified (Wright & Stone,

2004). From each pair, the item that demonstrated the best fit to the scale (using infit mean square scores and item-scale correlations) were retained while the other item was

98 dropped. For items with similar psychometric properties, the item that was easier to understand (based on participants’ comments or criticisms) was retained. Therefore, seven items were omitted (Table 2.13).

Table 2.13

BARCS: Largest Standardized Residual Correlations to Identify Dependent Items Residual Item Item correlation

40. trusted God would be at side 41. sought God's love & care .74

4. talked with clergy leaders 13. talked to religious leader .72

20. donated money to charity 25. gave money to organization .71

15. got help from religious leaders 21. asked advice of religious leader .69

13. talked to religious leader 15. got help from religious leaders .66

57. asked God to find new purpose 58. looked spiritual reawakening .63

13. talked to religious leader 21. asked advice of religious leader .60

34. wondered why i'm punished 39. prayed for a miracle .58

4. talked with clergy leaders 15. got help from religious leaders .58

4. talked with clergy leaders 21. asked advice of religious leader .57

Note. Items in bold were dropped from the scale.

Next, 18 items were removed due to one or more of the following reasons: (1) respondents’ written or verbal criticisms that the item was difficult to understand or not applicable to their faith, (2) redundancy of content with another item, and (3) redundancy of item difficulty on the logit scale. Items that yielded similar logit measures (near each other on the logit scale with measurement error that overlaps) were considered redundant

99 because they target similar levels of the construct. Appendix F lists the items that were removed along with the reason.

Table 2.14

BARCS: Largest Standardized Residual Correlations to Identify Dependent Items Residual Item Item correlation

7. tried to be less sinful 9. tried to make up for mistakes .56

4. talked with clergy leaders 15. got help from religious leaders .54

19. donated time to religious cause 20. donated money to charity .50

2. increased prayers to God 3. read scriptures .43

24. asked God to be forgiving 43. prayed to get mind off .41

9. tried to make up for mistakes 18. asked for God's forgiveness .41

61. used religious figure as 14. recalled religious passage .37 example

3. read scriptures 14. recalled religious passage .35

Note. Items in bold were dropped from the scale.

Rasch rating scale analysis (Wright & Masters, 1982) was applied to the remaining 28 items to further assess the utility of these items. Three items that demonstrated poor fit (infit mean square greater than the scale’s mean infit mean square score plus the mean standard deviation, or outfit mean square score greater than the scale’s mean outfit mean square score plus the mean standard deviation) were removed

(see Appendix G). To identify item pairs that were redundant, the largest standardized residual correlations were identified (Table 2.14). From each of the eight pairs of items, the item that demonstrated poorest fit to the scale (using infit mean squares and item-

100 scale correlations) and/ or measurement redundancy with other items at similar logit measures was dropped. Finally, three pairs of items that were near one-another on the logit scale were identified, and the items that demonstrated worse psychometric properties (e.g., fit scores, item-scale correlation) were removed (Appendix H).

As shown in Appendix H, the final 15 items retained for the BARCS demonstrate strong face validity. They include different types of religious coping strategies such as praying, putting the problem in God’s hands, or obtaining support from the congregation.

The logit order of the items supports the theoretical construct of “religious coping.”

Coping methods that are more popular and need less effort (e.g., praying for strength, trying to make up for one’s mistakes) were easiest to endorse. Intermediate levels of the construct were associated with greater commitment, contemplation, and knowledge of faith (e.g., increasing prayers to God, looking for a lesson from God in the situation, reciting a religious passage). Items that were the most difficult to endorse measured behaviors that take more energy and time and are reflective of even greater religious participation (e.g., donating time to a religious cause, attending a religious class, asking a religious leader for help).

Reliability. Reliability of the 15-item BARCS was assessed by investigating

Rasch item and person reliabilities as well as separation statistics. Person reliability was

.90, and item reliability was .95. Person separation was 3.06, indicating that the items differentiated respondents into at least 3 different levels of religious coping. The item separation index was 4.54, indicating that the 15 items spread over at least four different intensities of religious coping. Figure 2.3 displays the item-person map for the 15 items retained in the BARCS. The items were clustered towards the lower part of the map,

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PERSONS MAP OF ITEM (X= 1 person) | 5 XXXX + | | | | | 4 XXX + | | T| X | X | 3 XXXX + | | | | XX S| 2 XX + XX | X | XX | XX |T got help from religious leaders X | 1 XXXXXX + XXXX M| looked love from congregation XXXXXXXX |S used religious story XXX | attended religious classes XX | donated time to religious cause XXXXXXX | attended events at church/mosque shared religious beliefs 0 XXXX +M recalled religious passage XXX | prayed to get mind off X | asked for a blessing looked for lesson from God XXX | increased prayers to God XX S|S put my problem in God's hands | tried to make up for mistakes -1 XX + XXXXX | prayed for strength |T | | | -2 T+ | | | | | -3 + X | | | | | -4 + |

Figure 2.3. Person-Item Map for the 15-Item BARCS

102 indicating that while they were most useful in differentiating among persons of low and medium levels of religious coping, there were not enough items to target persons who reported very high levels of religious coping. In other words, although the spread of persons above a logit score of 2.0 indicates that these persons have varying levels of religious coping, the 15-item pilot BARCS did not include items that accurately differentiated among these persons. These persons are likely religiously-active respondents who were solicited from the mosques and churches.

Category Functioning. Table 2.15 presents a summary of the response category functioning. The categories were stable; in other words, respondents endorsed each category with satisfactory frequency. The category measure increased monotonically, and the outfit mean squares were within the acceptable limits, indicating that the respondents did not answer the items in an unpredictable manner. Therefore, the categories functioned as expected in that persons with higher levels of religious coping tended to endorse the high end of the rating scale more often. Although the step calibrations were ordered in the expected direction, the magnitude of difference between difficulty estimates for choosing

“used very often” over “used often” was very small (0.17), indicating that the psychological distance between these categories was not distinct.

The probability of responding to any one category is demonstrated visually in

Figure 2.4. A person whose ability is one logit lower than the difficulty of an item would most likely endorse “1” (“used sometimes”) whereas a person whose ability is one logit higher than the difficulty of an item would most likely endorse “3” (“used very often”).

While the probability curves were ordered, category “2” (“used often”) was never the most probable response along the continuum, indicating it is not contributing useful and

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Table 2.15 Category Functioning of the 15-Item BARCS Observed Category Infit Outfit Step Category label count measure MNSQ MNSQ calibration Step S.E. 0- not used at all/ 108 (-2.64) 1.33 1.34 None does not apply

1- used sometimes 194 -0.95 0.96 1.00 -1.38 .12

2- used often 172 0.05 0.83 0.71 0.03 .09

3- used very often 249 0.99 0.89 1.08 0.20 .09

4- used always 348 (2.48) 0.99 1.02 1.14 .09

CATEGORY PROBABILITIES: MODES - Step measures at intersections P ++------+------+------+------+------+------++ R 1.0 + + O | | B | | A |0 444| B .8 + 000 444 + I | 00 44 | L | 00 44 | I | 00 44 | T .6 + 00 44 + Y | 00 4 | .5 + 0 44 + O | 0*111111111 4 | F .4 + 111 00 11 3333**3 + | 111 0 11 333 4 3333 | R | 111 00 222****2 44 333 | E | 11 00222 331 22* 333 | S .2 + 1111 22200 33 1144 222 333 + P |1 222 ** 4411 222 3333| O | 2222 333 00*44 111 222 | N | 2222222 333333 4444 00000 11111 2222222 | S .0 +*****************444444444 000000000****************+ E ++------+------+------+------+------+------++ -3 -2 -1 0 1 2 3 PERSON [MINUS] ITEM MEASURE

Figure 2.4. Probability Curves for the 15-Item BARCS

104 distinct information to the data. Based on these category functioning diagnostics, the categories “used often” and “used very often” were combined into one category, and the rating scale was shortened to the following: 0= “not used at all/ does not apply,” 1= “used sometimes,” 2= “used often,” and 3= “used always.”

Final Questionnaire. The final 15-item BARCS can be found in Appendix C (p.

258). To reduce response set, items were re-arranged so that they did not follow the order of response difficulty. The measure began with the items “I prayed for strength,” and “I looked for a lesson from God in the situation,” to remind participants to focus on coping with stressors and problems instead of endorsing religious activities in which they are generally active. Respondents’ final score on the measure was the total sum of the 15 items and ranged from 0 to 45. Cronbach’s alpha for the current study was .94.

Beck Anxiety Inventory (BAI)

The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) is a general measure of anxiety that was initially developed for clinical samples. It is the third-most used anxiety measure in published literature, after the State-Trait Anxiety

Inventory (STAI) and the Fear Survey Schedule (Piotrowski, 1999). Unlike other common measures of anxiety that typically include symptoms that are confounded with symptoms of depression, from the outset the BAI was developed with the intention to select items that reliably discriminate anxiety from depression while still capturing the main components of anxiety (Beck & Steer, 1993). One of the main advantages for using the BAI with an Arab American population is that the items include physiological symptoms of anxiety such as dizziness, pounding heart, indigestion or discomfort in abdomen, and sweating. Because Arabs and Arab Americans tend to experience

105 psychological experiences as somatic complaints (Al-Issa, Bakal, & Fung, 1999; Al-

Krenawi & Graham, 2000; Sayed, 2003), such items are more culturally-sensitive to this population than items with ruminative, cognitive, or emotional emphases.

The BAI consists of 21 symptoms of anxiety (Beck et al., 1988; see Table 2.16).

Respondents are instructed to rate the extent to which they had been bothered by these symptoms during the past week on a 4-point Likert-type scale ranging from 0= “Not at all” to 4= “Severely (I could barely stand it.).” The total score is summed and ranges from zero to 63. Scores of 0-9 are considered normal or are indicative of no anxiety.

Scores of 10-18 reflect mild to moderate anxiety, scores of 19-29 indicate moderate to severe anxiety, and scores of 30-63 indicate severe anxiety (Shear et al., 2000).

The BAI has demonstrated strong psychometric properties for both clinical and non-clinical samples. The initial study reported a Cronbach’s alpha of .92 and a one-week test-retest reliability of .75 (Beck et al., 1988). Other clinical and non-clinical samples have yielded internal reliability indexes ranging from .91 to .94 and item-total correlations ranging from .41 to .70 (Borden, Peterson, & Jackson. 1991; Creamer, Foran,

& Bell, 1995; Fydrich, Dowdall, & Chambless, 1992; Osman, Barrios, Aukes, Osman, &

Markway, 1993). Item-scale correlations ranged from 0.30 to 0.71 (Shear et al., 2000).

With respect to convergent and discriminant validity, persons who were diagnosed with an anxiety disorder obtained significantly higher scores on the BAI than those with depression or who were in a control group. The BAI has correlated with other measures of anxiety such as the Hamilton Anxiety Rating Scale (.51) and the STAI (.47-

.58). Despite the authors’ intentions, the BAI correlated with the Beck Depression

Inventory (BDI; r= .48). However, compared to the Beck Depression Inventory, the BAI

106 demonstrated stronger correlations with other scales of anxiety, and the BDI correlated significantly higher with other measures of depression. The BAI has consistently been found to discriminate between anxiety and depression better than other measures of anxiety such as the STAI (Beck et al., 1988; Fydrich, et al., 1992; Shear et al., 2000).

Among non-clinical samples, the BAI has been found to correlate moderately with subjective distress and physiological responding (Borden et al., 1991), the State and Trait subscales of the STAI (Creamer et al., 1995), and the Cognitive-Somatic Anxiety

Questionnaire and Brief Symptom Inventory (Osman et al., 1993).

The BAI has been used with non-clinical Arab samples. Al-Issa and colleagues

(1999) administered the English BAI to 202 Lebanese students in Beirut, Lebanon, and

557 Canadian students in Calgary, Canada. They reported a Cronbach’s alpha of .89 for both samples. An Arabic version of the BAI was developed by Al-Issa, Al Zubaidi,

Bakal, and Fung (2000) and piloted on 240 university students in the United Arab

Emirates. Cronbach’s alpha was .87, and item-scale correlations ranged from .33 to .67.

In the current study, the 21st item of the BAI was not administered to the participants due to technical problems. Although the cause is not clear, it is likely that the

Internet form field that included the BAI items was limited to 20 lines, and therefore the

21st item was not posted on-line. The missing values mark just less than five percent of the BAI data, which is within acceptable limits. The missing scores would be considered

Missing Completely at Random (Rubin, 1976; Little & Rubin, 1987) rather than influenced by observed or unobserved participant characteristics. In order to render the measure in this study comparable to previous administrations of the BAI, a person mean substitution approach was used to create a 21st item response for each participant. For

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Table 2.16

Descriptive Statistics for BAI Items (n= 601) Item-Total Item Mean SD Correlation

1. numbness or tingling .43 .74 .54 2. feeling hot .72 .93 .51 3. wobbliness in legs .40 .76 .59 4. unable to relax 1.24 1.03 .63 5. fear of worst happening 1.23 1.11 .65 6. dizzy or lightheaded .66 .90 .63 7. heart pounding or racing .73 .94 .71 8. unsteady .51 .87 .74 9. terrified .46 .87 .70 10. nervous 1.19 .98 .69 11. feelings of choking .25 .69 .55 12. hands trembling .35 .74 .68 13. shaky .36 .73 .74 14. fear of losing control .60 .94 .61 15. difficulty breathing .38 .81 .68 16. fear of dying .49 .90 .48 17. scared .74 .95 .64 18. indigestion or discomfort in abdomen .78 1.00 .53 19. faint .24 .63 .62 20. face flushed .43 .80 .63 21. sweating (not due to heat) .58 .70 .92

Note. Item 21 was imputed for each person using the mean of the first 20 items. Item-total correlations are correlations between the item and the scale comprised of the remaining items.

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Table 2.17 Comparison of Correlations for BAI-20 and BAI-21 Measure BAI- 20 Items BAI- 21 Items

VIA-A Arab -.050__ -.049__

VIA-A American -.085*_ -.087*_

SAFE-R .411** .410**

FAD-GF .290** .290**

PRQ85-R -.299** -.300**

BARCS .038__ .039__

CES-D .685** .684**

BAI- 20 Items 1.00**

* p < .05. ** p < .01. Significance levels were based on two-tailed tests.

each participant, the mean score on the first 20 items (rounded to the nearest integer) was inserted as the 21st score. Mean substitution is a common missing data imputation technique. Imputation techniques are effective if they produce unbiased substitutions of the missing values, and if they preserve the relationships of the variables explored. As more accurate imputation strategies such as corrected item mean substitution or item correlation substitution were not possible because none of the cases included the 21st value, person mean substitution was a simple alternative that is believed to produce results that are similar to an intact data set. However, this strategy often results in overestimation of scale internal consistency, especially if more than 20% of the items are missing (Downey & King, 1998; Huisman, 2000).

Cronbach’s alpha for the 20-item BAI was .9331, while for the 21-item version it was .9396. Descriptive statistics for the 21 items are listed in Table 2.16. As

109 demonstrated in Table 2.17, the correlations produced by the 20-item BAI did not differ from the 21-item BAI, indicating that the imputed values did not significantly alter the relationships among variables. The administered BAI is found in Appendix C (p. 256).

Center for Epidemiologic Studies- Depression Scale (CES-D)

Unlike depression measures that were developed for clinical and diagnostic purposes, the Center for Epidemiologic Studies- Depression Scale (CES-D; Radloff,

1977) was conceptualized primarily as an epidemiological research tool to assess depression in community samples. Because it was established for non-clinical populations, the CES-D emphasizes affective experiences of depression rather than more severe physiological symptoms or suicidal ideation.

The CES-D questionnaire (see Appendix C, p. 257) contains 20 items reflecting six themes: depressed mood, helplessness and hopelessness, guilt and worthlessness, psychomotor retardation, appetite loss, and sleep disturbance. Participants are asked to rate the frequency at which they experienced these symptoms during the past week on a

4-point Likert-type scale ranging from 0= “rarely or none of the time (less than 1 day)” to

3= “most or all of the time (5-7 days).” Four items are reverse-scored to prevent response set. The final score is the total sum of the respondent’s answers, and it ranges from zero to 60 (Radloff, 1977; Shaver & Brennan, 1991).

Internal consistency reliability (split-half) for the CES-D was .77 for non-clinical groups and .85 for the patient samples. For both normal and patient groups, coefficient alpha and Spearman-Brown coefficients were at or above .90. Test-retest reliabilities ranged from .67 at 4 weeks to .32 at 12 weeks (Radloff, 1977; Shaver & Brennan, 1991).

110

With respect to criterion-related and convergent validity, the CES-D has been found to correlate (.60) with the Bradburn Negative Affect Scale (Radloff, 1977), the

Beck Depression Inventory (.81), The Self-Rating Depression Scale (.90; Shaver &

Brennan, 1991), and total number of recent negative life events. Despite the intention to utilize the CES-D in community samples, moderate convergent validity was found between the CES-D and clinicians’ ratings of their patients on the Hamilton and Raskin scales (r= .44 – -.56 ) within psychiatric samples. Also, significant decreases were identified in CES-D, Hamilton, and Raskin scores as patients improved over the course of treatment. A low negative correlation with the Marlowe-Crowne Social Desirability Scale was reported (r= -.18; Radloff, 1977; Shaver & Brennan, 1991).

To establish clinical caseness, Radloff (1977) suggested a score of 16 to determine clinically significant depression. She reported that in her validation study of psychiatric inpatients, 70% obtained a CES-D score above 16, and in another sample of psychiatric outpatients, 100% obtained a score of 16 or above. Expected normative caseness rates are about 20% of any population, and this rate has been reported in several studies using the 16-point cut-off (Alderete, Vega, Kolody, & Aguilar-Gaxiola, 1999).

The psychometric properties of an Arabic version of the CES-D were evaluated by Ghubash, Daradkeh, Al Naseri, Al Bloushi, and Al Daheri (2000). They reported inter-item, split-half, and test-retest reliabilities of .88, .83, and .59, respectively for a non-clinical sample. The test significantly distinguished between depressed and non- depressed women; however, the authors suggested a caseness score of 21 based on actual diagnoses of depression determined by the Structured Clinical Interview for DSM-III-R.

The CES-D has been successfully utilized in other studies with Arab samples in different

111

Arab states with a variety of samples such as undergraduate students and community samples (Al-Darmaki, 1999; Mosalum, 1999; Waszak, Severy, Kafafi, and Badawi,

2001). The CES-D was also piloted by Amer (2002) on a sample of 120 second- generation Arab Americans. The study reported a reliability coefficient of .90.

Cronbach’s alpha for the present study was .91.

Socio-Demographics Survey

A 25-item socio-demographic survey was included in this study (see Appendix C, p. 260). Questions regarding sex, age, ancestral background, marital status, religious affiliation, education, income, and location of residence were asked to determine if the characteristics of the sample were similar to the overall population, and to determine if the participant met criteria for participation. Factors associated with acculturation status

(e.g., generational status, frequency of visiting Arab world, choice in immigration, language spoken at home, legal residence status, location of extended family) were included. The method by which the respondent learned of the study was asked. Finally, there was opportunity for participants to provide feedback to the researcher.

The 24th item in the socio-demographics survey was the Arab Acculturative

Strategy Scale (AASS; Amer, 2002). The AASS is a two-item questionnaire that assesses

Arab American acculturation strategy consistent with Berry’s (1984) 4-factor model. The first question asks respondents to select one of four statements regarding their desired acculturative strategy, with the four statements representing the strategies of assimilation, integration, separation, or marginalization. The second item contains the same choices; however, participants are asked to select the choice that best represents the strategy that they have already adopted. This nominal scale is a modified version of the “Identification

112 with U.S. Culture” questions that were used in previous studies of Arab Americans (e.g.,

Faragallah et al., 1997; Schumm, 1995) and provides a rough indicator of the person’s perception of his or her cultural identity.

Amer (2002) evaluated convergent validity of the AASS by comparing participants’ endorsements to their responses on the Arab Acculturation Scale (AAS)

(Barry, 1996). The Arab Acculturation Scale was constructed based on Berry’s (1984) model and contains questions primarily emphasizing friendships. The AAS consists of two independent subscales: Integration versus Marginalization and Assimilation versus

Separation. In line with expectations, persons who selected the integrated category on the

AASS scored significantly higher (e.g., more integrated) on the AAS Integration vs.

Marginalization subscale (t= 2.01, p = .048). Likewise, respondents who selected the separated category on the AASS scored significantly lower (e.g., more separated) on the

AAS Assimilation vs. Separation subscale (t= –5.271, p < .0005).

Procedures

All Internet procedures and forms in this study followed the guidelines for protection of human participants as reviewed and approved by the University of Toledo’s

Institutional Review Board. Participants completed this study at an Internet site. Since the

1990’s there has been a dramatic growth in Web-based research. Compared to traditional means (e.g., university or community samples), Internet designs have numerous benefits, including access to demographically and geographically diverse samples, potential for larger sample sizes, targeting of specialized samples, anonymity of responses, inexpensiveness, time-effectiveness, and efficiency in processing data that are automatically downloaded into a statistical database. Internet samples have not been

113 found to differ from traditional samples in psychological adjustment, and research findings such as personality or self-esteem have been consistent with traditional samples

(Gosling, Vazire, Srivastava, & John, 2004; Kraut et al., 2004).

Moreover, Web-based designs may be effective for Arab American research. For example, Barry (2001) found that when using traditional sampling techniques, Arab immigrants to the U.S. were reluctant to participate in research due to fears that the research might portray Arabs in a stereotypically negative manner. On the other hand, the

Internet approach was received more positively by potential participants because there was the added option of participant-researcher e-mail exchange that served to discuss and alleviate participant concerns. He did not find any significant differences between his

Internet and community samples on a measure of Arab ethnic identity.

Participants for this study were obtained through the nonprobability convenience sampling technique known as “snowballing” or “networking” in which the researcher contacts respondents he or she knows to be eligible for the study, then these respondents in turn provide referrals for other potential participants (Barker, Pistrang, & Elliott, 1994;

Faugier & Sargeant, 1997). In the current study, participants also informed others about the study without the researcher directly contacting these additional individuals. Due to the dispersed nature of the Arab population, this is an appropriate sampling method

(Meleis et al., 1992). Moreover, a probability sample frame is not possible for this population. Because Arab Americans are categorized as “White” or “Other,” it is not possible to extract comprehensive lists of Arab Americans within a particular geographical area. Official governmental bodies, including the Census Bureau and

114 electoral registers, also do not provide accurate sampling frames for Arab Americans due to their inconsistent categorization of ethnic groups.

To access participants, e-mail invitations (see Appendix I for an example) were sent to individual contacts, listservs and Web communities, and organizations or institutions. The invitation listed the eligibility criteria for the study (both parents of Arab descent, current residence in the U.S., age 18 and above), the researcher’s contact information, and the study’s Web site address: www.arabamericanstudy.com. In an effort to motivate potential respondents to complete the study, the invitation also promised 20 cash rewards totaling $1,000 to randomly-selected participants.

Invitation e-mails were sent to 98 Arab American individuals, primarily the researcher’s family, friends, and colleagues. Another 81 non-Arabs residing in the U.S. and 45 Arabs residing in the Middle East were contacted and asked to forward the announcement to their Arab American acquaintances. Individuals were further contacted at www.naseeb.com, an Internet courtship and friendship Web site for Muslims. Through the demographic search function at that Web site, a total of 516 Arab Americans were identified and invited to participate in the study.

To obtain access to larger groups of Arab Americans, moderators of 94 Arab

American Internet communities (solicited by using the http://clubs.yahoo.com/ search function) were contacted and asked to forward the announcement to their members.

Membership at these yahoogroups ranged from less than 10 to more than 1,000 members.

The groups included, for example, the Arab American Women Club, Arabs in New York group, and the Arab American Studies Society. Many of the Internet communities were associated with university clubs or cultural centers. A total of 474 e-mails were moreover

115 sent to organizational leaders of 141 university-based clubs and unions. The majority of these clubs shared an Arab focus, such as the University of Michigan Lebanese Student

Association or University of Houston Arab American Student Association. Others included Muslim Students Association chapters, Christian fellowships, or international students associations that boasted North African or Middle Eastern members. These university organizations were identified through searches at Internet search engines such as www.yahoo.com and www.google.com, and by visiting the student activities Web pages at Web sites for universities in states where large groups of Arab Americans reside.

Also identified through Internet search engines, a total of 356 invitations were e- mailed to leaders from 90 Arab American organizations. These organizations included political advocacy centers (e.g., American-Arab Anti-Discrimination Committee), professional societies (e.g., National Arab American Medical Association, Arab

American Association of Engineers and Architects), community centers (e.g., The Arab

Cultural and Community Center of South Francisco, Greater Toledo Association of Arab

Americans), social service associations (e.g., Arab American Community Center for

Economic and Social Services), university departments (e.g., Center for Arab American

Studies at The University of Michigan, Center for Contemporary Arab Studies at

Georgetown University), and even artistic groups (e.g., Arab Theatrical Arts Guild). An additional 54 invitations were sent to leaders of Arab Churches and Christian associations such as the Illinois St. George Antiochian Orthodox Church, the Melkite Catholic

Eparchy of Newton, and the Arab American Roman Catholic Community. To further encourage Christian respondents, an Antiochian Lebanese undergraduate student at The

University of Toledo networked among his family and friends for respondents, and he

116 posted flyers announcing the study at Arab American churches in Greater Toledo such as the St. George Orthodox Cathedral in Toledo and the St. Elias Antiochian Orthodox

Church in Sylvania. Finally, the announcement was posted on Internet bulletin boards; for example, at www.cafearabica.com.

It is not possible to determine a response rate for this study. From the 1,718 e- mails sent as described above, 156 were returned undeliverable because the addressee’s account was expired or over quota. Five individuals replied that they were not interested in completing the study. However, it is not possible to determine if the remaining e-mails were successfully opened or read, or if leaders of university clubs, Internet groups, and

Arab American organizations forwarded the invitation to their members. Only 39 individuals and 17 group leaders indicated that they planned to complete the study or forward it to their groups’ listserv or Internet bulletin board. The researcher received numerous verbal and written responses from eligible participants who stated that they were not willing to complete the study due to fears that their responses would be identifiable or that the data would be used against the community (e.g., to defame them or support laws that will hurt them). However, it is not possible to determine how these persons learned of the study, and if they subsequently completed the study after reassurances from the researcher. Moreover, four persons complained of difficulties accessing the Web site due to technical difficulties, and therefore it is unknown if technical difficulties prevented others from accessing the Web site as well. A total of

44.7% (n= 273) of participants indicated that they had learned of the study from a personal acquaintance or friend, 32.9% (n= 201) heard of it from a cultural, ethnic-based,

117 or religious listserv or Internet discussion group, and 15.7% (n= 96) received the announcement from a university club or union.

The Web site for the present study was accessible to potential respondents from

April 1, 2004 to May 23, 2004. To enhance ease of participating in the research, the Web address (URL) for this study was simply named www.arabamericanstudy.com. This URL was re-directed to an Internet form with Secure Sockets Layer (SSL) technology hosted at FormSite.Com, which is an on-line HTML form builder Web site. To reduce the download time, the form was divided into five consecutive Web pages (see Appendix C).

The first page was the informed consent form, which described the study’s purposes, eligibility requirements, incentives and risks, and ways to contact the researcher.

Participants were informed that by proceeding to the following pages they were providing consent. The second page consisted of the VIA-A (acculturation) and SAFE-R

(acculturation stress), the third page contained the FAD-GF (family functioning) and

PRQ85-R (social support), the fourth page contained the BAI (anxiety), CES-D

(depression), and BARCS (religious coping), and the final page consisted of the socio- demographic questions. The socio-demographics survey was placed at the end of the measures because exposing Arab Americans to demographic questions at the start of the study may have increased suspiciousness of the researcher’s motives, fears relating to confidentiality, or feelings of personal intrusion. The length of time to complete this study was approximately 30 minutes.

To minimize incomplete questionnaires, the form was developed so that each data field (i.e., answer to a question) was required. Discontinuing the survey was possible at any time by changing the Web address or exiting the Internet browser. At the conclusion

118 of the study, participants were given the option to click a link to a separate SSL Web form (also hosted at FormSite.com; see Appendix C, p. 266) where they were given the opportunities to: 1) register for the random cash prize drawing, 2) provide comments regarding the study, and/ or 3) ask to receive results of this study. A separate Web form was used so as not to compromise the anonymity of study respondents.

Although the Web site was not designed to track the number of individuals who visited the form’s homepage, it tracked the number of persons who submitted incomplete surveys. A total of 358 individuals progressed past the informed consent page but did not complete the subsequent questionnaire pages. It is not possible to determine if any of these individuals returned to the Web site to complete the study at a later date. Another

58 persons discontinued after the second page (VIA-A and SAFE-R); these responses were not retained for analysis. A total of 10 persons did not complete the fourth page

(BAI, CES-D, and BARCS) and 11 persons did not complete the fourth and fifth (socio- demographics) pages. These results were retained in this study. Two forms did not include data from the first page (VIA-A and SAFE-R) but included data from subsequent pages; these were retained in this study. Because it was not possible to progress to later pages without successfully completing the first pages, this is indicative of Internet technical difficulties. Responses from ten participants who completed the forms were excluded because the participants did not meet study eligibility requirements (both parents of Arab descent, current residence in the U.S., age 18 and above). Thus, responses from a final 611 participants were retained for this study.

Each answered form was automatically downloaded into a password-protected e- mail account that was established solely for this research

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([email protected]). At the completion of the research, data from all completed questionnaires were downloaded into a Microsoft Excel file and then converted to an SPSS file. Data from the second form (the cash incentives and comments page) were similarly downloaded into an email account and a database file.

Chapter 3

Data Analyses

Several data analytic techniques were utilized in this study. The Rasch

Rating Scale Model (Wright & Masters, 1982) was used to assess the reliability, validity, and category functions of measures administered. A variety of bivariate statistics were employed to address the hypotheses listed in Research Focuses 1-6. Finally, structural equation modeling (SEM) was used for Research Focus 7. Justification and explanation of these techniques are described below.

Rasch Rating Scale Analysis

Rasch rating scale analysis (Wright & Masters, 1982) using the WINSTEPS software (Linacare & Wright, 2000) was used in this study to examine the psychometric properties of the revised Vancouver Index of Acculturation and the newly-developed

Brief Arab Religious Coping Scale. According to the Rasch model (Rasch, 1960, 1980), items which purport to measure a construct are characterized by a hierarchical ordering of increasing levels of “difficulty;” in other words, increasing levels of the measured variable. The raw ordinal data from participants’ responses are transformed to a hierarchical scale with equal intervals by using logarithmic transformations and probabilistic equations. Intervals on the scale are based on logit units, and the mean item measure is zero on the logit scale. Respondents (“persons”) are ordered on the same logit scale based on their “ability” level; in other words, their amount of endorsement of the

120 121 measured construct. The mean person measure is estimated in relation to the item difficulty estimates. The position of items and persons on the scale are presented graphically in the item-person map (Bond & Fox, 2001).

Validity. The validity of scales is investigated by assessing the extent to which there is a theoretically meaningful and hierarchical order to the items and the extent to which each item adheres to the measured construct. The empirical hierarchy and ordering of the items should match expectations based on the theoretical understanding of the variable. Construct validity is further investigated by assessing the extent to which each individual item on the scale conforms to– or “fits” with– the pattern of the measured construct. This is determined by fit statistics. The expected infit mean square value is

+1.0, and possible scores range from zero to positive infinity. It is calculated by chi- square statistics divided by their degrees of freedom. An infit mean square value of 1 + x is representative of 100x% more variation in the observed item responses than the predicted (or ideal) pattern. For example, an infit mean square value of 1.23 indicates that there was 23% more variation in the observed data than expected (Bond & Fox, 2001).

Several authors have provided suggestions for determining which items on a scale adhere to the underlying construct. A traditional approach, especially with dichotomous ratings (i.e., Yes/No questions) has considered z-scores (infit ZSTD) of less than -2.0 and more than 2.0 to indicate misfitting and overfitting items, respectively. A z-score of -2.0 is equivalent to a mean square of 0.75, and a z-score of 2.0 is equivalent to a mean square of 1.3. Items below the acceptable range are considered misfitting; in other words, they do not contribute to the measurement of the single underlying construct and are endorsed by respondents in an unpredictable pattern. These items may be measuring a different

122 construct or may be confounded by another variable. Overfitting items adhere rigidly to the scale and have less variation in responses than expected by the model. This could be due to redundancy with other items. Wright and Linacre (1994) suggested that infit mean scores between 0.6 and 1.4 are suitable for rating scales (e.g., Likert or survey), which is a more liberal standard than the traditional approach. For the current study, Wright and

Stone’s (2004) recommendations were followed. These authors suggested that items with an infit mean square score larger than the mean plus standard deviation of the total scale’s infit mean square scores may be not fit to the underlying construct.

Reliability. Rasch reliability indices are analogous to Cronbach’s alpha in that they represent the percentage of observed response variance that is reproducible. The item reliability index provides an estimate of the likelihood that the position of the items on the scale would be replicated if the measure were given to another sample of similar ability level. Item reliability can fall within the range of 0 to 1. Likewise, the person reliability index is indicative of the replicability of person ordering on the scale if the same sample were given a similar set of items that measure the same construct. Person reliability is also bound by 0 and 1. As with Cronbach’s alpha, an item or person index above .8 is considered acceptable, while an index above .9 is desirable (Bond & Fox,

2001; Wright & Masters, 1982).

The item separation index is the estimate of the separation of the items along the continuum of the measured variable. It is calculated by dividing the adjusted item standard deviation by the average measurement error, and it is expressed in standard error units. Likewise, the person separation index represents the estimated separation of the persons into different ability levels along the continuum of the measured variable. It is

123 determined by the adjusted person standard deviation divided by the average measurement error and is expressed in standard error units. Both item and person separations are not bound by 0 and 1. The minimal acceptable person separation index is

2.0, and the ideal item separation, although extremely difficult to attain, would equal the total number of items (Bond & Fox, 2001; Wright & Masters, 1982).

Item-person maps provide information regarding whether the items on the scale usefully target the participants. The distribution of the persons based on their ability level

(i.e., their level of the measured construct) is presented to the left of the logit scale, and the distribution of the items based on their difficulty level (i.e., the difficulty of endorsing the item) is to the right of the scale. The letter “M” represents the mean, “S” represents the standard deviation, and “T” represents two standard deviations. If a person and item share the same logit score, this indicates that there is a 50% probability that the person endorsed that item. In a well-functioning scale, the overall person mean is near the item mean (i.e., zero), and the spread of the items targets and differentiates the spread of the persons (Beltyukova & Fox, 2002; Bond & Fox, 2001).

Category Functioning Diagnostics. Rasch analysis provides information regarding functioning of rating scale options. Category use statistics include frequencies and average measures of each response category. Frequencies represent the number of respondents that endorsed a particular category. A minimum of 10 responses is recommended for each category, and higher frequencies indicate more stable categories.

Categories that have low frequencies do not provide useful information and may be unnecessary or redundant. It is recommended that they be collapsed with other response categories. Average measures represent the mean ability level (in logits) of all the persons

124 who endorsed that category. Logit scores are ordinal units of measurement transformed to log odds ratios on a common interval scale, with a value of zero typically assigned to the mean ability level. It is expected that the average measures should increase monotonically across categories representing increasingly higher levels of agreement with the variable (e.g., from “strongly disagree” to “strongly agree”) (Bond & Fox,

2001).

Step calibrations, also known as thresholds, reveal the estimated difficulty of choosing one category over another (e.g., choosing “strongly agree” over “agree”). The thresholds should increase monotonically across the rating scale. Linacre (1999) recommended that the magnitude of the differences between categories should be at least

1.4 logits but less than 5 logits. This would ensure that the psychological distance between categories is distinct but not too wide to indicate a large gap in the variable.

Linacre also suggested that category fit statistics be evaluated; an outfit mean square of more than 2 indicates that the category introduces undesired misinformation to the data.

The distinction between thresholds is visually presented in a graph of category probability curves. The x axis represents the difference between a person’s ability level and any given item’s level of difficulty. The y axis represents the probability of endorsing each category response. The intersection of rating scale categories corresponds to the threshold estimate. It is the point at which there is an equal probability of choosing either of the two adjacent responses. In a well-functioning response scale each category would have a distinct peak in the probability curve, indicating that it was the most probable response for part of the variable continuum. “Flat” categories are never most probable.

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Because they don’t provide valuable information, it is recommended that they be collapsed with other categories (Bond & Fox, 2001).

Descriptive and Bivariate Statistics

Descriptive and bivariate statistics were conducted for the “Participants” section and Research Focuses 1 through 6 using the SPSS 11.5 computer software. In order to obtain an understanding of the socio-demographic characteristics of the respondents, frequencies, means, standard deviations, and other descriptive statistics were conducted for the socio-demographic survey items. Descriptive statistics were also used to describe participants’ responses to the measures as listed in the first Results section. Bivariate statistics were used to test hypotheses listed in Research Focuses 1 through 6. For all statistical tests, a minimum level of p= .05 was used to indicate significance.

For the first research focus, which assess socio-demographic indexes believed to relate to acculturation strategy, two-tailed independent-samples t-tests and one-way analysis of variances (ANOVA) with Fisher’s least significant difference (LSD) post-hoc tests were employed. Independent samples t-tests were used to compare mean acculturation scores between two socio-demographic subgroups, and ANOVAs were used to compare three or more subgroups. To further test associations between acculturation and socio-demographic constructs, one-tailed Spearman rho correlations were used for ordinal variables, and one-tailed Pearson’s product-moment correlations were used for interval variables. For the second research focus, one-sample t-tests were used to compare participants’ mean scores on mental health measures to previously- published normative data. For the third and fourth research focuses, a series of one-tailed

Pearson’s product-moment correlations were employed to examine the relationships

126 among acculturation, stress, coping, and mental health variables; these variables were measured with continuous scales. For the fifth research focus, comparisons between female and male participants on levels of acculturative stress, anxiety, and depression were determined using independent-samples t-tests. Similarly, for the sixth research focus independent samples t-tests were used to compare Christian and Muslim participants on these variables in addition to Arab and American identities and coping supports.

Structural Equation Modeling

Structural equation modeling (SEM), also known as covariance structure modeling, was utilized in Research Focus 7 to examine the interactions among acculturation, mental health, and coping variables. Structural equation models depict hypothesized relationships among variables, which are then tested against data

(Schumacker & Lomax, 2004). SEM has multiple benefits. Because the researcher needs to develop a hypothetical model of how the variables are expected to interact with one another, SEM is often based on strong theoretical assumptions and previous empirical findings. The visual representation of these interactions is a powerful mode of presentation. Moreover, while other statistical methods are limited in the number of variables analyzed, SEM can analyze more sophisticated variable interactions and multiple “dependent” variables simultaneously. SEM offers the opportunity to moreover conceptualize the same variable as both an outcome and predictor variable. In addition to examining observed (i.e., directly measured) variables, SEM offers the opportunity to assess latent variables. Latent variables are theoretical constructs typically measured by two or more observed variables called indicators. Finally, another advantage of SEM is

127 that measurement errors are accounted for in the analysis (Kline, 2005; Nachtigall,

Kroehne, Funke, & Steyer, 2003; Schumacker & Lomax, 2004).

The Structural Regression Model. For the current study, a structural regression model, or hybrid model, was used. This type of SEM combines a structural model (i.e., relationships among observed variables, similar to path analysis) and a measurement model (i.e., relationships between a latent variable and its indicators, similar to confirmatory factor analysis). Variables that are not explained by any other variable in the model are considered exogenous. Variables that are explained by one or more other variables in the model are considered endogenous. Endogenous variables may predict other endogenous variables. An error or disturbance is associated with each endogenous variable and represents the causes for that variable that are not explained in the model, similar to regression residuals. Errors are also associated with each indicator for a latent variable. This error variance accounts for random errors due to measurement unreliability as well as sources of systematic variance (Hox & Bechger, 1998; Kline, 2005).

Observed variables, including indicators for the latent variables, are presented as squares or rectangles in the SEM model diagram. Latent variables are presented as circles or ellipses. Because they are not measured variables and therefore considered latent, the errors (named “e”) and disturbances (named “d) are also presented as circles or ellipses.

Single-headed arrows indicate a direct causal relationship between observed variables and represent path coefficients. Single-headed arrows from a latent variable to its indicators indicate the direct causal effects of the underlying latent variable on the indicators, and represent factor loadings. Double-headed arrows represent bidirectional associations. All relationships among variables; for example, path coefficients, factor

128 loadings, and covariances, are called parameters (Hox & Bechger, Kline, 2005;

Schumacker & Lomax, 2004).

Model Specification and Identification. SEM model specification involves the utilization of all information available (e.g., theories, previous empirical data) to specify the model of interactions among variables. Identification of a structural equation model is a requirement for producing estimable results. A model is considered identified if it is theoretically possible to determine a unique estimate of each parameter. For identification to occur, the number of free parameters must be less than or equal to the number of observations. Observations are calculated as v(v +1)/2, where v represents the number of observed variables. Estimated parameters include the total number of variances and covariances of exogenous variables as well as direct effects of predictors on endogenous variables. Free parameters differ from fixed parameters in that the estimate is not determined prior to analysis. The degrees of freedom, or difference between observations and parameters, must be zero or greater. A second requirement for model identification is that a scale or metric must be assigned for each latent variable. Thus, the residual path coefficient representing the effects of a (latent) disturbance on an (observed) endogenous variable is fixed to equal 1.0. For the measurement parts of the model, the unstandardized residual path coefficients representing the direct effects of the (latent) error on an

(observed) indicator is fixed to 1.0. Additionally, the unstandardized factor loading of a latent construct on one of its indicators is fixed at 1.0. The indicator that is chosen to be this reference variable is often the one with the most reliable scores (Kline, 2005).

Data Preparation and Screening. For an SEM analysis to be successful, there are several requirements. First, each observed variable must correspond to a reliable and

129 valid measurement. Second, the sample size must be sufficient. Researchers recommend

“large” sample sizes of at least 200 for SEM, with a preferred ratio of 10 cases per each free parameter and a desirable ratio of 20 cases per parameter. Results may be suspect if there are less than five cases per parameter. Third, issues of missing data should be addressed. Fourth, SEM assumes univariate normality; the distribution of scores for any one variable should approximate the normal curve. Although other common statistical tests (e.g., t-test, ANOVA) can be successfully conducted despite violations to normal assumptions, such violations can lead to inaccurate and even incalculable SEM analyses.

Therefore, outliers, skewness, and kurtosis should be examined and addressed. Finally, data should be examined for multivariate nonnormality, multicollinearity, and inconsistent scaling (Kline, 2005; Schumacker & Lomax, 2004).

Missing values can lead to inaccurate results or a model that can not be analyzed, particularly if a significant amount of data is missing. Most SEM computer programs automatically substitute missing values with imputations based on sophisticated estimates of the modeled relationships among variables, or make inferences for the missing data.

Therefore a few missing values, particularly if considered Missing Completely at

Random, are not serious (Kline, 2005; see “Beck Anxiety Inventory” section in Chapter 2 for a more detailed discussion regarding missing data).

There are no clear requirements for detecting and reducing the influence of outliers. In the present study, scores that fell three standard deviations below or above the mean were examined. Those that were separated by some distance from the remaining continuum of scores were considered outliers. Rather than deleting these scores, efforts

130 were made to reduce their influence by changing them to one unit higher or lower than the next extreme-most score (Tabachnick & Fidell, 2001).

Skewness refers to the symmetry of scores around the mean. Positive skew indicates a score distribution that is greater below the mean, and negative skew is when the majority of scores fall above the mean (Kline, 2005). Kurtosis refers to the density of observations compared to a normal distribution, with positive kurtosis indicating a higher peak and heavier tails, and negative kurtosis indicating a flatter peak and lighter tails.

Kurtosis is especially problematic in SEM because it can impact significance tests and standard errors of parameter estimates (DeCarlo, 1997; Hopkins & Weeks, 1990). There are several methods for assessing skewness and kurtosis, including using significance tests for nonnormality, viewing the distributions through visual representations (i.e., histograms), and examining the skewness and kurtosis values. Researchers have provided varying guidelines for the maximum levels of skewness and kurtosis that can be accepted.

Skewness scores falling below -3.0 or above 3.0 are generally considered “extremely” skewed and necessitate transformation. However, studies have found that scores above

2.0 can also lead to inflated chi-square test statistics (see “Evaluation of Model Fit” below) indicating poor model fit. Kurtosis scores are considered problematic if the absolute value is greater than 10.0, and “extreme” if above 20.0. Transformations can be considered for data that demonstrate skewness or kurtosis even if nonnormality is not

“extreme” (Curran, West, & Finch, 1996; Kline, 2005).

Other potential problems in the data set should be considered. First, multivariate normality is an important assumption of SEM, and violations may lead to inaccurate results. Multivariate normality indicates that the distribution of any pair of variables has a

131 bivariate normal distribution. Additionally, it is assumed that the relationship between any two variables is linear (i.e., falling along a straight line) and homoscedastic

(variability in values for one variable is the same for all values of the other variable).

Assessing multivariate normality can be a complex task. However, cases of multivariate nonnormality are often identified through examination of univariate normality, and deletion of univariate outliers can help prevent multivariate nonnormality. Second, multicollinearity should be avoided because it may lead to failed SEM outputs.

Multicollinearity occurs when the correlation among variables is extremely high (e.g., greater than .85), thereby indicating that the variables may be measuring the same construct. Third and final, variable scaling should be assessed. If the ratio of smallest to largest variance in the covariance matrix is greater than 10, the matrix is considered ill scaled and may lead to incalculable fit statistics. In cases of wide ranges of observed variances, variables with the highest and lowest scores can be multiplied by a constant to produce more consistent variances (Kline, 2005; Tabachnick & Fidell, 2001).

Model Estimation Procedures. The hypothesized model in this study was estimated with Amos 4.0 computer software (Arbuckle, 1999), using data from an SPSS file. Amos uses maximum likelihood (ML) estimation for determining parameter estimates. With ML, all parameters are estimated simultaneously, rendering it a full estimation method. The process is also iterative in that an initial solution is derived, then the program attempts to improve the estimates with subsequent calculation cycles. The final solution has the best data fit to the model (Kline, 2005). ML assumes multivariate normality and is more successful in estimating with larger sample sizes. Nonnormality can lead to inflated test statistics indicating poor model fit. ML also assumes that the

132 structure of the model represents the true structure of variable interactions in the population. Although it is not clear how misspecification of the model’s structure may impact overall model fit (Curran et al., 1996), a specification error in one parameter may impact other model parameters (Kline, 2005). These assumptions are rarely met by researchers; however, ML is advantageous because it has been found to be robust against violations of normality and is not as sensitive to variable scaling (Schermelleh-Engell,

Moosbrugger, & Müller, 2003). The Amos program also uses full information maximum likelihood estimation to handle missing data, by using the partially observed data to infer

(not impute or replace) the missing information. This procedure has been found to be superior to other missing data methods in providing unbiased model estimates (Enders &

Bandalos, 2001; Schumacker & Lomax, 2004).

Estimating Model Fit. To determine the extent to which the theoretical model fit the sample data, several fit statistics were used. Evaluating multiple fit statistics is necessary because different statistics may provide conflicting evidence regarding the fit of a particular model, and there is currently no consensus on how to determine a “good fit.” The basic fit statistic is the model chi-square (χ2), or likelihood ratio chi-square, which assesses overall fit to the model. This is a goodness-of-fit statistic. Higher values correspond to worse model fit, and a model that fits the data perfectly will have an index of zero. The null hypothesis in SEM is that the model is correct and fits perfectly to the population. Therefore, failure to reject the null hypothesis lends support to the accurateness of the model (this is different from other statistical tests in which rejection of the null hypothesis indicates that the test intervention had an effect). If the level of statistical significance for the χ2 statistic is below p= .05, this indicates that the tested

133 model did not fit the data. However, χ2 has many limitations. First, just-identified models, or models where the degrees of freedom equal zero (i.e., number of observations = number of free parameters), will likely explain data perfectly. However, models that are too complex with too many parameters may be confusing and theoretically implausible.

Second, expecting a model to fit a population perfectly is unrealistic. Third, if the χ2 index is not statistically significant, and the model is therefore deemed a “good fit,” this does not preclude the possibility that other models may fit the data equally well. Fourth, larger correlations in the data may lead to larger χ2 statistics. Fifth, multivariate nonnormality can inflate the statistic. Finally, larger sample sizes (greater than 200) will invariably lead to statistically significant results. These factors may lead the researcher to incorrectly reject the null hypothesis (Type I error) when the model is true (Kline, 2005;

Schermelleh-Engell et al., 2003; Schumacker & Lomax, 2004). In an effort to reduce the sensitivity of χ2 to sample size, some researchers have suggested using a normed chi square (NC) by dividing the χ2 index by the model degrees of freedom (Schumacker &

Lomax, 2004). Recommended values of 2.0 to 5.0 have been suggested as acceptable, with lower values indicating better fit (Kline, 2005; Schermelleh-Engell et al., 2003).

The root mean square error of approximation test (RMSEA) measures approximate fit to the population, and the hypothesized model is not expected to perfectly fit with the population. The RMSEA index corrects for parsimony; in other words, simpler models that explain the same data produce better statistics. If the null hypothesis is true and the model approximates fit in the population, then RMSEA will equal zero.

Values less than or equal to .05 indicate good fit, those between .05 and .08 are considered adequate, those between .08 and .10 are mediocre, and values above .10 are

134 considered poor or unacceptable. A 90% confidence interval can provide information on the lower and upper bounds of the RMSEA statistic to account for the uncertainty associated with the exact statistic (Kline, 2005; Schermelleh-Engell et al., 2003).

Several measures of fit are considered comparative, or incremental, indexes because they compare the tested model to a baseline model. Typically the independence model is used as the baseline comparison. The independence model is one with no parameters estimated (Schumacker & Lomax, 2004). It assumes that all observed variables are measured without error, and it is calculated by fixing factor loadings to one, fixing error variances to zero, and assuming zero population covariances among observed variables. Because it assumes that the variables are unrelated, the fit index for the independence model is considered “bad,” and the tested model is compared against it. For these comparative indexes, values generally range from zero to one. Indexes greater than

.90 suggest acceptable fit and above .95 indicate good fit, although some researchers have suggested .97 as a cut-off for good fit. An index of 1.0 indicates that the tested model is the best possible improvement over the independence model. Two such indexes are the

Comparative Fit Index (CFI) and Bentler and Bonnett’s Normed Fit Index (NFI).

Additionally, the Nonnormed Fit Index, otherwise known as the Tucker-Lewis Index

(TLI), is less sensitive to sample size and adjusts for parsimony. TLI values can sometimes be larger than 1.0; values above .95 are acceptable and above .97 indicate good fit. The drawback of relying on comparative indexes is that positive results may not always indicate a true model. This is because the assumptions of the independence model are implausible and may produce such bad fit that the tested model inevitably demonstrates better fit (Kline, 2005; Schermelleh-Engell et al., 2003).

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In addition to overall fit statistics, a model can be evaluated for fit based on the parameter estimates. Path coefficients and factor loadings are interpreted as multiple regression coefficients controlling for correlations among the other possible causes.

These regression weights can be unstandardized and standardized. Standard errors and tests of significance are calculated for the unstandardized solutions. To produce standardized estimates, the variances for the variables are set to equal 1.0. There are no clear guidelines for determining if coefficients demonstrate a small or large effect. The statistical test of significance is often used; however, the significance levels of the unstandardized estimates do not necessarily correspond to the standardized estimates.

Additionally, with larger sample sizes small effects can be statistically significant.

Interpreting the absolute magnitude of the coefficients may be an alternative method; however, the magnitude of coefficients can have different meanings for different academic fields. In general, absolute values less than .10 may signify a “small” effect, those near .30 may signify “medium” or “typical” effect, and those greater than or equal to .50 indicate “large” effects. Indirect effects, or coefficients that represent the impact of one variable on a third variable through a second mediating variable, are also estimated by SEM. Total effects (the combined indirect and direct effects from a predictor to an endogenous variable) are interpreted the same as single path coefficients and are the sum of both direct and indirect coefficients. Double-headed arrows represent bidirectional associations. These are typically reported as unstandardized covariances or standardized correlations (Kline, 2005).

Chapter 4

Results

Descriptive Statistics

Table 4.1 summarizes participants’ responses on the instruments used in this study. Although participants scored across the possible range of 0-5 on the VIA-A Arab and VIA-A American scales, the sample demonstrated relatively high levels of Arab ethnic identity (M= 4.14, SD= 0.66) and American cultural identity (M= 3.54, SD= 0.65).

Participants endorsed a moderate level of acculturative stress as measured by the SAFE-R

(M= 30.80, SD= 13.26). Family and social coping mechanisms were high for this sample.

The mean FAD-GF score, which assesses family dysfunction, was 1.95 (SD= 0.54) from a possible score range of 1-4. Lower scores indicate better family functioning. The mean social support score as measured by the PRQ85-R was 101.48 (SD= 14.12) from a possible score range of 25-125. On the other hand, use of religious coping was varied, with the mean BARCS score falling near the middle of the possible score range (M=

20.28, SD= 12.47). The mean BAI score fell in the mild to moderate range of anxiety

(M= 12.78; SD= 12.25). Participant scores ranged from 0 to 62. There was a wide range of responses on the CES-D depression scale (0-53), with the mean score falling just above Radloff’s (1977) suggested caseness level of 16 (M= 17.26, SD= 11.74).

136 137

Table 4.1

Summary of Participant Responses on Research Measures Possible Actual Measure N Mean SD Range Range Alpha

VIA-A Arab 609 4.14 0.66 1.0 – 5.0 1.0 – 5.0 .88

VIA-A American 609 3.54 0.65 1.0 – 5.0 1.0 – 5.0 .82

SAFE-R 609 30.80 13.26 0 – 84 2 – 72 .89

FAD-GF 609 1.95 0.54 1.0 – 4.0 1.0 – 4.0 .86

PRQ85-R 609 101.48 14.12 25 – 125 50 – 125 .91

BARCS 601 20.28 12.47 0 – 45 0 – 45 .94

BAI 601 12.78 12.25 0 – 63 0 – 62 .94

CES-D 601 17.26 11.74 0 – 60 0 – 53 .91

Appendix J summarizes participant responses to the Arab Acculturative Strategy

Scale (AASS). More than half of the participants (53.7%, n= 328) desired an integration strategy, and 45.2% (n= 276) indicated that they were currently integrated in both Arab and American cultures. About one-third (29.5%, n= 180) wished to be separated from

American culture while retaining their Arab ethnic identity. However, more than one- third (37.2%, n= 227) indicated that they were currently separated. Only eight (1.3%) indicated that they wished to become assimilated in American culture, although 19

(3.1%) reported that they were currently assimilated. A total of 11.1% (n= 68) indicated that they were currently marginalized, denying affinity to both cultures.

Research Focus 1: Socio-Demographic Factors Relating to Acculturation

The first research focus in this study examined the relationships between socio- demographic variables and acculturation. Acculturation was operationalized as a person’s

138 levels of American and Arab ethnic identities and was measured by the American and

Arab subscales of the VIA-A. Bivariate statistics were used to first examine the relationships between socio-demographic variables and American ethnic identity, and then to second examine the relationships between the socio-demographic variables and

Arab ethnic identity. Correlations are listed in Table 4.2

Table 4.2

Correlations Between Socio-demographic Variables and Acculturation Socio-demographic Variable American identity Arab identity n

Income .16**** -.00____ 521

Education -.03____ -.17**** 586

Generational Status .29**** .08*___ 527

Age of immigration to U.S. -.13*___ -.03____ 262

Length of residence in U.S. .22**** -.07____ 262

Frequency of visits to Arab world -.18**** .06____ 549

Recentness of visits to Arab world -.07*___ .08*___ 588

Frequency of Arabic language use -.34**** .11***_ 573

Frequency of Arabic TV viewing -.24**** .32**** 587

Note. American identity= VIA-A American; Arab identity= VIA-A Arab. Age of immigration and length of residence in the U.S. are calculated for participants from the sojourner, immigrant, and 1.5 generation categories, and do not include persons of U.S. born, “mixed,” or atypical generational statuses. Spearman correlations were used for all variables with the exception of age of immigration and length of residence, which were calculated using Pearson correlations. Significance levels are based on one-tailed tests. * p < .05. *** p < .005. **** p < .001.

Spearman correlations were conducted to test the hypotheses that higher income, greater education, and later generational status would be associated with greater

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American identity. As expected, income was positively correlated with American identity

(r= .16, p< .001). Education was not significantly related to American identity.

Generational status was positively correlated with American identity (r= .29, p< .001), indicating that participants of later generations (e.g., third or later) endorsed greater

American identity than those of earlier generations (e.g., sojourner or immigrants).

For immigrants to the U.S., it was hypothesized that immigration by choice would be related to greater American identity. However, only 17 individuals indicated that their immigration was involuntary or unplanned. An independent samples t-test was conducted to evaluate if persons who immigrated for purely voluntary reasons endorsed greater

American identity than those who immigrated for mixed voluntary and involuntary reasons. The difference was not significant.

Pearson’s correlations were conducted to test the hypotheses that earlier age of immigration and longer time of residence in the U.S. would be associated with greater

American identity. Only sojourner, first generation, and 1.5 generation participants who were born in an Arab country were included in these analyses; those who had mixed histories (e.g., raised in Europe then moved to the U.S.) were excluded. As expected,

American identity was negatively correlated with age of immigration (r= -.13, p= .02) and positively correlated with length of residence in the U.S (r= .22, p<.001).

Spearman correlations were conducted to test the hypotheses that greater frequency and recentness of visits to the Arab world would be related to less American identity. As expected, frequency of visits was negatively correlated with American identity (r= -.18, p< .001). Recentness of visits demonstrated a very weak correlation (r=

-.07, p= .03).

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A one-way ANOVA with LSD post-hoc comparisons was conducted to test the hypothesis that having an American passport would be associated with greater American identity compared to having a Green Card or temporary visa. The analysis was significant: F(2, 573) = 8.54, p< .001. Participants with an American passport (M= 36.0,

SD= 6.40), endorsed significantly greater American identity than those with a temporary visa (M= 32.48, SD= 6.77; p< .001). An independent samples t-test was conducted to test the hypothesis that having a passport from an Arab country would be associated with less

American identity. The analysis was significant (t= -5.32, p< .001).

Spearman correlations were conducted to test the hypotheses that greater Arabic language use at home and more frequent Arabic TV viewing would be related to less

American identity. As expected, American identity was negatively correlated with Arabic language use (r= -.34, p<.001) and Arabic TV viewing (r= -.24, p< .001).

Finally, a one-way ANOVA with LSD post-hoc comparisons was conducted to test the hypothesis that participants who self identified as American (as measured by selection of current assimilation or integration cultural strategies on the AASS) would endorse higher levels of American identity than those who did not identify as American.

The analysis was significant: F(3, 584) = 30.31, p< .001. Participants who selected the assimilation strategy (M= 38.37, SD= 5.84) endorsed significantly greater American identity than those who were separated (M= 32.78, SD= 6.40; p< .001) or marginalized

(M= 33.81, SD= 6.16; p= .004). Similarly, participants who selected the integration strategy (M= 37.74, SD= 5.86) endorsed significantly greater American identity than those who were separated (p< .001) or marginalized (p< .001).

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With respect to socio-demographic influences on Arab ethnic identity, Spearman correlations were conducted to test the hypotheses that higher income, greater education, and later generational status would be associated with less Arab identity. As expected, education was negatively correlated with Arab identity (r= -.17, p< .001). Income was not significantly related to Arab identity. Generational status yielded a very weak correlation with Arab identity (r= .08, p= .03)

For immigrants to the U.S., it was hypothesized that immigration by force would be related to greater Arab identity. However, only 17 individuals indicated that their immigration was involuntary or unplanned. An independent samples t-test was conducted to evaluate if persons who immigrated for purely voluntary reasons endorsed less Arab identity than those who immigrated for mixed voluntary and involuntary reasons. The difference was not significant.

Pearson’s correlations were conducted to test the hypotheses that earlier age of immigration and longer time of residence in the U.S. would be associated with less Arab identity. Only sojourner, first generation, and 1.5 generation participants who were born in an Arab country were included in the analyses; those with mixed histories (e.g., raised in Europe then moved to the U.S.) were excluded. The analyses were not significant.

Spearman correlations were conducted to test the hypotheses that greater frequency and recentness of visits to the Arab world would be related to greater Arab identity. The analysis for frequency of visits was not significant, and recentness of visits yielded a very weak correlation (r= .08, p= .03).

A one-way ANOVA was conducted to test the hypothesis that having an

American passport would be associated with less Arab identity compared to having a

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Green Card or temporary visa. The analysis was not significant: F(2, 573) = 2.60, p= .08.

An independent samples t-test was conducted to test the hypothesis that having a passport from an Arab country would be associated with greater Arab identity. The analysis was not significant (t= .55, p= .59).

Spearman correlations were conducted to test the hypotheses that greater Arabic language use at home and more frequent Arabic TV viewing would be related to greater

Arab identity. As expected, Arab identity was positively correlated with Arabic language use (r= .11, p= .004) and Arabic TV viewing (r= .32, p< .001).

Finally, a one-way ANOVA with LSD post-hoc comparisons was conducted to test the hypothesis that participants who self identified as Arab (as measured by selection of current separation or integration cultural strategies on the AASS) would endorse higher levels of Arab identity than those who did not identify as Arab. The analysis was significant: F(3, 584) = 29.7, p< .001. Participants who selected the separation strategy

(M= 43.87, SD= 5.59) endorsed significantly greater Arab identity than those who were integrated (M= 40.52, SD= 6.51; p< .001), assimilated (M= 33.37, SD= 7.51; p< .001), or marginalized (M= 38.44, SD= 6.30; p< .001). Participants who selected the integration strategy endorsed significantly greater Arab identity than those who were assimilated (p<

.001) or marginalized (p= .01). Moreover, participants who selected the marginalization strategy endorsed significantly greater Arab identity than those who were assimilated (p=

.002).

Research Focus 2: Mental Health Status Compared to Norms and Other Groups

The second research focus examined the overall status of Arab American mental health. Mental health was defined as levels of anxiety (as measured by the BAI) and

143 depression (as measured by the CES-D). It was hypothesized that Arab Americans would endorse greater levels of anxiety and depression compared to normative samples, but would demonstrate levels comparative to other acculturating groups. One-sample t-tests were conducted to compare the current means to means in previous studies.

The mean BAI score in this study was 12.78 (SD= 12.25, n= 601), which falls in the mild to moderate range of anxiety per the guidelines recommended by Beck and his colleagues (Shear et al., 2000). About half of the total study sample (51.9%, n= 317) scored within the normal range with scores of zero to 9; 21.9% (n= 134) scored in the mild to moderate range with scores of 10-18; 13.6% (n= 83) scored in the moderate to severe range with scores of 19-29; and 11.0% (n= 67) scored in the severe range with scores of 30-63.

Table 4.3 lists descriptive data for the BAI from the current study as well as from normative studies. The Beck Anxiety Inventory was initially developed for a clinical population of outpatients receiving outpatient psychiatric services (Beck et al., 1988).

The mean score in the current study was significantly lower than the mean score for the initial clinical sample (t= -19.15, p< .001). After the initial study, a series of additional studies attempted to establish normative data for levels of anxiety in community and non- clinical samples. The mean score in the current study was significantly higher than scores in Borden and colleagues’ (1991) study of undergraduate psychology students (t= 4.07, p< .001), Osman and colleagues’ (1993) study of non-clinical adult community members

(t= 2.49, p< .05), and Gillis, Haaga and Ford’s (1995) census-matched normative community sample (t= 12.37, p< .001). Current scores did not differ significantly from

Creamer and colleagues’ (1995) study of non-clinical undergraduate students.

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Table 4.3 BAI Descriptive Statistics for Current Study and Normative Studies

Study and Sample n Mean SD Alpha

Current study

Total Arab American sample 601 12.78 12.25 .94

Sojourner _53 17.30 12.82

Immigrant 112 10.43 12.02

1.5 generation 100 14.10 13.74

Second generation 221 12.14 11.72

Third and later generation _43 11.14 11.42

Beck, Epstein, Brown, & Steer (1988)

Outpatient psychiatric patients at a cognitive therapy 160 22.35 12.36 .92 center, in Philadelphia, PN

Borden, Peterson, & Jackson (1991)

Nonclinical undergraduate introductory psychology 293 10.75 _9.12 .91 students

Osman, Barrios, Aukes, Osman, & Markway (1993)

Nonpatient community adult volunteers from randomly- 225 11.54 10.26 .92 selected residential areas, in Midwest

Creamer, Foran, & Bell (1995)

Nonclinical undergraduate students 326 13.10 _9.6 .91

Gillis, Haaga, & Ford (1995)

Normative community sample matching U.S. demo- 242 _6.60 _8.1 graphic profile per 1990 Census, in Washington D.C.

Research examining the norms, reliability, and validity of the BAI with other ethnic groups has been scant. As listed in Appendix K, mean scores from the current study were compared to scores from studies in which the BAI was administered to ethnic

145 minorities in the U.S. and other international groups, even though the purpose of these studies was not to develop normative data for these groups. The mean score in the current study was significantly lower than Al-Issa and colleagues’ (1999) study of Lebanese university students (t= -8.24, p< .001) and Al-Issa and colleagues’ (2000) study of

Emirati university students (t= -8.64, p< .001). However, mean BAI score in the current study was significantly higher than Al-Issa and colleagues’ (1999) study of Canadian university students (t= 9.17, p< .001) and Contreras and colleagues’ (2004) study of

Caucasian American college students (t= 7.47, p< .001) and Latino college students (t=

5.85, p< .001). Scores in the current study were significantly lower than studies of psychiatric patients (Novy et al., 2001; Ulusoy et al., 1998).

The mean CES-D score in the current study was 17.26 (SD= 11.74, n= 601), which falls above Radloff’s (1977) suggested clinical caseness score of 16. Nearly half of the total sample (49.3%, n= 301) obtained a total CES-D score of 16 or higher. This differs from previous literature indicating that approximately 20% of any non-clinical sample would be expected to report scores of 16 or higher (Alderete et al., 1999).

Ghubash and colleagues (2000) recommended a caseness cut-off of 21 for Arab samples.

In the current study 33.6% (n= 205) of the total sample obtained scores of 21 or higher.

Table 4.4 lists descriptive data for the CES-D in the current study as well as in

Radloff’s (1977) initial normative samples. The mean score in the current study was significantly higher than Radloff’s probability sample (t= 16.74, p< .001), standardization sample (t= 18.99, p< .001), and probability samples re-test (t= 20.33, p< .001).

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Table 4.4 CES-D Descriptive Statistics for Current Study and Normative Study

Study and Population n Mean SD Alpha

Current study

Total Arab American sample 601 17.26 11.74 .91

Sojourner 53 21.66 10.48

Immigrant 112 14.39 11.89

1.5 generation 100 17.81 11.34

Second generation 221 16.81 11.22

Third and later generation 43 16.44 13.58

Radloff, 1977

Probability samples: White Americans in Missouri 2,514 _9.25 8.58 .85 and Maryland

Standardization sample: White Americans in 1,060 _8.17 8.23 .85 Maryland

Reinterview (retest) of the probability samples 1,422 _7.94 7.53 .84

Multiple studies have attempted to assess the psychometric properties of the CES-

D and to establish normative data for acculturating and ethnic minority populations.

Appendix L lists descriptive statistics for CES-D scores in several of these studies. The mean score in the current study was significantly higher (p< .05) than scores reported in all studies listed with African American, non-patient Asian, non-patient Latino, and college or older American Indian samples. However, it was significantly lower than

Manson and colleagues’ (1990) study of American Indian adolescents in boarding school

(t= -4.67, p< .001). The mean score in the current study was significantly higher than

Ghubash and colleagues’ study of Arab females in the United Arab Emirates (t= 3.68, p<

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.001). The present study results were non-significant when compared to Chung and colleagues’ (2003) study of Asian and Latino primary care patients.

Research Focus 3: Acculturative Strategy, Stress, and Mental Health

The third research focus explored the relationship between acculturation strategy on the one hand and acculturation stress and mental health (anxiety and depression) on the other. It was hypothesized that adoption of American identity, as well as identification with the integration and assimilation acculturation strategies, would be associated with less acculturation stress and better mental health. On the other hand, it was hypothesized that higher Arab ethnic identity and association with the separation or marginalization strategies would be associated with greater acculturation stress and worse mental health.

Table 4.5 Correlations between Cultural Identities and Mental Health Scale American identity Arab identity

Acculturation stress -.20**** .05

Anxiety -.09*___ -.05

Depression -.14**** -.07

Note. American identity= VIA-A American; Arab identity= VIA-A Arab; acculturation stress= SAFE-R; anxiety= BAI; depression= CES-D. Sample size for SAFE-R correlations was 609. Sample size for BAI and CES-D correlations was 599. Significance levels were based on one-tailed tests. * p < .05. **** p ≤ .001

As listed in Table 4.5, Pearson’s correlations were conducted to assess the hypotheses that greater American identity (as measured by the VIA-A American) would be associated with less stress (SAFE-R), anxiety (BAI), and depression (CES-D).

Consistent with expectations, American identity correlated negatively with stress (r= -

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.20, p< .001) and depression (r= -.14, p< .001). A weak negative correlation was found between American identity and anxiety (r= -.09, p= .02).

Pearson’s correlations were conducted to assess the hypotheses that greater Arab identity (as measured by the VIA-A Arab) would be associated with greater stress

(SAFE-R), anxiety (BAI), and depression (CES-D). Table 4.5 lists the correlations. Arab identity did not significantly correlate with any of the stress and mental health variables.

One-way ANOVAs with LSD post-hoc comparisons were conducted to assess the hypothesis that integration and assimilation would be associated with less acculturation stress, less anxiety, and less depression than separation and marginalization.

Acculturation strategy was measured by current self-identification on the AASS.

Descriptive data for the mental health variables per each acculturation strategy are listed in Table 4.6. The analysis for stress as measured by the SAFE-R was significant: F (3,

584)= 9.28, p< .001. Participants who were integrated scored significantly lower on acculturation stress compared to those who were separated (p< .001) or marginalized (p<

.001). Participants who were assimilated also scored significantly lower on acculturation stress compared to those who were separated (p= .02) or marginalized (p= .003). The analysis for anxiety as measured by the BAI was significant: F(3, 586)= 4.23, p= .006.

Participants who were integrated scored significantly lower on anxiety than those who were separated (p= .001). The analysis for depression as measured by the CES-D was significant: F(3, 586)= 4.66, p= .003. Respondents who were integrated scored significantly lower on depression compared to those who were separated (p= .001) or marginalized (p= .01).

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Table 4.6 Stress and Mental Health Scores Based on Acculturation Strategy Acculturation stress Anxiety Depression

Strategy n Mean SD Mean SD Mean SD

Assimilation 19 25.63 15.75 14.95 13.39 17.58 11.32

Integration 276 28.32 12.12 10.85 11.09 15.37 11.27

Separation 225 32.86 13.45 14.58 13.37 18.89 11.92

Marginalization 68 35.57 14.20 13.56 12.08 19.43 12.53

Note. Acculturation stress= SAFE-R; anxiety= BAI; depression= CES-D. Acculturation strategy was measured by self-identification on the AASS.

Research Focus 4: Relationships among Stress, Coping, and Mental Health

The fourth research focus in this study explored the relationships among acculturation stress, coping, and mental health. Pearson’s correlations were used to assess the relationships among these variables. Correlations are listed in Table 4.7.

Table 4.7 Correlations among Stress, Coping, and Mental Health (n= 609) Scale 1 2 3 4 5 6

1. Acculturation stress – .27**** -.36**** .06____ .41**** .47****

2. Family dysfunction – -.47**** -.19**** .29**** .38****

3. Social support – .18**** -.30**** -.48****

4. Religious coping – .04____ -.03____

5. Anxiety – .68****

6. Depression –

Note. Acculturation stress= SAFE-R, family dysfunction= FAD-GF; social support= PRQ85-R; religious coping= BARCS; anxiety= BAI; depression= CES-D. Significance levels are based on one-tailed tests. **** p < .001.

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First, it was hypothesized that greater acculturation stress would be associated with greater anxiety and depression. Significant correlations between acculturation stress (as measured by the SAFE-R) and both anxiety (BAI; r = .41) and depression (CES-D; r =

.47) supported this hypothesis. It was secondly hypothesized that coping supports such as family functioning, social support, and religious coping would each be associated with less stress, anxiety, and depression. Family dysfunction (FAD-GF) correlated positively with acculturation stress (r = .27), anxiety (r = .29) and depression (r = .38), supporting the hypothesis. Likewise, social support (PRQ85-R) correlated negatively with acculturation stress (r= -.36), anxiety (r= -.30) and depression (r= -.48), supporting the hypothesis. However, religious coping as measured by the BARCS did not correlate with acculturation stress, anxiety, or depression. All significant correlations were below the p=

.001 level.

Research Focus 5: Gender Differences in Stress and Mental Health

The fifth research focus in this study examined the relationship between gender and mental health. It was hypothesized that female respondents would report greater levels of acculturation stress and mental health problems (anxiety and depression) compared to male respondents. A series of two-tailed independent sample t-tests were conducted to determine if there were significant differences in acculturation stress (as measured by the SAFE-R), anxiety (BAI), and depression (CES-D) between males and females. None of the analyses were significant below a .05 level.

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Table 4.8 Stress and Mental Health Scores Based on Gender Acculturation Stress Anxiety Depression

Sex n Mean SD n Mean SD Mean SD

Total sample

Males 223 31.96 14.23 224 11.48 11.66 16.39 10.82

Females 365 30.10 12.64 366 13.49 12.63 17.80 12.31

Total 609 30.80 13.26 601 12.78 12.25 17.26 11.74

Sojourners subsample

Males 38 36.24 13.69 38 14.37 10.65 19.47 8.93

Females 15 39.73 14.02 15 24.73 15.09 27.20 12.31

Note. Acculturation stress= SAFE-R; anxiety= BAI; depression= CES-D.

Because findings were not significant for the total sample, additional independent sample t-tests were conducted to determine if there were significant differences in acculturation stress, anxiety, or depression between males and females within subgroups based on generational status. Among sojourners, females scored significantly higher on anxiety (t= -2.83, p= .007) and depression (t= -2.54, p< .05) compared to males, but did not differ in acculturation stress. Analyses were not significant for respondents in the immigrant, 1.5 generation, second generation, and third and later generation subsamples.

Table 4.8 lists means for sojourners and the total sample.

Research Focus 6: Christian-Muslim Differences in Acculturation and Mental Health

The sixth research focus in this study examined the differences between Christian and Muslim respondents on acculturation and mental health variables. It was hypothesized that compared to Muslims, Christians would demonstrate greater American

152 identity (as measured by the VIA-A American), less Arab identity (VIA-A Arab), less acculturative stress (SAFE-R), less anxiety (BAI), and less depression (CES-D). A series of independent samples t-tests were conducted to determine if there were significant differences in these variables based on religious affiliation. Means and standard deviations for each religious group are listed in Table 4.9. As expected, compared to

Muslims, Christians reported significantly higher American identity (t= 7.18, p < .001) and lower acculturation stress (t= -5.05, p < .001), anxiety (t= -2.59, p= .01), and depression (t= -3.28, p= .001). Levels of Arab ethnic identity were not significantly different between the Christian and Muslim subgroups.

Table 4.9 Acculturation and Mental Health Scores Based on Religious Affiliation Christians Muslims

Scale n Mean SD n Mean SD

American identity 131 3.88 0.59 422 3.43 0.63

Arab identity 131 4.16 0.63 422 4.15 0.67

Acculturation stress 131 25.90 13.71 422 32.42 12.64

Anxiety 132 10.39 10.22 423 13.55 12.78

Depression 132 14.33 10.50 423 18.11 11.85

Family dysfunction 131 1.86 0.54 422 1.97 0.54

Social support 131 105.02 12.25 422 100.95 14.01

Religious coping 132 18.54 12.87 423 22.10 11.61

Note. American identity= VIA-A American; Arab identity= VIA-A Arab; Acculturation stress= SAFE-R; anxiety= BAI; depression= CES-D; family dysfunction= FAD-GF; social support= PRQ85-R; religious coping= BARCS.

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Due to the significant differences found in acculturation, stress, and mental health between Christians and Muslims, differences in coping supports were also explored.

Independent samples t-tests were conducted to determine if there were significant differences based on religious affiliation in family dysfunction (as measured by the FAD-

GF), social support (PRQ85-R), or religious coping (BARCS). Compared to Muslims,

Christians reported less family dysfunction (t= -2.01, p= .05), greater social support (t=

2.99, p= .003), and less religious coping (t= -3.00, p= .003).

Research Focus 7. Structural Model of Acculturation, Coping, and Mental Health

Specification and Identification of the Hypothesized Model. The hypothesized structural regression model for Arab American acculturation, coping, and mental health is presented in Figure 4.1. Acculturation variables and socio-economic status were expected to predict acculturative stress, which in turn would predict anxiety and depression. To capture the acculturation process, Arab ethnic identity (as measured by the VIA-A Arab) and American identity (VIA-A American) were included as observed variables. A third variable termed “Acculturation” was a latent variable that represented the extent to which participants were exposed to and engaged with American society. Indicators for

Acculturation were later generation status, longer stay in the U.S., longer time since last visit to the Arab world, greater English (versus Arabic) language use at home, and less

Arabic TV viewing. Acculturation was believed to covary with American identity in that exposure to American culture during the acculturation process would be associated with greater adoption of American identity. Both Acculturation and American identity were hypothesized to predict less acculturative stress (SAFE-R), while Arab identity was expected to predict greater acculturative stress.

154 social support social d3 1 depression family funct family 1 d2 anxiety religious cope religious 1 d4 d1 1 accult stress accult e7 1 Arabic TV 1 e6 language 1 e2 1 education 1 e5 SES Arab Arab visit Arab ID Arab Acculturation 1 American ID American 1 e1 1 income e4 stay in US 1 e3 1 generation

Figure 4.1. Hypothesized Model of Arab American Acculturation, Coping, and Mental Health. Arab ID= VIA-A Arab; American ID= VIA-A American; acculturation stress= SAFE-R; religious coping= BARCS; family functioning= FAD-GF; social support= PRQ85-R; anxiety= BAI; depression= CES-D.

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Socio-economic status (SES) was a latent factor that loaded onto annual family income and highest educational level attained. SES was believed to covary with

Acculturation and American identity in that persons with higher income and education were likely to be more successfully engaged in American society and to have adopted greater American identity. Lower SES was hypothesized to predict greater acculturative stress. Acculturative stress was hypothesized to serve as a mediating variable between acculturation and SES factors on the one hand, and mental health outcomes on the other.

Mental health outcomes were anxiety (as measured by the BAI) and depression

(CES-D). Because factors unexplained in the model could have simultaneously contributed to both anxiety and depression, the disturbances for these two variables were covaried. Religious coping (BARCS), family functioning (FAD-GF), and social support

(PRQ85-R) were conceptualized as coping resources that would predict less anxiety and depression, both directly as well as indirectly by buffering stress. Because religion is intertwined with the Arab culture, Arab identity was expected to predict religious coping.

Family and social supports were expected to covary since persons with strong family relationships would be expected to perceive greater social support in their environment.

In the hypothesized model, exogenous variables were Acculturation, American identity, Arab identity, SES, family functioning, social support, and all errors and disturbances. Endogenous variables were the indicators for Acculturation (generation status, length of stay in the U.S., recentness of visits to the Arab world, English language use, Arabic TV viewing), indicators for SES (income, education), acculturative stress, religious coping, anxiety, and depression. The model was identified. There were 135 observations, 60 free parameters, and thus 75 degrees of freedom. A coefficient of 1.0

156 was assigned to the direct effects of the disturbances on their corresponding endogenous variables, the errors on their corresponding indicators, and the latent variables each on one of their indicators (in the case of SES, on both indicators).

Data Preparation and Screening. For the hypothesized model, Arab and American identities were measured by the mean score on the VIA-A Arab and American subscales, respectively. For ease of interpretation, the indicators for the latent variable Acculturation were all ordered so that higher scores indicated greater exposure to American society; therefore the original scores for recentness of visits to the Arab world, language, and

Arabic TV viewing were reflected. The five levels of generation status were, in order: sojourner, immigrant, 1.5 generation, second generation, and third and later generation.

Length of stay corresponded to the number of years the participant had lived in the U.S.

Most recent visit to the Arab world ranged from 1= “Within past 12 months” to 7=

“Never.” Language spoken at home was assessed on a 5-point scale ranging from 1=

“Only Arabic” to 5= “Only English,” with the midpoint corresponding to equal use of both Arabic and English. Frequency of watching Arabic TV scores ranged from 1=

“Always (almost every day, or every day)” to 5= “Never.” The latent variable socio SES loaded on annual family income before taxes (8-point scale ranging from less than

$15,000 to over $150,000) and highest educational attainment (7-point scale ranging from below high school to doctoral-level degree). Acculturation stress, religious coping, social support, anxiety, and depression were measured by total scores on the SAFE-R,

BARCS, PRQ85-R, BAI, and CES-D, respectively. Family functioning was assessed by the mean score on the FAD-GF, and for ease of interpretation the scores were reflected so that higher scores indicated better family functioning.

157

For the current study, listwise deletion was used for 23 cases in which a significant amount (i.e., 30% or more) of observed variables were missing. These included 11 cases with missing demographic variables (i.e., all the acculturation and SES indicators), 10 cases with missing demographic variables, BARCS, BAI, and CES-D scores, and two cases with missing VIA-A Arab, VIA-A American, SAFE-R, FAD-GF, and PRQ85-R scores. A total of 588 cases remained, which is a large sample size.

Generational status posed a challenge to missing data because 60 participants reported mixed or unique immigration patterns that did not conform to the traditional generational levels. From these, 55 were assigned to the category that most closely resembled their situation. For example, persons who were unsure whether they were planning to return to the Arab world and those who were planning to return to the Arab world were coded as sojourners regardless of where they were born or raised. Those who were raised in the Arab world and moved to the U.S., Canada, or U.K. as children were coded as 1.5 generation, regardless of their place of birth or family immigration history.

Those who were raised in the Arab world and moved to the U.S., Canada, or U.K. as adults were considered immigrants, regardless of their place of birth or family immigration history. Persons who were born and raised in a non-Arab country (e.g., U.K.,

France, Brazil) were coded as second-generation; or third-generation if it was their grandparents who had first immigrated to the non-Arab country. Descriptive statistics of the variables after addressing missing values are listed in Table 4.10; as indicated, the number of missing values for each variable ranged from zero to 67 (for income).

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Table 4.10 Original Descriptive Characteristics of Observed Variables Variable n Mean SD Skewness Kurtosis

Arab identity 588 4.13 0.66 -1.38 2.97

American identity 588 3.54 0.65 -0.57 0.54

Generation 581 3.13 1.16 -0.39 -0.92

Stay in US 586 20.04 11.16 0.82 2.47

Arab visits 588 3.05 1.62 0.84 0.23

English language 573 3.02 1.06 -0.06 -0.39

Arabic TV 587 3.12 1.33 -0.20 -1.15

Income 521 4.90 2.20 -0.34 -1.00

Education 586 4.64 1.52 -0.12 -1.12

Acculturation stress 588 30.81 13.28 0.55 -0.08

Religious coping 588 20.27 12.46 0.16 -0.93

Family functioning 588 3.05 0.54 -0.37 -0.08

Social support 588 101.62 13.89 -0.49 -0.25

Anxiety 588 12.73 12.31 1.33 1.27

Depression 588 17.27 11.80 0.72 -0.14

Note. These statistics are provided after addressing missing data problems. Arab ID= VIA-A Arab; American ID= VIA-A American; acculturation stress= SAFE-R; religious coping= BARCS; family functioning= FAD-GF; social support= PRQ85-R; anxiety= BAI; depression= CES-D. High scores on Arab visits indicate less frequent visitations. High scores on Arabic TV indicate less frequent TV viewing.

The next step in the data preparation phase was addressing outliers. For length of stay in the U.S., one score of 81 and one score of 70 were considered outliers, falling considerably higher than the next highest score of 58. They were changed to scores of 60 and 59, respectively; in other words, two and one units above the next most extreme

159 score of 58. For the PRQ85-R, two scores of 53 were considered outliers, falling considerably lower than the next lowest score of 60. They were changed to a score of 59, which was one value lower than the next lowest score. For the BAI, one score of 62 was considered an outlier, falling considerably higher than the next highest score of 56. This outlier was changed to a score of 57, which was one point higher than the next highest score. For education, only two persons endorsed educational attainment below the high school level. These two cases were added to the high school category, and education was re-coded 1= high school to 6= doctoral degree.

Variables were next assessed for skewness and kurtosis. The Shapiro-Wilk test of nonnormality was conducted for all variables in the current sample. Each analysis was significant below the p= .001 level, indicating that all variable distributions differed significantly from the hypothesized normal distribution. The Shapiro-Wilk test has been found to be a more powerful test of nonnormality than other commonly used goodness- of-fit tests (Hopkins & Weeks, 1990). However, the significant results in this sample are not surprising because with larger sample sizes even minor departures from the normal distribution can yield significant results that are in effect trivial with respect to the impact on analyses with the variables (Kline, 2005; Tabachnick & Fidell, 2001). Although the absolute values for skewness and kurtosis (as listed in Table 4.10) were not severe, efforts were made to explore and address nonnormality for the variables that demonstrated skewness and/ or kurtosis greater than 1.0. These were: Arab identity (VIA-

A Arab), length of stay in the U.S., Arabic TV viewing, income, education, and BAI.

As demonstrated in Figure 4.2, scores on the VIA-A Arab were substantially negatively skewed, with a peaked curve. The recommended transformation for such a

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50 50

25 25 0 Frequency 0 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 0.00 .06 .13 .19 .25 .31 .38 .44 .50 .56 .63 .69

Original VIA-A Arab Mean Score VIA-A Arab Score After Transformation

Figure 4.2. Histograms for VIA-A Arab Scores Before and After Transformation

distribution is to reflect and use the logarithm [log10(K-X) where K equals the largest

score plus 1] (Tabachnick & Fidell, 2001). Because conducting this transformation

included reflection of the distribution, higher scores now represented less Arab identity.

The transformed distribution is displayed in Figure 4.2. For ease of interpretation, these

scores were reflected again so that higher scores indicated greater Arab identity.

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50 50

25 25

0 0 Frequency 0 5 10 15 20 25 30 35 40 45 50 55 60 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5

Length of Stay in US (Outliars Corrected) Stay in US After Transformation

Figure 4.3. Histograms for Length of Stay in U.S. Before and After Transformation

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As demonstrated in Figure 4.3, the distribution for length of stay in the U.S. (after

correction for outliers) was moderately positively skewed, with a kurtosis of 1.13. The

recommended transformation to produce normality was to take the square root of the

scores (Tabachnick & Fidell, 2001). The resultant distribution is displayed in Figure 4.3.

Frequency of Arabic T.V. viewing had a kurtosis score of -1.15 while skewness

was not severe. Problems with kurtosis are more difficult to resolve than problems with

skewness (Schumacker & Lomax, 2004). Based on the histogram (see Figure 4.4),

skewness did not appear significantly biased in order to warrant any transformations.

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175

150

125

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0 Frequency 1 2 3 4 5

Arabic TV Viewing (1= always, 5= never)

Figure 4.4. Histogram for Frequency of Arabic TV Viewing

Annual family income in dollars had a kurtosis score of -1.00. As demonstrated in

Figure 4.5, this was due to the nearly even distribution of cases in each income level,

yielding a flat-like curve. This type of kurtosis is difficult to resolve, and may require

additional sampling to render a more normal-shaped distribution (Schumacker & Lomax,

2004). Because the kurtosis was not severe and skewness was acceptable, no

transformation was made.

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40 20

Frequency 0 1 2 3 4 5 6 7 8

Income (1= less than 15,000; 8= over 150,000)

Figure 4.5. Histogram for Annual Family Income in Dollars

Kurtosis for education (after the “below high school” category was collapsed with

“high school”) was -1.17. As demonstrated in Figure 4.6, this may have been affected by

the low numbers of cases in the third category for associates degrees. Because persons

with associates degrees typically have had 1-3 years of schooling post high school, this

category was logically collapsed with the second category, which represented college

classes but no degree. Students who had taken college classes but had not obtained their

bachelors were likely to also have completed 1-3 years of schooling post high school.

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Frequency 0 0 1 2 3 4 5 6 1 2 3 4 5

Education (1= high school or less; 6= doctoral) Education (1= high school or less; 5= doctoral)

Figure 4.6. Histograms for Education Before and After Collapsed Categories

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The scale for educational level was re-coded with a range of 1 (high school or less) to 5

(doctoral degree or equivalent). The resultant distribution is displayed in Figure 4.6.

As demonstrated in Figure 4.7, the BAI score distribution was moderately

positively skewed, with a kurtosis of 1.16. The recommended transformation to produce

normality was to take the square root of the scores (Tabachnick & Fidell, 2001). The

resultant distribution is displayed in Figure 4.7.

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175 175

150 150 125 125 100 100 75 75 50 50 25 25 0

0 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 Frequency 0 5 10 15 20 25 30 35 40 45 50 55 .5 1.5 2.5 3.5 4.5 5.5 6.5 7.5

BAI Total Score (after correction for outliars) BAI Scores After Transformation

Figure 4.7. Histograms for BAI Scores Before and After Transformation

All observed variables were explored further to assess for other potential

problems in the data. Multivariate normality was not evaluated in full. However, because

outliers and univariate nonnormality were carefully assessed and addressed, it is likely

that multivariate nonnormality was also improved in that process (Kline, 2005;

Tabachnick & Fidell, 2001). A correlation matrix of the variables included in the current

model was examined to identify pairwise multicollinearity; none of the correlations were

high enough to suggest a problem.

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Table 4.11

Final Descriptive Characteristics of Observed Variables Variable N Mean SD Skewness Kurtosis

Arab identity 588 0.45 0.14 -0.35 -0.15

American identity 588 3.54 0.65 0.57 0.54

Generation 581 3.13 1.16 -0.39 -0.92

Stay in US 586 4.27 1.34 -0.45 0.15

Arab visits 588 3.05 1.62 0.84 0.23

English language 573 3.02 1.06 0.06 0.39

Arabic TV 587 3.12 1.33 -0.20 -1.15

Income 521 4.90 2.20 -0.34 -1.00

Education 586 2.98 1.13 0.28 -0.80

Acculturation stress 588 1.10 0.47 0.55 -0.08

Religious coping 588 1.35 0.83 0.16 -0.93

Family functioning 588 3.05 0.54 -0.37 -0.08

Social support 588 4.06 0.56 -0.49 -0.25

Anxiety 588 3.11 1.74 0.30 -0.48

Depression 588 0.86 0.59 0.72 -0.14

Note. Arab ID= VIA-A Arab; American ID= VIA-A American; acculturation stress= SAFE-R; religious coping= BARCS; family functioning= FAD-GF; social support= PRQ85-R; anxiety= BAI; depression= CES-D. High scores on Arab visits indicate less frequent visitations. High scores on Arabic TV indicate less frequent TV viewing.

With respect to variable scaling, covariances for the variables in the current model were examined in a covariance matrix and found to range from -67.63 to 193.05, indicating a potential challenge for the SEM analysis. Variables with extremely large variances were acculturative stress (SAFE-R), religious coping (BARCS), social support

165

(PRQ85-R), and depression (CES-D). Thus, rather than use the total scores for these variables, their mean scores were used (i.e., total score divided by the number of questionnaire items). The final covariance matrix (see Appendix M) yielded scores ranging from -.68 to 4.82, which is within acceptable limits. The descriptive statistics of the final variables used in the model are listed in Table 4.11. The correlation matrix can be found in Appendix N.

Evaluation of Model Fit. For the theoretical model, χ2= 636.13, df= 75, p < .001, indicating poor model fit. However, this is not surprising considering that the model was over-identified (more observations than parameters) and the sample size was large. The normed chi square was 636.13 / 75 = 8.48, indicating poor model fit. RMSEA was .11

(lower bound= .105, upper bound= .121), indicating poor model fit. Comparative fit indexes, on the other hand, yielded acceptable to good fit: CFI= .97, NFI= .97, TLI= .96.

Model Respecification. Because the hypothesized model produced less than adequate fit statistics on chi square and RMSEA scores, a series of modifications were made. Modifications may include deleting parameters or adding parameters. Any changes must be theoretically meaningful or based on previous empirical literature (Hox &

Bechger, 1998; Schumacker & Lomax, 2004).

Because previous research on Arab American mental health is minimal and no previous models have been introduced, data from the present study (Research Focuses 1-

6; variable correlation matrix) were also used to guide modifications to the model. To identity any misspecifications, parameter estimates (including path coefficients, factor loadings, covariances, and variances of the disturbances) were examined. The standardized parameter estimates for the hypothesized model are presented in Figure 4.8.

166

Several modifications to the model were made. First, religious coping was removed from the model because the total effects of religious coping on anxiety and depression were both very small: .09 and .06, respectively. This indicated that based on current data, religious coping did not serve as an important coping mechanism in reducing stress, depression, or anxiety. Next, the latent variable SES was removed and replaced with observed variables for education and income. This modification was made because latent variables with only two indicators may produce less accurate estimates (Kline, 2005), and it was possible that education and income could relate differently to the other variables.

Parameters that were not significant and had extremely low coefficients or correlations were deleted; this included the correlation between acculturation and Arab identity. This association may have been low because persons may retain varying levels of Arab identity throughout the acculturation process, with some persons maintaining their culture of origin and others abandoning it. Additional parameters were added. For example, an association between Arab and American identities was added; persons who scored high on both constructs would be considered integrated. With each modification to the parameters, model fit was estimated to determine if the modification improved the model.

Several modifications were found to worsen the model fit, and were therefore not retained. These included: converting the observed variables family functioning and social support to indicators for a latent factor of “interpersonal support,” converting the observed variables anxiety and depression to indicators for a latent factor of “mental health,” adding direct effects from acculturation and American identity to anxiety and depression, and conceptualizing anxiety as a predictor for depression.

167 -.29 social support social d3 -.16 .47 depression -.13 .60 .03 family funct family -.15 -.28 .31 d2 anxiety -.17 .13 .05 .32 religious cope religious .10 d4 d1 .14 accult stress accult e7 .15 Arabic TV .03 .13 .26 -.05 -.19 e6 .65 language e2 education .56 e5 SES Arab Arab visit .32 Arab ID Arab Acculturation .29 American ID American e1 income e4 .77 .40 stay in US .04 .77 -.11 e3 -.11 generation

Figure 4.8. Standardized Parameter Estimates for Hypothesized Model. Arab ID= VIA-A Arab; American ID= VIA-A American; acculturation stress= SAFE-R; religious coping= BARCS; family functioning= FAD-GF; social support= PRQ85-R; anxiety= BAI; depression= CES-D.

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Final Model. The final model for Arab American acculturation and mental health is presented in Figure 4.9. There were 119 observations and 60 free parameters, with 59 degrees of freedom. Acculturation- conceptualized as greater engagement in American society- was associated with income (positively), education (negatively), and American identity (positively). Acculturation also predicted greater social support and less acculturative stress. Similarly, American identity predicted greater social support.

Because family and social relationships are important values in Arab culture, Arab identity was a predictor for family functioning and social support. Consistent with this study’s hypotheses, Arab identity also served as a predictor for acculturative stress.

Higher family income was a predictor for better family functioning and social support, while education had direct effects on anxiety and depression. Acculturative stress was a mediating factor between acculturative factors (acculturation and Arab identity) and mental health outcomes, and it also mediated an indirect effect from the support variables to mental health. The disturbances for family functioning and social support were correlated, and both support factors had direct effects on anxiety and depression.

Fit statistics for the modified model were: χ2 = 338.99, df= 59, p< .001; NC=

5.75; RMSEA= .090 (90% confidence range= .081-.099); CFI= .99; NFI= .98; TLI= .98.

Thus, goodness-of-fit statistics suggested mediocre to poor fit while comparative fit indexes indicated good fit. As listed in Tables 4.12 and 4.13, all parameter estimates were significant. Factor loadings onto the acculturation indicators demonstrated moderate to large effects, while other path coefficients were small to moderate.

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.59 d4 d5

anxiety

depression

.47

-.15 .32

-.12 .34 -.29 -.13 d2

d3 d1

-.16 -.13 -.26 -.12

funct family social support social accult stress accult

e5 .21 Arabic TV .17 .13 .10 .25 .19 .12

.14 -.24 e4 .63 language

e3 Arab Arab visit .31 income Arab ID Arab education acculturation ID American e2 .76 .39 .16 stay in US

.78 .15 -.14 e1 .17 generation

.25 -.15

Figure 4.9. Final Model with Standardized Parameter Estimates. Arab ID= VIA-A Arab; American ID= VIA-A American; acculturation stress= SAFE-R; religious coping= BARCS; family functioning= FAD-GF; social support= PRQ85-R; anxiety= BAI; depression= CES-D.

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Table 4.12 Summary of Parameter Estimates for Covariances in Final Model Parameter Covariance S.E. Correlation

Acculturation  American identity .299**** .029 .388

Acculturation  income .486**** .100 .246

Acculturation  education -.139***_ .048 -.137

American identity  Arab identity .016**** .004 .170

American identity  income .216**** .061 .150

Arab identity  education -.023**** .006 -.147 income  education .404**** .107 .164 disturbance1  disturbance3 .128**** .013 .470 disturbance4  disturbance5 .426**** .035 .593

Note. American identity= VIA-A American; Arab identity= VIA-A Arab.

Table 4.13 Summary of Parameter Estimates for Coefficients in Final Model Unstandardized Standardized Regression Weights

Direct Indirect Total Parameter Direct Effect S.E. Effect Effect Effect

Acculturation  generation 1.000____ .777 .777

Acculturation  stay in U.S. 1.129**** 0.074 .758 .758

Acculturation  Arab visit 0.559**** 0.083 .311 .311

Acculturation  language 0.746**** 0.062 .633 .633

Acculturation  Arabic TV 0.368**** 0.071 .249 .249

Acculturation  stress -0.126**** 0.023 -.238 -.048 -.286

Acculturation  social support 0.115**** 0.027 .185 .185

Acculturation  anxiety -.118 -.118

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Unstandardized Standardized Regression Weights

Direct Indirect Total Parameter Direct Effect S.E. Effect Effect Effect

Acculturation  depression -.146 -.146

American identity  stress -.030 -.030

American identity  social sup. 0.100***_ 0.032 .117 .117

American identity  anxiety -.024 -.024

American iden.  depression -.044 -.044

Arab identity  stress 0.435**** 0.126 .130 -.070 .060

Arab identity  family funct. 0.373*___ 0.155 .098 .098

Arab identity  social support 0.808**** 0.151 .206 .206

Arab identity  anxiety -.017 -.017

Arab identity  depression -.055 -.055 income  stress -.066 -.066 income  family funct. 0.035**** 0.011 .140 .140 income  social support 0.042**** 0.011 .166 .166 income  anxiety -.060 -.060 income  depression -.091 -.091 education  anxiety -0.184**** 0.057 -.119 -.119 education  depression -0.070**** 0.017 -.133 -.133 stress  anxiety 1.227**** 0.144 .336 .336 stress  depression 0.400**** 0.044 .322 .322 family funct.  stress -0.145**** 0.037 -.165 -.165 family funct.  anxiety -0.424**** 0.133 -.132 -.055 -.187 family funct.  depression -0.165**** 0.041 -.152 -.053 -.205 social support  stress -0.222**** 0.039 -.260 -.260

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Unstandardized Standardized Regression Weights

Direct Indirect Total Parameter Direct Effect S.E. Effect Effect Effect social support  anxiety -0.370**__ 0.134 -.119 -.087 -.206 social support  depression -0.307**** 0.041 -.291 -.084 -.375

Note. generation= generation status (higher scores indicate later generation); stay in U.S.= length of residence in the U.S.; Arab visit= recentness of visits to the Arab world (higher scores indicate less recent visitations); language= language use at home (higher scores indicate more English and less Arabic); Arabic TV= frequency of Arabic TV viewing (higher scores indicate less viewing); stress= acculturation stress (SAFE-R); social support= PRQ85-R; anxiety= BAI; depression= CES-D; American identity= VIA-A American; Arab identity= VIA-A Arab; family funct.= family functioning (FAD-GF)

Chapter 5

Discussion

Research Focus 1: Socio-Demographic Factors Relating to Acculturation

The first research focus in this study explored the relationship between socio- demographic factors and acculturation. It was hypothesized that higher income, higher education, later generation status, earlier age of immigration to the U.S., voluntariness of immigration, longer length of residence in the U.S., acquisition of an American passport, less frequent and less recent visits to the Arab world, greater use of English compared to

Arabic language, and less frequent viewing of Arabic TV channels would each be associated with greater American identity. In other words, it was assumed that the more exposure a person had to American society through the acculturation process, the greater chance there would be to adopt American values and cultural practices. On the other hand, these socio-demographic factors were hypothesized to relate to less Arab identity because they are associated with a reduced emphasis and engagement with the Arab world.

Results generally supported the hypothesized relationships with respect to

American identity. Persons of later generations (i.e., second, third, or later) reported significantly greater adoption of American cultural practices compared to sojourners and immigrants. For those born in the Arab world, earlier age of immigration to the U.S. and greater number of years of residence in the U.S. was each associated with greater

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American identity. This is consistent with acculturation theories that argue that the more time a person spends in a new culture, the greater chance there will be to adopt the values and behaviors common to that culture (e.g., Szapocznik & al., 1978). It is also consistent with previous research with Arab Americans (Ajrouch, 2000; Faragallah et al., 1997;

Meleis et al., 1992) documenting the association between length of time in the U.S. (i.e., later generation status, earlier age of immigration, greater years of residence) and adoption of American identity. Additionally, participants with American citizenship reported significantly greater American identity than those with temporary visas, and participants with Arab passports demonstrated less American identity. Citizenship can therefore be seen as a more permanent commitment to a culture. It is also possible that citizenship is not directly associated with ethnic identity, but that both are instead influenced by generation status and length of stay in the culture.

Just as the length of time participants were exposed to the American society correlated with levels of American identity, less exposure to Arab culture was also associated with greater American identity. It was found that participants who visit the

Arab world less frequently reported greater American identity. This is consistent with previous literature (Faragallah et al., 1997). It is probable that persons who receive less exposure to the Arab world will have less affinity and commitment to the Arab culture, and will instead have greater affinity to the American culture to which they are more exposed. On the other hand, persons with high levels of American identity may be less likely to be interested in visiting the Arab world. Watching Arabic TV channels may be considered a vicarious form of “visitation” to the Arab world, and as hypothesized, persons who watched less Arabic TV reported greater American identity. Similar to

175 actual visitations, the relationship between American identity and Arabic TV viewing may be reciprocal. Persons who watch Arabic TV may maintain a stronger bond with the

Arab world and may be unwilling or unlikely to adopt American culture, particularly if they are bombarded with messages of anger and injustice towards U.S. foreign policy propagated by Arabic news stations. Conversely, persons who have strong American identities would be less likely to watch Arabic TV. This type of bidirectional relationship can also explain the finding that greater use of English versus Arabic language was associated with greater American identity. Preference for the dominant culture’s language has been conceptualized as an index for acculturation level and adoption of the new culture by previous authors (e.g., Baez, 2002; Campbell & Kaplan, 1997; Dion, Dion, &

Pak, 1990; Romero, Robinson, Haydel, Mendoza, & Killen, 2004; Wallen, Feldman, &

Anliker, 2002). As highlighted by Schumann’s (1986) Acculturation Theory, second language use may act as a reliable and valid indicator of acculturation because it is typically associated with other acculturation factors such as generation status and acculturation strategy (Marin, Sabogal, Mann, Otero-Sabogal, & Perez-Stable, 1987;

Portes & Hao, 2002; Wallen et al., 2002).

Results in this study did not support many of the hypotheses regarding socio- demographic variables expected to relate to Arab identity. Generation status, age of immigration, length of stay in the U.S., frequency of visits to the Arab world, and

American or Arab citizenship status did not correlate with levels of Arab ethnic identity.

This may be explained by the high levels of Arab identity shared by participants in this sample. Because this study was advertised as a survey on Arab Americans, many participants were likely attracted to the study if they identified with the Arab culture.

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Because there was not enough variability in the Arab ethnic identity scores, this may explain the non-significant results. However, two variables were found to strongly relate to Arab identity: greater use of Arabic language and more frequent Arabic TV viewing.

These behaviors are markers of the Arab cultural environment found in the participants’ homes. Persons with greater Arab identity would be expected to be more interested in continuing to speak in the Arabic tongue and in watching news, movies, and talk shows hosted in the Arab world. Second- and later generation individuals may learn or use the language of their ethnic heritage as a way to reclaim or search for their ethnic identity

(Lee, 2002; Zavala, 2000). On the other hand, constant exposure to the Arabic language and Arabic channels could also aid participants in maintaining their Arab identity.

Because Arabic language and TV at home may allow a person to establish a “virtual Arab world” on U.S. soil (Ahmed, 2003), this may also help explain why length of stay in the

U.S. was not significantly related to Arab identity. For example, it could be imagined that a second-generation Lebanese woman who was born and raised in Dearborn, where she speaks Arabic at home, watches Arabic TV, and has Arab friends, would be likely to demonstrate high Arab identity despite never having visited the Arab world.

While recentness of visits to the Arab world was expected to relate to less

American identity and greater Arab identity, the correlations were weak. This may have been impacted by U.S. immigration and visitation policies after the World Trade Center attacks. For example, after September 11, many sojourners and immigrants with green cards were afraid to travel to the Arab world due to concerns that they would not be able to return to the U.S. (Arab American Institute, n.d., 2002; Smith, 2003). Families that were accustomed to visiting the Arab world on a regular basis may have been hesitant to

177 travel due to fears of airline discrimination and harassment. Moreover, it is possible that financial constraints associated with the economic crisis post September 11 may have prevented persons who regularly visit the Arab world from scheduling a trip.

With respect to socio-economic status (SES), it was hypothesized that higher education and income would each be related to greater American identity and less Arab identity. Previous research has found a positive correlation between acculturation and

SES (Castro, 2003; Shen & Takeuchi, 2001). Persons with higher education and income would likely be more engaged in American society; for example, by gaining knowledge of American culture, adopting American values and beliefs, and establishing relationships with non-Arab peers in the academic and occupational settings. Research has also found

SES to be associated with positive psychological adaptation through its provision of coping skills used to negotiate ethnic identity development and acculturative stressors

(e.g., Scott, 2004). Additionally, persons who immigrate to the U.S. with higher levels of education and income may be more equipped to interact with and adopt American culture. For example, they may already know the English language or have marketable employment skills. They may be escaping the limited educational and occupational opportunities in their home country, sometimes due to political restrictions, and therefore may be more open to adopting America as their new home. This is contrasted with Arab immigrants who are less educated or poor who tend to isolate themselves in ethnic enclaves, working in jobs where they are less exposed to American culture (see discussion of “Acculturation Strategies within a Historical Context” in the Introduction).

Despite these arguments, this study demonstrated an unanticipated paradox: higher income was associated with American identity but did relate to Arab identity, and lower

178 education was associated with greater Arab identity but did not relate to American identity. This is not consistent with behavioral health research that has continued to use

Kuppuswamy and Srinivas’ (1960) conceptualization of education, income, and occupation as interrelated indicators for SES. This suggests that education and income may serve different functions or have different impacts on the acculturation process.

Another variable that was found to relate to acculturation was self-identification as an Arab or American. Participants who identified themselves as assimilated obtained high American identity scores and low Arab identity scores. Those who selected the integration strategy scored high on both American and Arab identities. Those who selected the separation strategy scored low on American identity and high on Arab identity. Finally, those who identified with the marginalized category scored significantly lower on both American and Arab identities compared to the other participants. These results indicate that Arab Americans are generally aware of their acculturation status and are accurate in their assessment of the extent to which they have adopted either or both of the cultures. The results provide evidence for the utility and effectiveness of the four- point Arab Acculturative Strategy Scale as an acculturative strategy measurement tool.

Research Focus 2: Mental Health Status Compared to Norms and Other Groups

Consistent with expectations, Arab Americans in this study demonstrated significantly higher levels of anxiety and depression compared to normative samples. In fact, according to normative guidelines, nearly a quarter of this sample (24.5%) reported moderate or severe anxiety and nearly one half (49.3%) reported depression scores above the clinical cut-off. This is consistent with previous literature documenting that acculturating and minority groups are at-risk for mental health problems due to

179 acculturation stressors (Hovey & King, 1997; Lee et al., 2004; Organista et al., 2003;

Thoman, & Surís, 2004). Arab Americans may report greater anxiety and depression compared to normative samples due to the unique stressors they face such as discrimination and feeling ostracized by the mainstream culture. On the other hand, it may be possible that the high rates of anxiety and depression in this sample are partly due to other factors; for example, measurement artifacts such as Arab-specific test-taking behaviors. For example, Arabs tend to be emotionally expressive (Nobles & Sciarra,

2000) and tend to choose the extreme-most choices in rating scales (Amer, 2002; Bilal et al., 1987), and these behaviors may contribute to inflated scores mental health measures.

The significantly higher anxiety and depression scores for participants in the present study compared to those from studies with other ethnic groups were not expected.

The large magnitude of differences compared to multiple studies conducted in different locations with different ethnic groups lends evidence to the uniquely high amount of psychological distress that Arab Americans may be facing. However, without further research such as direct comparative studies between Arab Americans and other groups, at the present time it may not be accurate to assume that Arab Americans suffer quantitatively more psychological distress than the other groups. This is due to the numerous differences between the present study and the previous ethnic minority studies in terms of timing (e.g., cohort differences or time-limited environmental factors), sample selection strategies, questionnaire administration procedures, evaluation of measurement validity and reliability, and ethnic-specific test-taking behaviors.

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Research Focus 3: Acculturative Strategy, Stress, and Mental Health

The third research focus examined the impact of acculturation strategy on stress and mental health (anxiety and depression). Previous literature has indicated that persons who are integrated in both traditional and mainstream cultures experience the least stress and best psychological adjustment compared to those who are separated, assimilated, or marginalized. Additionally, assimilation into the new culture has also been associated with better mental health than marginalization (Berry, 2003; Castro, 2003; LaFromboise et al., 1993; Phinney et al., 2001). The expected pattern of acculturation strategy with stress and mental health was supported in this study. Persons who identified themselves as integrated or assimilated reported less acculturation stress compared to those who were self-identified as separated or marginalized. Integrated and assimilated persons share many of the values, traditions, and behaviors associated with American culture and may not face acculturation stressors such as feelings of alienation, discrimination, or language barriers. Hypotheses regarding anxiety and depression were also substantiated: participants who were integrated demonstrated the best mental health profiles, particularly compared to those who were separated. These results suggest that Arab

Americans who are culturally isolated from American society may experience greater anxiety and depression, perhaps due to greater acculturative stress. They may have less knowledge and understanding of the protocol and policies of American systems (e.g., educational, occupational, social, etc.). They may also experience an on-going feeling of being displaced or not “at home,” even if the alternative of returning to the Arab world is not a viable choice. Many may resent or disagree with American cultural practices, and may therefore fear that their children or other family members might begin adopting

181 these behaviors. Moreover, separation may have been forced due to mainstream

American society’s anti-Arab backlash and general unwillingness to welcome Arabs to the folds of the culture. All of these factors can lead to chronic worries and sadness.

In addition to acculturation strategy, it was also hypothesized that Arab ethnic identity would be associated with greater psychological distress because persons with strong ties to the Arab world would be more easily identifiable as an “Arab,” rendering them likely targets for post September 11 discrimination and hate crimes. On the other hand, American identity was expected to be associated with less stress, anxiety, and depression. Results supported the hypothesis regarding American identity. However,

Arab identity was not associated with stress or psychological distress. As noted earlier, this may be due to the high levels of Arab identity and low variability in scores in this study. On the other hand, it may be possible that the results are accurate and Arab identity does not relate to mental health problems. As noted above, persons who select the integration strategy have preserved their Arab heritage in addition to adopting American culture, and these were the participants who demonstrated the best mental health profiles.

Research Focus 4: Relationships among Stress, Coping, and Mental Health

The fourth focus of this study explored the relationships among acculturation stress, coping variables, and mental health outcomes. It was hypothesized that greater acculturation stress would relate to greater mental health distress, whereas coping factors would be related to less stress, anxiety, and depression. In support of these hypotheses, acculturative stress demonstrated strong correlations with anxiety and depression. In other words, respondents who faced acculturation stressors such as discrimination, alienation from mainstream society, and difficulty speaking English were likely to

182 experience greater psychological distress. This is consistent with previous literature documenting the relationship between acculturation stress and mental health problems

(Hovey & King, 1997; Lee et al., 2004; Organista et al., 2003; Thoman, & Surís, 2004).

Also supporting the hypotheses, family functioning and perceived social support were associated with less stress. Sharing cohesive and supportive family ties and feeling supported and connected to a social group can protect against acculturating stressors and can help a person successfully cope with life obstacles and challenges (Hovey & King,

1996; Lee at al., 2004; Santisteban & Mitrani, 2003). Likewise, family and social support were both associated with less anxiety and depression in this study, which is consistent with previous research evidence documenting these relationships (Hovey & Magaña,

2000; Oppedal et al., 2004). Family and social support can help protect against developing mental illness, and these supports can also help individuals successfully cope with their psychological distress. There was a moderate correlation between family functioning and social support. The social support questionnaire in this study (PRQ85-R) included questions relating to family relationships, and therefore the two constructs overlapped in content, likely at least partially accounting for the correlation.

The correlation between anxiety and depression was high (.68) although the anxiety measure used (BAI) was purportedly developed with an aim to discriminate anxiety from depression (Beck & Steer, 1993). Indeed, with the exception of one item on the depression scale (CES-D) that assessed feelings of fearfulness, at face value the two measures appear to be drawing upon different symptomatic experiences. It is possible that the high correlation is not due to confounding measurement content, but rather similar stressors and factors that are predictive of both anxiety and depression. It is also

183 possible that for Arab Americans, symptoms of anxiety and depression are experienced together rather than as two qualitatively distinct psychological disorders.

The hypothesis that religious coping would be related to less stress, anxiety, and depression was not supported in the present study. This is surprising considering a wealth of previous studies that have documented the role of religiosity and religious coping in buffering against stress and mental illness (Koenig et al., 2001; Levin & Chatters, 1998;

Pargament, 1997; Pargament & Brant, 1998; Pargament et al., 1990; Plante & Sharma,

2001; Smith et al., 2003). It is also surprising considering that religion is an important value in the Arab culture. Religiosity and religious coping have been found to prevent mental health problems and serve as a source of support in the Arab acculturation process

(Abudabbeh & Hamid, 2001; Hatter-Pollara & Meleis, 1995b; Maloof, 1981). One may argue that the non-significant finding may be due to poor validity of the newly-developed

BARCS measure. However, this is unlikely since items on the BARCS were based on previously-established religious coping scales. Additionally, the measure demonstrated strong face and content validities, and rigorous Rasch analysis was used to improve construct validity. Furthermore, internal consistency for the BARCS was very high (.94).

To explain this finding, it may instead be possible that Arab Americans who are actively associated with Arab-specific churches or mosques may face greater acculturative stress due to the values and traditions promoted by these religious institutions that conflict with American culture (e.g., no pre-marital dating, male patriarchy). Therefore, persons who are religiously active may have more difficulty negotiating their Arab and American identities, and the benefits of practicing religion may be counterbalanced by the stressors, leading to nonsignificant findings. Alternatively

184 or additionally, it is possible that persons associated with Arab churches or mosques may be more easily recognized as an “Arab” to others in their community, and therefore more likely to be subjected to harassment and discrimination. These additional stressors may offset the benefits of religious coping, thus leading to a null finding. This may be especially salient for Muslims with the increase in hate rhetoric and anti-Muslim biases since the September 11 attacks. Muslims may be afraid to practice their religion, may experience angst over understanding and negotiating why or how their Muslim brothers caused the attacks under the banner of Islam, and may experience greater discrimination due to commitment to their faith (see Introduction for further discussion on these issues).

Although religious coping was not significantly related to anxiety or depression, it was significantly related to family functioning and social support. This is not surprising because in the Arab culture religion is intertwined with family and social traditions

(Abudabbeh, 1996, 1997; Abudabbeh & Nydell, 1993). Also, religiosity can lead to greater family cohesion and social support since Christianity and Islam strongly encourage, for example, family bonds, respect to parents, kindness to neighbors, and participating in religious rituals with peers. Religious and social activities at the church or mosque can moreover provide a backdrop for the development of social networks. With this in mind, it is possible that religious coping therefore has an indirect effect on anxiety and depression through mediating variables of family functioning and social support.

Research Focus 5: Gender Differences in Stress and Mental Health

It was hypothesized in this study that females would report greater levels of stress, anxiety, and depression compared to males. This hypothesis was not confirmed. With the exception of greater anxiety and depression among women compared to men within the

185 sojourner subgroup, gender differences were not found. These results are not consistent with previous literature suggesting greater levels of stress and mental health problems among females in acculturating groups (Dion & Dion, 2001) and the greater population in general (Davis, Matthews, & Twamley, 1999). The results are also surprising because a higher prevalence of anxiety and depression among women is a well-established finding that has been replicated in cultures and countries worldwide (American Psychiatric

Association, 2000; Comer, 2004). It may be possible that male Arab Americans, who are traditionally responsible for supporting the household while females prioritize their household responsibilities, are more exposed to American society through academic and occupational public spheres (Abudabbeh, 1996, 1997; Aswad, 1994; Read, 2004). They thererefore may have more opportunity to experience harassment and discrimination.

Additionally, males may face unique post-September 11 stressors such as fears of being detained. These stressors would make the differences between males and females negligible because stressors and psychological distress for males would be raised to equal the level of that faced by females. However, it would be expected that differences in gender roles and male-specific acculturative stressors would be reduced over subsequent generations, although stress and mental health differences between males and females were not found for second and later generations in this study. Further exploration of possible differences in the types of acculturative stressors faced by Arab American men and women would be useful.

Research Focus 6: Christian-Muslim Differences in Acculturation and Mental Health

The sixth area of focus in this study was the exploration of acculturation and mental health differences between Christians and Muslims. It was hypothesized that

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Christians would demonstrate greater American identity than Muslims. This hypothesis was supported and is consistent with previous research (Faragallah et al., 1997; Schumm,

1995). Because Christians share the same religion as the majority culture, they have an easier time adjusting to American culture and adopting American traditions. This is in contrast to Muslims for whom many of the values and behaviors associated with

American culture are in direct conflict with the Islamic belief system. On the other hand, the hypothesis that Christians would demonstrate less Arab identity than Muslims was not supported. This is likely a function of the study methods: This study was marketed as a survey for Arab Americans, and thus Christians with high affiliation to the Arab culture would have been more likely to complete the study. Alternatively, it is possible that the hypothesis is indeed false, and that Christian families are just as likely to maintain their

Arab identities as the Muslim ones. This belief can be supported by historical literature documenting the role that Christian intellectuals played in propagating the Arab nationalism movement (Dawisha, 2001; Munson, 2003) and the high numbers of

Christians who are in top-level administrative positions at Arab American organizations such as the American-Arab Anti-Discrimination Committee and Arab American Institute.

It was moreover hypothesized that Christians would report less stress, anxiety, and depression compared to Muslims due to their adoption of American culture and less chance of facing discrimination and other acculturative stressors. This was indeed supported in the results. Moreover, analyses were conducted to explore possible differences in coping strategies: Christians also reported better family functioning and social support. Thus, in general Christians demonstrated better social and mental health profiles; in other words, better psychological adaptation. As discussed earlier, Christians

187 are able to adjust to American culture more easily than Muslims, and they face less acculturative stress. Because Christians are a minority group in the Arab world, it is moreover possible that they are already adept at negotiating minority status and they may transport the social and institutional coping supports that they had created in the Arab world when they immigrate to America. On the other hand, Muslims reported greater use of religious coping. This on the one hand is not surprising due to the important role Islam plays in the Arab culture, which increases the likelihood that Arab Muslims would turn to their religion for support in the face of hardships.

Research Focus 7: Structural Model of Acculturation, Coping, and Mental Health

The seventh purpose of this study was to develop a tenable model of the complex interrelationships among the acculturation, coping, and mental health variables explored in this study. Structural regression modeling was used due to its unique ability to statistically estimate these relationships. Because no previous model of Arab American acculturation has been presented in the literature, and because structural models for other acculturating groups are uncommon (Shen & Takeuchi, 2001), the final model was developed with a combination of confirmatory and exploratory methods, with an emphasis on utilizing empirical results found in the variable correlation matrix to guide model modifications. The hypothesized model was explored to identity misspecifications or nonsignificant parameters, and additional parameters were added and assessed for the strength of their coefficients and impact on overall model fit. This “post-hoc” modification approach is less preferred to a more theory-based comparison of “a priori” established competing models because the results are impacted by variable interactions unique to the sample, especially for smaller sample sizes (Hoyle & Panter, 1995).

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The final model demonstrated conflicting conclusions for model fit, with chi square and RMSEA indexes indicating poor fit and comparative or incremental fit indexes indicating good fit. The inflated chi square result is at least in part due to the large sample size. However, the RMSEA score was not within adequate limits. Because

RMSEA adjusts for parsimony, it could be that the fit was low due to the complexity of the model. Although overall model fit produced contradictory results, the parameter estimates were all significant and most yielded moderate or large effects, further lending evidence in support of the validity of the modeled relationships in explaining the observed data. One caution to note, however, is that the directionality of relationships in any model is established by the researcher, and it is quite possible that reversing the directionality of the paths may produce similar parameter estimates and model fit (Hoyle

& Panter, 1995). For example, rather than the hypothesized direct path from family functioning to acculturative stress, it is theoretically plausible that an increase in acculturative stress may place a burden on a family, leading to worsened family functioning. In sum, results regarding the validity or strength of the final model were mixed. This dilemma of contradictory evidence for model fit is common to structural equation modeling research (Hu & Bentler, 1995).

The final model depicted a series of relationships in which socio-demographic and acculturation variables served as predictors for stress, coping, and mental health.

Acculturation was conceptualized as the dynamic change process associated with interacting with a new culture. As described in the Introduction, several variables have been found to be associated with a person’s level of acculturation, including generation status, length of stay in the new culture, visitations to the homeland, and language use. In

189 the final model, acculturation was represented as a latent construct, with these variables, in addition to Arabic TV viewing, serving as indicators. The substantial factor loadings supported this measurement model. In the overall structural regression model, greater acculturation predicted less acculturative stress and greater social support, and it covaried with income and American identity. The negative correlation between education and acculturation may seem counterintuitive; however, a large percentage of the current sample (32.6%) were college students or below (i.e., lower education) who were likely to be U.S.-born second or later generation individuals (i.e., higher acculturation).

Conceptualization of income and education as two exogenous variables rather than indicators for a single latent variable of SES produced better fit to the observed data.

This supports results in Research Focus 1 that suggested that these variables may have differing patterns of relationships with acculturation and mental health. Income had a direct effect on both family functioning and social support, which were mediators between income and mental health. Education had a direct effect on anxiety and depression. The final SEM model depicted acculturation stress as a mediator between

Arab identity on the one hand and acculturation and mental health outcomes on the other.

Greater Arab ethnic identity and less acculturation to American society each had direct effects on increasing stress. Family functioning and social support had direct effects on anxiety and depression, as well as indirect effects on these mental health outcomes through acculturation stress. Theoretical and empirical support for these relationships are discussed in the Discussions for “Research Focus 3” and “Research Focus 4.” Religious coping was dropped from the model due to nonsignificant effects. The lack of significant findings for religious coping was discussed above in “Research Focus 4.”

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Clinical Implications

Arab Americans face unique acculturative stressors associated with the post-

September 11 socio-political climate, such as loss of employment, discrimination, hate crimes, and anger and helplessness over American foreign policies in the Middle East

(i.e., Iraq war). As demonstrated in this study, these stressors are predictive of anxiety and depression. The significant portion of the current sample that reported clinical anxiety and depression supports the need for treatment services. Although difficult to estimate, anecdotal observations by clinicians and researchers have indicated an increase in service utilization since the World Trade Center attacks (Sayed, 2003; “Stress-Related

Ailments,” 2003). In recent community-based samples, the percentage of Arab American

Muslims who admitted to receiving professional psychological services was 10.4%

(Khan, 2003) and 9.6% (Aloud, 2004). A total of 32.5% of Arab Muslims in another community study reported that they or someone close to them had received professional mental health services during the two years prior to the study (Amer et al., 2003). For clinicians treating these clients, an accurate understanding of Arab American acculturative and mental health patterns can lead to more effective assessment and treatment.

Based on the results in the present study, assessment of a client’s acculturation status is essential and should not be overlooked in the face of the more prominent psychological disorder symptoms. Assessment of acculturation can be conducted by administering measures such as the VIA-A or asking questions about engagement in

American and Arab cultures. For example, a clinician can inquire about the extent to which the client feels at “home” in either culture, the ethnic backgrounds of friends, the

191 language/s spoken at home, frequency of watching Arabic TV, and frequency of visits to the Arab world. Although generation status has been found to relate to acculturation, it should not be assumed that a person of second or later generation will possess low levels of Arab identity or that an immigrant will be more committed to the Arab heritage. It should also not be assumed that treatment found to be effective for European-Americans would demonstrate similar effectiveness for later generation Arab Americans. Based on results of the acculturation assessment, a clinician and client can together begin to develop hypotheses on how the acculturation process is impacting current mental health.

Mental health professionals have historically been ethnocentric in their tendency towards spurning their clients’ ethnic traditions and viewing the American culture as the gold standard for psychological adjustment (Copeland, 1983). Clinicians should be aware of this bias since integration (strong American and Arab identities) has instead been found to predict best mental health, and in the present study Arab identity did not relate to stress or mental health problems. Rather, efforts should be made in therapy to support the client in negotiating his or her cultural identities with the goal of developing a bicultural approach in which Arab beliefs and behaviors are also valued and applied. This may prove to be a complex process in which the client develops awareness of his or her worldviews, clarifies his or her values, reconciles the cultural traditions and messages offered by both cultures, and learns to cope with acculturative challenges to positive self- concept. This complex, conflictual, and evolving process was described in Ghanem-

Ybarra’s (2003) interview study of 11 second generation Christian Palestinian American women. Interactions with familial and societal factors will be important to the

192 development of ethnic identity, and identification of a mentor or role model from the

Arab American community can help the client transition through this process.

A clinician can also support the client in coping with acculturation stressors by teaching culturally-sensitive stress-reduction techniques or attempting to address the specific acculturative challenges the client is facing. For example, clients may report stressors relating to difficulties acquiring skills needed to adjust to American society

(e.g., English language, drivers’ license, educational system policies). The therapist can help the client search for resources in the community that assist in the attainment of these skills. If the client experiences ostracism or discrimination from others, he or she can be encouraged to establish alternative social connections and to gain empowerment by advocating for rights (i.e., filing a discrimination lawsuit). Other clients may experience the compounding stressors associated with both adjusting to American culture in addition to vicariously living in the Arab world (i.e., through watching Arabic TV, reading Arabic newspapers). This situation presents with the almost insurmountable task of negotiating conflictual messages propagated by both cultures. For example, an Arab American may feel guilty as an American for coming from the background of the World Trade Center hijackers and may feel guilty as an Arab for residing in the country that has killed hundreds of thousands of their brethren in the Arab world.

These acculturation stressors may be an especially distressing for Muslims, who were blamed for the September 11 tragedy and as a result experienced the brunt of the backlash (Masroor, 2003; Ulrich, 2003). Moreover, Muslims often view many American traditions and behaviors (e.g., dating, drinking alcohol) to be contrary to their faith. It is therefore not surprising that Muslims are more likely to be separated from American

193 culture than their Christian counterparts. Because separation has been found to increase stress, anxiety, and depression, clinicians can actively support culturally isolated Muslim clients in identifying aspects of American culture that are consistent with their faith (e.g., punctuality, freedom, strong work ethic, charity), and support the client in establishing proactive relationships with mainstream activities and persons with similar interests.

Because religious affiliation, religiosity, and religious coping can significantly relate to acculturation and mental health, assessment of these factors should be conducted at the start of therapy, and can be incorporated in an ongoing dialogue throughout the therapeutic process. Religious affiliation- or the religion a person belongs to- can inform expectations about the client’s acculturation, stress, and mental health. Based on this study’s results, Arab Americans who are affiliated with the Islamic religion might be expected to report less adoption of American cultural identity, greater acculturative stress, greater psychological distress, and less social supports than those who are self- identified as Christian. Clients of all religious affiliations may endorse varying levels of religiosity, or commitment to following a religious belief system, as well as varying degrees of using religion to cope with problems. Religious affiliation, religiosity, and religious coping should not be determined based on a client’s appearance; rather, a careful assessment should be preformed. Assessment of religious affiliation can be conducted by asking the client if he or she is affiliated with any religion. Assessment of religiosity can be conducted by asking about: religious values and beliefs; the role religion, God, or Jesus plays in the person’s life; frequency of prayer and attending religious services; and keeping to religious prohibitions (i.e., pre-marital sex; for

Muslims, alcohol, gambling, non-Islamic slaughtered meats). Assessment of religious

194 coping can be conducted by administering a religious coping inventory such as the

BARCS or asking about religious beliefs or behaviors that the client uses in order to reduce distress and solve problems when faced with stressors.

Psychologists have historically been biased against discussing religiosity in the therapeutic setting and have dismissively viewed religiosity as part of the problem rather than as part of the solution (Coyle, 2001; Fallot, 2001). Therapists are encouraged not to take this stance in light of research demonstrating the positive impact that religiosity (life commitment to religious beliefs and rituals) and religious coping (using religiously-based methods of coping with stress or problems) can have on reducing stress and improving mental health (Koenig et al., 2001; Levin & Chatters, 1998; Pargament, 1997; Pargament

& Brant, 1998; Plante & Sharma, 2001; Siegel et al., 2001).The religious setting can also provide an alternative opportunity for clients to develop social supports in the face of acculturative stressors. A recent study (Amer & Hovey, 2005) found that religiosity was especially effective for Muslim compared to Christian Arab Americans in improving mental health status. In the present study, however, religious coping did not serve as an important predictor of stress and mental health, although it was associated with better family functioning and social support. Clinicians should therefore explore the roles that religiosity and religious coping play in the client’s stress and mental health on an individual basis, and clients can provide feedback as to whether religious commitment or coping has been found to be beneficial, ineffective, or a source of stress for them in the past. If religion is an important aspect to the client’s identity, clinicians can work with clients to integrate religious concepts and behaviors in the therapeutic planning.

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As demonstrated in this study, family and social supports can be critical to the acculturation process, with these supports acting as buffers to stress and as predictors of less anxiety and depression. However, many acculturating Arab Americans are faced with loss of both kinds of supports. For example, sojourners and immigrants may have left their family behind in the Arab world, and persons of all generations may find difficulty developing friendships with peers from other cultures if there are few or no other Arabs living in the same vicinity. Additionally, conflicts and family distress are common when youth begin to question or reject the Arab traditions that their parents espouse (Abudabbeh, 1997; Abudabbeh & Nydell, 1993; Budman et al., 1992; Maloof,

1981) or when married partnerships are strained or spouses desire different acculturation strategies (Abudabbeh, 1997; Aswad, 1994; Kulwicki & Miller, 1999).

Because family and interpersonal relations serve important functions in the Arab culture, loss of these supports can be especially taxing for Arab Americans. Therefore, developing stronger social supports can be an important part of the therapeutic process. In the cases of intergenerational or marital conflict, other members of the client’s family can be invited to therapy sessions using a systems approach. Because the family structure carries much esteem and is viewed as the basic unit of society for Arabs (Abudabbeh,

1996, 1997; Audabbeh & Nydell, 1993), family therapy can be an especially useful and culturally-responsive modality. In such sessions, clinicians should avoid siding with the youth or one spouse and instead attempt to negotiate a balance between the needs and desires of all persons involved. Clients who are lonely or have had difficulty establishing meaningful relationships with peers can be encouraged to seek relationships in alternative settings such as places of worship or in organizations that revolve around the clients’

196 interests. For example, a client who is interested in animal rights can volunteer at a local animal shelter, or someone who is interested in sports can join a local sports team. Clients can also join Arab American organizations and attend Arab-specific conferences where they can meet others who share the same heritage and backgrounds. Finally, the Internet can also serve as an invaluable source of support, especially as virtual Arab clubs abound and there are also numerous Web sites aimed at finding romantic partners.

Community Implications

This study demonstrated that Arab Americans are at-risk for acculturation stress and mental health problems. Particular risk factors include: Muslim religious affiliation, low acculturation, separation strategy or low American identity, low income, low education, family dysfunction, and poor social support. Arab organizations and religious institutions can therefore develop research-informed policies and programs aimed at reducing stress and promoting better mental health.

It is recommended that Arab American organizations and associations provide specialized programs that cater to Arab Americans of different generational levels. For example, local Arab cultural centers can provide services to help sojourners and immigrants adjust to American society. This can include support and legal representation for visa and citizenship procedures, English language courses, classes that teach other skills (e.g., computer literacy), workshops about American culture, and stress reduction workshops. The Arab Community Center for Economic and Social Services (ACCESS) in Dearborn, Michigan offers many such services. Organization leaders can teach

American norms such as driving and road rules, shopping and check-out procedures, and tax regulation procedures. These skills can be taught through instructional classes or

197 group “field trips.” For sojourners who are studying at universities, similar types of programs can be provided by the university’s international student office or by Arab cultural unions. Arab clubs and unions can serve as important sources of social support for student sojourners, young immigrants, and second generation individuals. Second and later generation individuals may have an especially difficult time negotiating their Arab and American identities, especially if they have low or ambivalent affinity to the Arab culture and perceive their parents as superimposing Arab-based restrictions on their behaviors (Abudabbeh, 1997; Abudabbeh & Nydell, 1993; Timimi, 1995). To address this inter-generational gap and other related acculturative challenges, mentorship programs can be established, and family counseling can also be provided.

Other types of prevention and intervention services can be made available by

Arab organizations and local cultural centers to support the acculturation process.

Although parenting and youth issues were not directly assessed in the present study, based on the literature review it is apparent that services can be established to support child identity development and parenting challenges related to the acculturation process.

For example, parenting workshops and support groups can help parents, especially mothers who are typically responsible for child-rearing, to cope with conflict and stressors associated with raising children in the U.S. Many Arab parents, especially mothers, attempt to prevent their children from adopting American behaviors that are seen as unacceptable or shameful to the Arab culture (Abudabbeh, 1997; Abudabbeh &

Nydell, 1993; Hattar-Pollara & Meleis, 1995a; Maloof, 1981). For example, a study of

139 Muslim Arab American parents found that they believed that American TV promoted improper and immoral values, and the parents therefore did not want their children to

198 watch TV, particularly violent programs (Al Yacoub, 1997). Additionally, due to prejudice and marginalization, Arab American youth tend to feel isolated from their peers and surrounding academic environment (Ayish, 2003). This kind of separation may be stressful for children, and parenting workshops can help parents identify alternative social circles and activities that increase cultural integration without violating cultural values.

For example, children can be encouraged to join sports teams, or Muslim Girl Scouts troops can share activities with the other Girl Scouts troops. Moreover, more extensive prevention and intervention programs that target youth themselves would be useful. An example of this is ACCESS’s 15-week depression program for at-risk teens focusing on developing a stronger sense of identity and increasing self-esteem (Bouffard, 2004).

Because based on the current study education acts as a predictor for mental health, it is important that as children grow they are encouraged to pursue higher education. Arab cultural organizations can provide academic mentorship and both need- and merit-based scholarships to encourage furthering education. These incentives can support immigrants as well, who may find better employment opportunities with higher education.

One of the critical acculturative stressors that Arab Americans of all generations and ages have faced since the World Trade Center attacks has been discrimination and hate crimes. Arab cultural and political organizations can aim to target these stressors on a national level through providing cultural sensitivity trainings to police and FBI departments, participating in inter-cultural and inter-faith councils, petitioning against inaccurate media biases, and lobbying against legislative bills that unfairly target Arab

Americans. On a local level, organizations can offer legal council for persons who have faced discrimination. Many national organizations such as the American-Arab Anti-

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Discrimination Committee, Council on American-Islamic Relations, and Arab American

Institute have actively engaged in such activities, even disseminating “tool kits” for communities instructing them on how to manage discrimination. However, most of these efforts have targeted the adult population. Additional efforts should be made to help children cope with ethnic-based harassment and bullying (Ayish, 2003; “Protecting Arab-

American Students,” 2001) and prejudicial and inaccurate portrayals of Islam and Arabs in American school curriculums (Douglass & Dunn, 2003).

Religious institutions can also play a role in addressing stress and mental health problems in the community. Lectures regarding the identification and treatment of psychological symptoms, as well as other types of mental health awareness campaigns, can be held at the church or mosque. The popular “health day” screenings that are held at these places of worship should include mental health screenings and referrals.

Religiously-based support groups, in addition to social activities and festivities, can provide a virtual extended family for those who have left their family behind in the Arab world. This additional source of support can help buffer against stress. Sermons, open forums, and assemblies should tackle topics such as negotiation of religious and

American identities, and they should provide encouragement for ways to integrate with

American society without violating central religious tenets. Mosques and churches can also offer many of the acculturation supports mentioned above such as classes in English and American culture, interfaith dialogues, and parenting and child programs.

Strengths and Limitations of the Present Study

To the author’s knowledge, the present research study is the largest investigation of Arab American acculturation and mental health to date; previous studies were

200 generally based on small-sample interview and survey research. The sample size of 611 is also large with respect to social and behavioral health research samples which typically range from 100 to 400 participants (Hoyle & Panter, 1995). Such a large sample size offered the valuable opportunity to rigorously test hypotheses offered by previous researchers and to use more complex statistical methods such as SEM to account for the interactions among multiple variables. It also provided the luxury of subgroup comparisons, producing comprehensive results. For example, most Arab American studies have focused on one particular generational group; for example, immigrants or sojourners, while the current study provided the chance to compare generational levels ranging from sojourner to third and later generation. Because of the large sample size, however, it was not surprising that many of the bivariate relationships were found to be statistically significant, and that the SEM model chi square statistic was inflated.

Although the sample size was large, it is not clear to what extent the current sample is representative of the Arab American community, and readers should be cautioned from blindly generalizing the results to the overall population. The sample was not randomly selected from a population frame, and the convenience sampling was largely dependent on the contacts and networking of the author. However, because random samples of Arab Americans are not feasible, one way to increase generalizabiltiy is to obtain larger and more diverse samples, as was accomplished in this study. Indeed, the current sample was geographically and socio-demographically diverse, including participants from 34 states and the District of Columbia. Additionally, the sample included persons of different religious affiliations, income, and educational levels.

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Because the research was marketed as a study of Arab Americans, participants were self-selected based on higher Arab ethnic identity. This led to low variability in levels of Arab identity, which may have influenced some of the nonsignificant results.

Arab Americans who were assimilated would have been less likely to complete a study on Arab Americans; this was evident in that only 19 from the 611 participants considered themselves to be assimilated. Participants from other various segments of the Arab

American community may have also been unwilling to complete a study on “Arab

Americans.” For example, some Arab-based associations responded that they were unwilling to support and advertise the research due to suspiciousness of the researcher’s motives and the possibility that the information gathered would serve to only further defame or harm the Arab American population. Some Christian groups from the Middle

East, such as Coptic Egyptians, criticized the study for its use of the term “Arab,” arguing that the Arab identity is a socio-political– and not ethnic– movement that was superimposed on them by an Islamic consciousness. Chaldean Americans (typically from villages in Northern Iraq) also do not define themselves as Arab. Finally, sojourners such as visiting university students may have been less likely to have heard of this study due to their separation from Arab American milieu, and some indicated that they weren’t sure if they were eligible for the study because they were not “American.”

Obtaining a geographically and socio-demographically diverse sample was possible through the use of Internet research, a technique that offered multiple benefits.

This method of collecting data was simple, time efficient, and less costly than traditional techniques. Additionally, it offered a more confidential and private atmosphere for survey completion, which is important for Arab Americans who may be ashamed of or unwilling

202 to disclose psychological symptoms or may be suspicious of research and fear that their answers will be identified and possibly used against them. On the other hand, there were several drawbacks of using this approach. Due to the sampling method, it is not possible to determine the response rate for this study. In some cases technical problems led to loss of data or technological difficulty accessing the Web site. With respect to differences in measured variables impacted by Internet research methods, previous research has indicated that Internet samples produce results that are similar to university-based or community-based research in personality or psychological adjustment (Gosling et al.,

2004; Kraut et al., 2004). Moreover, Barry (2001) did not find significant differences in acculturation between his community-based and Internet-based Arab American samples.

Still, it is evident that the research procedures did not allow for full representation of all segments of the Arab American community, which may have biased the results obtained.

For example, research procedures precluded the participation of monolingual Arabic speakers, persons of low income or education who do not have Internet access, and refugees, all of who would be expected to report greater acculturation distress. Moreover, as indicated on the initial Informed Consent page, the study was time-consuming (20-40 minutes), and many potential respondents may have been therefore unwilling to participate in completing the measures.

Another challenge to external validity relating to Internet research methods is that this type of research draws on respondents who have computers and Internet in the home; in other words, persons who are more educated, affluent, and young compared to the general population. It could be argued that this is not a serious shortcoming of the present study as the Arab American population is younger, more educated, and richer than the

203 general American population (El-Badry, 1994; Samhan, 2001; Zogby, 1990). According to the U.S. Census 2000 Special Report on people of Arab ancestry (Brittingham & de la

Cruz, 2005), the median age was 33, compared to the current sample which was 25.0. A total of 41% of the Census sample had obtained a bachelors degree or higher, compared to 53% in the current sample, not including 26.4% who had completed some college classes and are expected to earn a degree. The median Arab American family income in

1999 per Census report was $52,300. In the current sample, 31.6% reported incomes less than $50,000, 16.0% reported between $50,000 and $75,000, and 38.0% reported above

$75,000 (the remaining participants did not provide an answer). Thus, while Arab

Americans demonstrate younger age and higher SES than the general American population, the current sample was even younger with even higher SES.

One of the common criticisms of ethnic minority research is the use of measures that are not valid or culturally sensitive (Bhui, Mohamud, Warfa, Craig, & Stansfeld,

2003). Measures used in the present study underwent rigorous assessment of validity and cultural sensitivity for the Arab American population, including pilot testing and Rasch modeling. Moreover, internal consistency reliability was high: .82 and .88 for the shorter

10-item VIA-A subscales and .86 to .94 for the other measures. However, further examination of the VIA-A (Vancouver Index of Acculturation- Arab Version) and

BARCS (Brief Arab Religious Coping Scale) may be useful. For the VIA-A, many participants criticized that questions such as “I believe in Arab values” are vague and were difficult to respond to. Operationalization of acculturation and ethnic identity has been a challenging task, and the VIA is unique in its assessment of traditional and mainstream identities on orthogonal but meaningfully comparative continuums (Ryder et

204 al., 2000). However, the scale was developed so that each item assessing traditional culture was followed by the corresponding item assessing the dominant or new culture. It is possible that this could have biased respondents’ answers in that their ratings were based on internal comparisons of the differences between their Arab and American identities rather than their separate assessment of each identity. To reduce this bias, the groups of questions representing Arab identity can be separated from the American ones, and perhaps even placed at different points in the survey packet. The BARCS is another measure that may need further development or examination, particularly since religious coping scores did not interact as expected with other variables. Because a measure of general religiosity was not provided in this study, it was not possible to determine convergent validity, and it was not possible to ascertain whether religiosity and religious coping provide different mental health benefits to the acculturation process.

Recommendations for Future Research

The present study provided a comprehensive assessment of Arab American acculturation, covering issues relating to acculturation strategies and factors impacting ethnic identity, the relationship between acculturation and mental health, the impact of interpersonal and religious supports on the acculturative and mental health process, and between-groups differences based on; for example, gender, religious affiliation, and generation status. The study also advanced knowledge on Arab American acculturation and mental health by testing numerous theoretically- and empirically-based hypotheses proposed by previous researchers. Thus, this study lays the groundwork for future research in similar and related Arab American mental health issues.

205

Results in this study supported some hypotheses proposed by previous researchers and did not support others. It will be important for future studies to examine the hypotheses that were not supported by the current study to determine if the hypotheses should be rejected or modified, or if this study provided idiosyncratic results. For example, the association between Arab ethnic identity and acculturation indicators (e.g., generation status, length of stay in the U.S., frequency of visits) can be explored further with a sample that draws upon a wider variability in Arab identity levels. Similar analyses can explore the relationship between Arab identity and acculturation stress.

Religious coping did not serve as a predictor for mental health in the present study.

Further work is needed to assess the validity of the BARCS measure and to determine why religious coping was not relevant and in what situations or under what conditions it does support mental health. Further research is moreover needed to clarify why males and females reported similar levels of stress and mental health problems in contrast to expectations based on previous research that females would report higher levels.

There were many areas in this research that did not receive adequate attention and also deserve further exploration. For example, the geographical location of participants was not considered, although persons who live in ethnic-specific communities such as

Dearborn, Michigan may encounter different acculturation stressors compared to those living in predominantly European-American locations. Location of the extended family and availability of other Arab families in the same neighborhood can similarly impact acculturation. Future research on these variables can produce ideas for prevention and intervention services specific to particular localities. Education and income, although correlated with one another, appeared to play different roles in the acculturation process.

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Review of the literature on socio-economic status can explain this finding or generate ideas for further study of these variables. Acculturation stress was conceptualized as one construct assessed by experiences such as discrimination, alienation from mainstream culture, language barriers, difficulty establishing friendships, and anger toward U.S. foreign policies. A more intensive investigation of the unique acculturative stressors faced by Arab Americans is warranted in order to isolate the stressors that contribute most to mental health problems and to identify any subgroup differences (e.g., male- female, Christian-Muslim) in stressors encountered. Although the Christian-Muslim differences were striking in this study, it will be important to conduct further research to explain these effects. For example, it would be valuable to determine if these differences are still evident when socio-economic status, social supports, and other potentially confounding variables are controlled for. Understanding the reasons for the high correlation between anxiety and depression is another potential area of investigation.

The impact of generational status on acculturation and mental health also did not receive thorough scrutiny in this study, and therefore additional research on persons of different generational status is encouraged. A total of 60 participants did not conform to the traditional generation status categories due to living in multiple countries or moving back and forth between the American and Arab worlds. Research on immigration patterns may be helpful in identifying if this is an emerging trend among persons of Arab descent, or to understand the motivations behind the moves. It would be interesting to examine how changing residence more than once among different countries may impact the acculturation process, and if these individuals experience more distress due to the experience of never feeling “at home” or settling in any one place. Qualitative data may

207 prove useful in this area for describing the unique experiences of these individuals.

Another unique group was the 1.5 generation. More research is needed to determine if persons from the 1.5 generation experience qualitatively different acculturation and mental health patterns depending on the age at which they immigrated, and if so, what subdivisions of age groups are the most accurate. Such research can draw upon the field of developmental psychology, including language development and identity development. Perhaps a “window of opportunity” for the ideal ages for immigration can even be proposed.

It is recommended that the singular experiences of sojourners be more intensively examined, particularly in light of the increasingly stringent U.S. visa and immigration policies. It would moreover be interesting to investigate the motivations that lead a sojourner to decide to remain in the U.S., and the types of re-acculturation stressors that are faced when he or she returns to the Arab world. Additionally, virtually no studies on

Arab Americans have focused on third- and later-generation individuals, another unique subgroup that merits attention. Many of these individuals would be considered assimilated into American culture, which makes them difficult to access. Efforts should be made to develop procedural strategies to acquire larger samples of persons who are self-identified as assimilated. Finally, none of the participants indicated that they had immigrated for involuntary reasons, and assessment of acculturation strategies and stress relating to voluntariness of immigration is an area that continues to need consideration

Limitations of the research methods used in this study can be carefully addressed in future research. Although Internet research has proven to be advantageous, it should be complimented with community-based research to provide a more holistic perspective of

208 the acculturation process and to test for ways in which the Internet samples may differ from community ones. Community-based participatory research can provide additional benefits such as increasing awareness of mental health problems and initiating community-based advocacy and intervention programs. Studies can be advertised as focusing on “Middle Eastern” or “North African” Americans rather than the term “Arab

American” to which many groups oppose. Moreover, Arabic questionnaire versions can target monolingual participants. These chances can help increase the diversity of samples and generalizability of results. Truly random sampling of the Arab American population is currently not feasible, and therefore larger and diverse sample sizes are recommended.

However, with the collaboration of the Arab American Institute, the U.S. Census Bureau has improved its classification of Arab Americans. Despite underestimating the total population by maybe more than one million and some imprecision in ethnic categorization, the U.S. Census Bureau is providing estimates that are increasingly accurate (Arab American Institute, 2003). Therefore, it may be useful to use the census data to draw a random sample or match participants to census characteristics.

Also in regards to methodology, a wider range of culturally-sensitive and valid measurement tools for different Arab American acculturative, coping, and mental health variables can provide greater flexibility for researchers wishing to analyze different combinations of variables. Further studies assessing the diagnostic sensitivity and specificity of these measures; for example, with the use of structured diagnostic interviews, is recommended. This could inform caseness cut-off scores and help explore the causes for the high psychological distress scores endorsed in this study. Because acculturation and mental health patterns are likely even more complex than what has

209 been described in this study, using more sophisticated statistical modeling techniques is recommended. The final model developed in this study was based on post-hoc modifications and demonstrated contradictory evidence for model fit, and therefore much work is needed to improve this model with other Arab American samples. Further assessment may include breaking up the model into smaller sub-parts and testing these further, or adding potentially important variables that were not included in the present study (e.g., personality). Moreover, group comparisons (e.g., male-female, Christian-

Muslim, immigrant-second generation) can be made to determine if model parameters differ between the subgroups. On the other hand, while larger sample sizes and more sophisticated techniques may be beneficial, one can not deny the benefits of the intensity, depth, and detail associated with utilizing qualitative research designs such as interviews and focus groups (Barker et al., 1994). A blended research modality that incorporates both quantitative and qualitative techniques can bring life and depth to research findings, and qualitative information can help generate explanations for any unexpected or seemingly counterintuitive quantitative research findings.

Finally, other areas of research relating to Arab American acculturation and mental health are suggested. For example, other psychological conditions such as posttraumatic stress disorder, somatization, eating disorders, and substance abuse can be assessed in relation to the acculturation process. Alternative forms of coping supports

(e.g., Internet support groups) and acculturative stress reduction techniques (e.g., instructional courses on American culture) can be evaluated for their effectiveness in buffering stress and reducing mental health symptoms. Participants in the current sample were adults, and it is not clear to what extent the present results can be generalized to

210 children. Further research is needed in regards to Arab American child acculturation and mental health, especially because recent reports from Wayne State University and

ACCESS both determined that more than 40% of Arab American teens struggle with depression (Bouffard, 2004). Further research can help identify child-specific acculturative stressors (e.g., immigration trauma, homesickness, bullying and other backlash, child-parent cultural gap), effective coping mechanisms and resources, and differences in the acculturation process for children of different age groups. Such an in- depth examination of child identity development and coping within the context of the acculturation process could help generate recommendations for scientifically-informed prevention and support programs aimed at improving the psychological well-being of

Arab American children. Finally, literature on Arab American aging is largely absent

(Salari, 2002), although in a recent study of older (ages 60-97) women of ethnic minority groups, Middle Eastern Americans reported significantly higher depression than women from other groups (Laganà & Sosa, 2004). Coupled with research on youth, studies with older samples can help generate a life-span perspective on the acculturation and mental health patterns of Arab Americans.

211

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Appendix A Vancouver Index of Acculturation (Ryder et al., 2000)

Please answer each question as carefully as possible by circling one of the numbers to the right of each question to indicate your degree of agreement or disagreement. Many of these questions will refer to your heritage culture, meaning the culture that has influenced you most (other than North American culture). It may be the culture of your birth, the culture in which you have been raised, or another culture that forms part of your background. If there are several such cultures, pick the one that has influenced you most (e.g., Irish, Chinese, Mexican, Black). If you do not feel that you have been influenced by any other culture, please try to identify a culture that may have had an impact on previous generations of your family. Please write your heritage culture in the space provided. ______Use the following key to help guide your answers:

Strongly Neutral/ Strongly Disagree Disagree Depends Agree Agree 1 2 3 4 5 6 7 8 9

1. I often participate in my heritage cultural traditions. 1 2 3 4 5 6 7 8 9 2. I often participate in mainstream North American cultural traditions. 1 2 3 4 5 6 7 8 9 3. I would be willing to marry a person from my heritage culture. 1 2 3 4 5 6 7 8 9 4. I would be willing to marry a North American person. 1 2 3 4 5 6 7 8 9 5. I enjoy social activities with people from the same heritage culture as myself. 1 2 3 4 5 6 7 8 9 6. I enjoy social activities with typical North American people. 1 2 3 4 5 6 7 8 9 7. I am comfortable working with people of the same heritage culture as myself. 1 2 3 4 5 6 7 8 9 8. I am comfortable working with typical North American people. 1 2 3 4 5 6 7 8 9 9. I enjoy entertainment (e.g., movies, music) from my heritage culture. 1 2 3 4 5 6 7 8 9 10. I enjoy North American entertainment (e.g., movies, music). 1 2 3 4 5 6 7 8 9 11. I often behave in ways that are typical of my heritage culture. 1 2 3 4 5 6 7 8 9 12. I often behave in ways that are 'typically North American.' 1 2 3 4 5 6 7 8 9 13. It is important for me to maintain or develop the practices of my heritage culture. 1 2 3 4 5 6 7 8 9 14. It is important for me to maintain or develop North American cultural practices. 1 2 3 4 5 6 7 8 9 15. I believe in the values of my heritage culture. 1 2 3 4 5 6 7 8 9 16. I believe in mainstream North American values. 1 2 3 4 5 6 7 8 9 17. I enjoy the jokes and humor of my heritage culture. 1 2 3 4 5 6 7 8 9 18. I enjoy typical North American jokes and humor. 1 2 3 4 5 6 7 8 9 19. I am interested in having friends from my heritage culture. 1 2 3 4 5 6 7 8 9 20. I am interested in having North American friends. 1 2 3 4 5 6 7 8 9 Note. The heritage subscore is the mean of the odd-numbered items, whereas the mainstream subscore is the mean of the even-numbered items.Researchers studying acculturation in other mainstream contexts may wish to change "North American" to another descriptor such as "American" in the United States or "British" in Great Britain. Copyright 1999 by Andrew G. Ryder, Lynn E. Alden, and Delroy L. Paulhus.

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Appendix B Pilot Questionnaires for the Present Study

PART 1 PILOT STUDY

Arab Culture and Mental Health Survey # 2 (Pilot) Information and Informed Consent

Thank you for your interest in this study. My name is Mona Amer; I am a Clinical Psychology graduate student at The University of Toledo in Ohio. As part of my Ph.D. dissertation I am developing questionnaires to measure cultural affiliation and religious coping among Arab Americans. These questionnaires will then be used in a larger internet study of Arab American culture and mental health. To complete these questionnaires:

1) you must be 18 years or older 2) you must currently reside in the United States 3) BOTH of your parents must have ethnic or ancestral heritages from one or more of the following Arab states: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Kuwait, Jordan, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Syria, Sudan, Tunisia, United Arab Emirates, Yemen

You will be asked to complete two questionnaires followed by a few demographics questions. The completion time is approximately 10-15 minutes. There are no known risks associated with participating, although you may find the procedure time-consuming.

This study has been approved by the University of Toledo‟s Human Subjects Research and Review Committee. Participating in this study is completely voluntary. You may choose to withdraw at any time without negative consequences. Results are confidential.

If you are interested in learning more about the rest of this study and its purposes or results, or have any questions prior to participating, please call Mona Amer at (419) 530- 2721 or e-mail [email protected].

By completing the enclosed questionnaires you are consenting to participate in this study and agree that 1) you are at least 18 years old, and 2) you understand the above-mentioned procedures, risks, and the voluntary nature of this study.

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In addition to answering these questionnaires, please provide comments or suggested changes regarding the questions either in the margins or on the back of these forms.

VIA- Arab Version

Please answer each question as carefully as possible by selecting one of the following choices to indicate your degree of agreement and disagreement. In the statements, the term “ARAB” is used to refer to the ARABIC CULTURE or to persons who have an Arabic ethnic background (even if the person is “Arab- American”). The term “AMERICAN” is used to refer to MAINSTREAM EUROPEAN-AMERICAN CULTURE or persons who have a European-American ethnic background.

1= Strongly Disagree, 2= Disagree, 3= Slightly Disagree, 4= Neutral/ Depends, 5= Slightly Agree, 6= Agree, 7= Strongly Agree

1 2 3 4 5 6 7 1) I often participate in Arab cultural traditions.

I often participate in mainstream American cultural 1 2 3 4 5 6 7 2) traditions. I would be willing to marry a person of Arab ethnic 1 2 3 4 5 6 7 3) background. I would be willing to marry a (non-Arab) American 1 2 3 4 5 6 7 4) person. 1 2 3 4 5 6 7 5) I enjoy social activities with people of Arab ethnicity.

1 2 3 4 5 6 7 6) I enjoy social activities with typical American people.

I am comfortable working with people of Arab 1 2 3 4 5 6 7 7) ethnicity. I am comfortable working with typical American 1 2 3 4 5 6 7 8) people. 1 2 3 4 5 6 7 9) I enjoy Arab entertainment (e.g., movies, music).

1 2 3 4 5 6 7 10) I enjoy American entertainment (e.g., movies, music).

I often behave in ways that are typical of the Arab 1 2 3 4 5 6 7 11) culture. 1 2 3 4 5 6 7 12) I often behave in ways that are „typically American.‟

It is important for me to maintain or develop the 1 2 3 4 5 6 7 13) practices of the Arab culture

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1= Strongly Disagree, 2= Disagree, 3= Slightly Disagree, 4= Neutral/ Depends, 5= Slightly Agree, 6= Agree, 7= Strongly Agree

It is important for me to maintain or develop American 1 2 3 4 5 6 7 14) cultural practices. 1 2 3 4 5 6 7 15) I believe in Arab values.

1 2 3 4 5 6 7 16) I believe in mainstream American values.

1 2 3 4 5 6 7 17) I enjoy typical Arab/ Arabic jokes and humor.

1 2 3 4 5 6 7 18) I enjoy typical American jokes and humor.

1 2 3 4 5 6 7 19) I have friends of Arab ethnic background.

1 2 3 4 5 6 7 20) I have friends who are mainstream American.

BARCS- Pilot Study Items

Please read each statement carefully and select how often you have engaged in the following behaviors when you have experienced a STRESSFUL SITUATION OR PROBLEM. Please make ONLY ONE selection.

0= not used at all/ does not apply 1= used sometimes 2= used often 3= used very often 4= used always

0 1 2 3 4 1. I said supplications (duaa).

0 1 2 3 4 2. I increased my prayers to God.

0 1 2 3 4 3. I read scriptures (e.g., Bible, Qur‟an).

0 1 2 3 4 4. I talked with church/ mosque/ temple leaders.

0 1 2 3 4 5. I attended events at the church/ mosque/ temple.

0 1 2 3 4 6. I looked for a lesson from God in the situation.

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0= not used at all/ does not apply 1= used sometimes 2= used often 3= used very often 4= used always

0 1 2 3 4 7. I tried to be a less sinful person.

0 1 2 3 4 8. I prayed to God for inspiration.

0 1 2 3 4 9. I tried to make up for my mistakes.

0 1 2 3 4 10. I put my problem in God‟s hands.

0 1 2 3 4 11. I prayed for strength.

0 1 2 3 4 12. I counted my blessings.

0 1 2 3 4 13. I talked to my religious leader (minister, priest, imam, etc.).

0 1 2 3 4 14. I recalled a passage from a religious text (e.g., Bible, Qur‟an).

0 1 2 3 4 15. I got help from religious leaders.

I used a religious story (e.g., from Bible or Qur‟an) to help 0 1 2 3 4 16. solve the problem. 0 1 2 3 4 17. I prayed to a religious figure for help (e.g., Jesus, Imam Ali).

0 1 2 3 4 18. I asked for God‟s forgiveness.

0 1 2 3 4 19. I donated time to a religious cause or activity.

0 1 2 3 4 20. I donated money to a religious charity.

0 1 2 3 4 21. I asked my religious leader for advice.

0 1 2 3 4 22. I shared my religious beliefs with others.

0 1 2 3 4 23. I got involved with church/mosque/temple activities.

0 1 2 3 4 24. I asked God to help me be more forgiving.

0 1 2 3 4 25. I gave money to a religious organization.

0 1 2 3 4 26. I based life decisions on my religious beliefs.

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0= not used at all/ does not apply 1= used sometimes 2= used often 3= used very often 4= used always

0 1 2 3 4 27. I found peace by going to a religious place or sanctuary.

0 1 2 3 4 28. I asked someone to pray for me.

0 1 2 3 4 29. I asked for a blessing.

0 1 2 3 4 30. I found peace by sharing my problems with God.

0 1 2 3 4 31. I recited a psalm, ayat, or surah.

I tried to see how God might be trying to strengthen me in the 0 1 2 3 4 32. situation. 0 1 2 3 4 33. I saw the situation as part of God‟s plan.

0 1 2 3 4 34. I wondered what I did for God to punish me.

0 1 2 3 4 35. I believed that the devil was responsible for my situation.

0 1 2 3 4 36. I did my best then turned the situation over to God.

0 1 2 3 4 37. I expected God to solve my problems for me.

0 1 2 3 4 38. I bargained with God to make everything work out.

0 1 2 3 4 39. I prayed for a miracle.

0 1 2 3 4 40. I trusted that God would be by my side.

0 1 2 3 4 41. I sought God‟s love and care.

0 1 2 3 4 42. I asked God to help me overcome my negative qualities.

0 1 2 3 4 43. I prayed to get my mind off my problems.

0 1 2 3 4 44. I asked forgiveness for my sins.

0 1 2 3 4 45. I hoped for a spiritual rebirth.

0 1 2 3 4 46. I sought a stronger spiritual connection with other people.

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0= not used at all/ does not apply 1= used sometimes 2= used often 3= used very often 4= used always

0 1 2 3 4 47. I asked for God to help me be less sinful.

0 1 2 3 4 48. I sought a stronger connection with God.

0 1 2 3 4 49. I avoided people who aren‟t of my faith.

0 1 2 3 4 50. I ignored advice that is not consistent with my faith.

0 1 2 3 4 51. I stuck to the teachings and practices of my religion.

0 1 2 3 4 52. I looked for love and concern from the members of my church.

I asked clergy or religious leaders to remember me in their 0 1 2 3 4 53. prayers. 0 1 2 3 4 54. I prayed for the well-being of others.

0 1 2 3 4 55. I offered spiritual support to family or friends.

0 1 2 3 4 56. I tried to comfort others through prayer.

0 1 2 3 4 57. I asked God to help me find a new purpose in life.

0 1 2 3 4 58. I looked for a total spiritual reawakening.

0 1 2 3 4 59. I prayed for a complete transformation of my life.

0 1 2 3 4 60. I asked God to help me overcome my bitterness.

I used a religious figure (e.g., Christ, Muhammad) as an 0 1 2 3 4 61. example of how I should live. I attended religious classes or lectures (e.g., Bible study, 0 1 2 3 4 62. Islamic halaqa)

Please answer the following questions about yourself:

Age: ______Ethnic-country background of mother (e.g., Lebanese, Syrian): ______Ethnic-country background of father (e.g., Lebanese, Syrian): ______Religious affiliation: ______Marital status (e.g., single, divorced): ______Education: (e.g., M.A., U.T. sophomore): ______

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Appendix C Web site Questionnaires for the Present Study

Arab Culture and Mental Health Survey # 2 Information and Informed Consent

Welcome to this website! My name is Mona Amer. I am a Clinical Psychology graduate student at The University of Toledo in Ohio, USA. As part of my Ph.D. dissertation I am conducting a national study on the relationships among acculturation, stress, social support, religious coping, and mental health for Arab Americans. The requirements for participating in this study are:

1) you must be 18 years or older 2) you must currently reside in the United States 3) BOTH of your parents must have ethnic or ancestral heritages from one or more of the following states: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Kuwait, Jordan, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Syria, Sudan, Tunisia, United Arab Emirates, Yemen

You will be asked to complete a series of questionnaires in which you select the option that best represents your experience. The completion time is approximately 20-40 minutes. A demographics page is also included. There are no known risks associated with participating, although you may find the procedure time-consuming. There is no option to save your responses in the middle of the survey, so please schedule yourself ample time to complete it.

At the end of this study you will be asked if you would like to be included in a random draw for $1,000 in cash rewards: five $10 gifts, four $25 gifts, seven $50 gifts, three $100 gifts, and one $200 gift.

This study has been approved by the University of Toledo‟s Human Subjects Research Review Committee. Participating in this study is completely voluntary. You may choose to withdraw at any time without negative consequences by exiting your web browser. Results are confidential, and all identifying information for the rewards drawing is asked at a different website so WE WILL NOT BE ABLE TO IDENTIFY WHICH SURVEY YOU COMPLETED. If you are interested in learning more about this study and its purposes or results, or have any questions prior to participating, or are having technical difficulties and would prefer me to e-mail you the research questionnaires, please call Mona Amer at (419) 530-2721 or e-mail me at [email protected].

By clicking “Next” and completing this study, you are agreeing to the following statements: I understand the requirements of this project, my role as a participant, and the associated risks involved. I understand that my participation is completely voluntary and that I have the right to withdraw at any time. I acknowledge that I am 18 years or older.

[for administration only: ____]

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[VIA- Arab Version]. Please answer each question as carefully as possible by selecting one of the following choices to indicate your degree of agreement and disagreement. In the statements, the term “ARAB” is used to refer to the NORTH AFRICAN/ MIDDLE EASTERN CULTURES or to persons who have a North African/ Middle Eastern ethnic background (even if the person identifies themselves with a different term such as “Arab American,” “Coptic,” or “Lebanese.”). The term “AMERICAN” is used to refer to MAINSTREAM EUROPEAN-AMERICAN CULTURE or persons who have a European-American ethnic background.

1= Strongly Disagree…. 2= Disagree…. 3= Neutral/ Depends…. 4= Agree…. 5= Strongly Agree

1 2 3 4 5 21) I often participate in Arab cultural traditions.

1 2 3 4 5 22) I often participate in mainstream American cultural traditions.

I would be willing to marry a person of Arab ethnic 1 2 3 4 5 23) background. 1 2 3 4 5 24) I would be willing to marry a (non-Arab) American person.

1 2 3 4 5 25) I enjoy social activities with people of Arab ethnicity.

1 2 3 4 5 26) I enjoy social activities with typical American people.

1 2 3 4 5 27) I am comfortable working with people of Arab ethnicity.

1 2 3 4 5 28) I am comfortable working with typical American people.

1 2 3 4 5 29) I enjoy Arab entertainment (e.g., movies, music).

1 2 3 4 5 30) I enjoy American entertainment (e.g., movies, music).

1 2 3 4 5 31) I often behave in ways that are typical of the Arab culture.

1 2 3 4 5 32) I often behave in ways that are „typically American.‟

It is important for me to maintain or develop the practices of 1 2 3 4 5 33) the Arab culture. It is important for me to maintain or develop American 1 2 3 4 5 34) cultural practices. 1 2 3 4 5 35) I believe in Arab values.

1 2 3 4 5 36) I believe in mainstream American values.

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1= Strongly Disagree…. 2= Disagree…. 3= Neutral/ Depends…. 4= Agree…. 5= Strongly Agree

1 2 3 4 5 37) I enjoy typical Arab/ Arabic jokes and humor.

1 2 3 4 5 38) I enjoy typical American jokes and humor.

1 2 3 4 5 39) I have friends of Arab ethnic background.

1 2 3 4 5 40) I have friends who are mainstream American.

[SAFE Scale Revised]. Below are listed a number of statements which might be seen as stressful. FIRST, decide if you have experienced the situation described in each statement. NEXT, select only one of the following choices (0,1,2,3) according to how stressful the experience has been to you.

0= have not experienced/ not at all stressful… 1= a little stressful… 2= moderately stressful… 3= very stressful

I feel uncomfortable when others make jokes about or put down 0 1 2 3 1) people of my ethnic background. 0 1 2 3 2) I have more barriers to overcome than most people.

It bothers me that family members I am close to do not understand 0 1 2 3 3) my new values. Close family members have different expectations about my future 0 1 2 3 4) than I do. 0 1 2 3 5) It is hard to express to my friends how I really feel.

0 1 2 3 6) My family does not want me to move away but I would like to.

0 1 2 3 7) It bothers me to think that so many people use drugs.

0 1 2 3 8) It bothers me that I cannot be with my family.

In looking for a good job, I sometimes feel that my ethnicity is a 0 1 2 3 9) limitation. 0 1 2 3 10) I don‟t have any close friends.

Many people have stereotypes about my culture or ethnic group and 0 1 2 3 11) treat me as if they are true. 0 1 2 3 12) I don‟t feel at home.

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0= have not experienced/ not at all stressful… 1= a little stressful… 2= moderately stressful… 3= very stressful

People think I am unsociable when in fact I have trouble 0 1 2 3 13) communicating in English. 0 1 2 3 14) I often feel that people actively try to stop me from advancing.

It bothers me when people pressure me to become part of the main 0 1 2 3 15) culture. 0 1 2 3 16) I often feel ignored by people who are supposed to assist me.

0 1 2 3 17) Because I am different I do not get enough credit for the work I do.

0 1 2 3 18) It bothers me that I have an accent.

Loosening the ties with my country (or family ethnic background) is 0 1 2 3 19) difficult. 0 1 2 3 20) I often think about my cultural background.

Because of my ethnic background, I feel that others often exclude 0 1 2 3 21) me from participating in their activities. 0 1 2 3 22) It is difficult for me to “show off” my family.

0 1 2 3 23) People look down upon me if I practice customs of my culture.

0 1 2 3 24) I have trouble understanding others when they speak.

It bothers me when the media portrays a negative image of Arabs 0 1 2 3 25) and Arab Americans Discrimination because of my ethnic background has hindered my 0 1 2 3 26) ability to reach short-term or long-term personal goals. It bothers me that current governmental policies and laws unfairly 0 1 2 3 27) target against persons of my ethnic background. The international policies of the U.S. toward Arab countries bother 0 1 2 3 28) me.

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[FAD- GF]. The following statements are about families. Please read each statement carefully, and decide how well it describes YOUR OWN FAMILY. You should answer according to how you see your family. For each statement there are four (4) possible responses: 1= strongly disagree (the statement does not describe your family at all); 2= disagree (the statement does not describe your family for the most part); 3= agree (the statement describes your family for the most part); 4= strongly agree (the statement describes your family very accurately). Try not to spend too much time thinking about each statement, but respond as quickly and as honestly as you can. If you have trouble with one, answer with your first reaction. Be sure to answer every statement.

1= Strongly Disagree… 2= Disagree… 3= Agree… 4= Strongly Agree

Planning family activities is difficult because we misunderstand 1 2 3 4 1) each other. 1 2 3 4 2) In times of crisis we can turn to each other for support.

1 2 3 4 3) We cannot talk to each other about the sadness we feel.

1 2 3 4 4) Individuals are accepted for what they are.

1 2 3 4 5) We avoid discussing our fears and our concerns.

1 2 3 4 6) We can express feelings to each other.

1 2 3 4 7) There are lots of bad feelings in the family.

1 2 3 4 8) We feel accepted for what we are.

1 2 3 4 9) Making decisions is a problem for our family.

1 2 3 4 10) We are able to make decisions about how to solve problems.

1 2 3 4 11) We don‟t get along well together.

1 2 3 4 12) We confide in each other.

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[PRQ Questionnaire Pt2]. Below are some statements with which some people agree and others disagree. Please read each statement and select only one response that is most appropriate for you. There is no right or wrong answer.

1= strongly disagree… 2= disagree… 3= neutral… 4= agree… 5= strongly agree

There is someone I feel close to who makes me feel 1 2 3 4 1) 5 secure. 1 2 3 4 2) I belong to a group in which I feel important. 5

People let me know that I do well at my work (job, 1 2 3 4 3) 5 homemaking). I can‟t count on my relatives and friends to help me with 1 2 3 4 4) 5 problems. I have enough contact with the person who makes me feel 1 2 3 4 5) 5 special. I spend time with others who have the same interests that 1 2 3 4 6) 5 I do. There is little opportunity in my life to be giving and caring 1 2 3 4 7) 5 to another person. Others let me know that they enjoy working with me (job, 1 2 3 4 8) 5 committees, projects). There are people who are available if I needed help over 1 2 3 4 9) 5 an extended period of time. 1 2 3 4 10) There is no one to talk to about how I am feeling. 5

1 2 3 4 11) Among my group of friends we do favors for each other. 5

I have the opportunity to encourage others to develop their 1 2 3 4 12) 5 interests and skills. My family lets me know that I am important for keeping the 1 2 3 4 13) 5 family running. I have relatives or friends that will help me out even if I 1 2 3 4 14) 5 can‟t pay them back. When I am upset there is someone I can be with who lets 1 2 3 4 15) 5 me be myself. 1 2 3 4 16) I feel no one has the same problems as I. 5

I enjoy doing little “extra” things that make another 1 2 3 4 17) 5 person‟s life more pleasant. 1 2 3 4 18) I know that others appreciate me as a person. 5

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1= strongly disagree… 2= disagree… 3= neutral… 4= agree… 5= strongly agree

1 2 3 4 19) There is someone who loves and cares about me. 5

1 2 3 4 20) I have people to share social events and fun activities with. 5

I am responsible for helping provide for another person‟s 1 2 3 4 21) 5 needs. If I need advice there is someone who would assist me to 1 2 3 4 22) 5 work out a plan for dealing with the situation. 1 2 3 4 23) I have a sense of being needed by another person. 5

1 2 3 4 24) Peopl e think that I‟m not as good a friend as I should be. 5

If I got sick, there is someone to give me advice about 1 2 3 4 25) 5 caring for myself.

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[Beck Anxiety Inventory]. Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by each symptom DURING THE PAST WEEK, INCLUDING TODAY, by selecting the corresponding choice (0-3). [Item not included here pursuant copyright laws]

0= not at all … 1= mildly (It did not bother me much.)… 2= moderately (It was very unpleasant, but I could stand it.)… 3= severely (I could barely stand it.)

0 1 2 3 1) Numbness or tingling.

0 1 2 3 2) Feeling hot.

0 1 2 3 3) Wobbliness in legs.

0 1 2 3 4) Unable to relax.

0 1 2 3 5) Fear of the worst happening.

0 1 2 3 6) Dizzy or lightheaded.

0 1 2 3 7) Heart pounding or racing.

0 1 2 3 8) Unsteady.

0 1 2 3 9) Terrified.

0 1 2 3 10) Nervous.

0 1 2 3 11) Feelin gs of choking.

0 1 2 3 12) Hands trembling.

0 1 2 3 13) Shaky.

0 1 2 3 14) Fear of losing control.

0 1 2 3 15) Difficulty breathing.

0 1 2 3 16) Fear of dying.

0 1 2 3 17) Scared.

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0= not at all … 1= mildly (It did not bother me much.)… 2= moderately (It was very unpleasant, but I could stand it.)… 3= severely (I could barely stand it.)

0 1 2 3 18) Indigestion or discomfort in abdomen.

0 1 2 3 19) Faint.

0 1 2 3 20) Face flushed.

0 1 2 3 21) Sweating (not due to heat).*

(Copyright © 1990, 1987 by Aaron T. Beck. Reproduced by permission of the publisher, The Psychological Corporation. All rights reserved. "Beck Anxiety Inventory" and "BAI" are trademarks of The Psychological Corporation registered in the United States of America and/or other jurisdictions.)

[CES-D Questionnaire]. Below is a list of ways you may have felt or behaved recently. Please decide how often you have felt this way DURING THE PAST WEEK, using the following choices.

1= rarely or none of the time (less than 1 day) … 2= some or a little of the time (1 – 2 days)… 3= occasionally or a moderate amount of time (3 – 4 days)… 4= most or all of the time (5 – 7 days)… During the past week: 1 2 3 4 1) I was bothered by things that usually don‟t bother me.

1 2 3 4 2) I did not feel like eating; my appetite was poor.

I felt that I could not shake off the blues even with help from 1 2 3 4 3) my family or friends. 1 2 3 4 4) I felt that I was just as good as other people.

1 2 3 4 5) I had trouble keeping my mind on what I was doing.

1 2 3 4 6) I felt depressed.

1 2 3 4 7) I felt that everything I did was an effort.

1 2 3 4 8) I felt hopeful about the future.

* [This item was not displayed on the internet website]

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1 2 3 4 10) I felt fearful.

1 2 3 4 11) My sleep was restless.

1 2 3 4 12) I was happy.

1 2 3 4 13) I talked less than usual.

1 2 3 4 14) I felt lonely.

1 2 3 4 15) People were unfriendly.

1 2 3 4 16) I enjoyed life.

1 2 3 4 17) I had crying spells.

1 2 3 4 18) I felt sad.

1 2 3 4 19) I felt that people dislike me.

1 2 3 4 20) I could not get “going.”

[BARCS Questionnaire]. Please read each statement carefully and select how often you have engaged in the following behaviors when you have experienced a STRESSFUL SITUATION OR PROBLEM.

0= not used at all/ does not apply… 1= used sometimes… 2= used often… 3= used always

0 1 2 3 1) I prayed for strength.

0 1 2 3 2) I looked for a lesson from God in the situation.

0 1 2 3 3) I got help from religious leader/s.

0 1 2 3 4) I recalled a passage from a religious text (e.g., Bible, Qur‟an).

259

0= not used at all/ does not apply… 1= used sometimes… 2= used often… 3= used always

0 1 2 3 5) I attended events at the church/ mosque/ temple.

0 1 2 3 6) I put my problem in God‟s hands.

0 1 2 3 7) I increased my prayers to God.

0 1 2 3 8) I attended religious classes (e.g., Bible study, Islamic halaqa)

0 1 2 3 9) I tried to make up for my mistakes.

0 1 2 3 10) I asked God for a blessing.

0 1 2 3 11) I used a religious story to help solve the problem.

0 1 2 3 12) I shared my religious beliefs with others.

0 1 2 3 13) I donated time to a religious cause or activity.

I looked for love and concern from the members of my church/ 0 1 2 3 14) mosque/ temple. 0 1 2 3 15) I prayed to get my mind off my problem/s.

Next >> (Page 4 of 5)

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DEMOGRAPHICS SURVEY

For each of the following questions, please select the answer that best describes you. You will not be asked your name or any other identifying information.

1. Location/ residence: State: [drop-down list of 50 states]

City (type answer):

2. Sex: Male Female

3. Current Age (in years): [drop-down list of ages 18-100 or more]

4. Marital Status: Single Engaged Married Separated Divorced Widowed Domestic partnership Other (explain):

5. Education: highest level COMPLETED: Elementary, junior high, or middle school High school degree (e.g., diploma, vocational school, GED) College/university classes, but no degree yet Associates degree (or 2 years post high school) Bachelors degree (or 4 years post high school) Masters degree (or equivalent) Doctoral degree (or equivalent) Other (explain):

6. Mother‟s education (highest degree COMPLETED): (?) No education Elementary school Junior high or middle school High school degree (e.g., diploma, vocational school, GED) Associates degree (or 2 years post high school) Bachelors degree (or 4 years post high school) Masters degree (or equivalent) Doctoral degree (or equivalent) Other (explain):

(?)If your mother studied in a different educational system, select the option that is most equivalent.

261

7. Father‟s highest education: highest degree completed: (?) No education Elementary school Junior high or middle school High school degree (e.g., diploma, vocational school, GED) Associates degree (or 2 years post high school) Bachelors degree (or 4 years post high school) Masters degree (or equivalent) Doctoral degree (or equivalent) Other (explain):

8. Annual family income before taxes (in dollars): [drop-down list of the following:] less than 15,000 15,000 – 24,999 25,000 – 34,999 35,000 – 49,999 50,000 – 74,999 75,000 – 99,999 100,000 – 149,999 over 150,000 I‟m not sure

9. Occupation/ Job (please type answer):

10. Religious Affiliation: Atheist/ agnostic/ none Druze Christian (specify below, e.g., Maronite, Greek Orthodox, Catholic): Jewish Muslim (specify below, e.g., Sunni, Shi`aa): Other (please specify) or type specific affiliation:

11. Birthplace (please type COUNTRY):

12. Age when moved to the United States (if born in the U.S., please type “0”):

13. My mother‟s family origin is: [drop down list of the following]: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Kuwait, Jordan, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Syria, Sudan, Tunisia, United Arab Emirates, Yemen, United States, More than one Arab state, Arab state + non-Arab state, Other]

14. My father‟s family origin is: [drop down list of the following]: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Kuwait, Jordan, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Syria, Sudan, Tunisia, United Arab

(?)If your father studied in a different educational system, select the option that is most equivalent.

262

Emirates, Yemen, United States, More than one Arab state, Arab state + non-Arab state, Other] 15. Please check the category that best describes you: (?) Sojourner (I am living in the U.S. temporarily, for example for school or work, and plan to return to my home country) First generation (I am the first of my family to immigrate to the U.S.) Second generation (My parents were the first from our family to immigrate) Third generation (My grandparents were the first to move to the U.S.) Fourth, fifth, etc. generation (My great-grandparents, etc. were the first to come here) Other (please explain):

16. My immigration or visitation to the U.S. was: Completely voluntary (e.g., for better opportunities) Involuntary or unplanned (e.g., political or religious exile, refugee) Both voluntary and involuntary Does not apply (e.g., I was born here) Other (please explain):

17. My legal status to live in the United States is: U.S. Citizenship/ passport Green Card Temporary visa (e.g., student, work) Refugee, asylum, etc. status Decline to answer Other (please explain):

18. I have citizenship (i.e., passport) in an Arab country: Yes No Other (please explain):

19. My extended family (e.g., parents, aunts and uncles, grandparents, siblings, children) live: Mostly in the United States in the same city as I Mostly in the United States but in other cities About half in the U.S. and half in an Arab State About half in the U.S. and half in another non-Arab country Mostly in an Arab State Mostly in another non-Arab country Other (please explain):

20. I visit / have visited an Arab state: Never Once or twice in my life Three to six times in my life I visit/ed on a regular basis (e.g., every year, every couple of years)

(?)If your parents are of different generational status, select the higher generation. For example, if your father's parents moved to the U.S. and your father was born here (= you are 3rd generation), but your mother immigrated (= you are 2nd generation), select 3rd generation.

263

Other (please explain):

21. The last time I visited or lived in an Arab state was: This year 1 year to less than 2 years ago 2 years to less than 5 years ago 5 years to less than 10 years ago 10 years to less than 20 years ago More than 20 years ago Never Other (please explain):

22. At home we speak: Only English Mostly English English and Arabic about equally Mostly Arabic Only Arabic Another language combination (please explain):

23. I watch Arabic television: Never Once in a while (every few months) Sometimes (about every couple of weeks to every month) Often (about once a week or more) Always (almost every day, or every day) Other (please explain):

24.A. Choose only one answer from the four choices that best reflects your opinion. To what extent do you want to adopt American culture? I want to see myself as American rather than Arab or Arab-American. I want to become a regular American who is proud of my Arab background and follows the values and traditions of both American and Arab cultures. I want to remain Arab in my values and culture; I don‟t want to become “Americanized.” I do not want to see myself or categorize myself as either Arab or American.

24.B. Choose only one answer from the four choices that best reflects your opinion. To what extent do you think you have adopted American culture so far?

I see myself as American rather than Arab or Arab-American. I see myself as a regular American who is proud of his/ her Arab background and follows some Arabic traditions. I see myself as mostly Arab in my values and culture. I don‟t see myself as either Arab or American, neither category describes me.

264

25. I heard about this study from: Internet listserv of an Arab cultural center (specify below): Internet listserv of an Arab specialty group, i.e., lawyers or doctors (specify below): Internet listserv of Arab university club or union (specify below): Internet listserv of a university or college (specify below): Internet mailing group posting/ website posting (specify below): Personal acquaintance or friend Other/ I‟m not sure/ Explanation of above choice:

That was my last question! Please quick "Submit." You will next have the chance to visit a different webpage if you would like to 1) register for the $1,000 in cash rewards random draw, 2) send comments about this study to the researcher, and/ or 3) ask to receive study results. If you have any difficulties, please contact [email protected].

Submit (Page 5 of 5)

265

Your Form Was Successfully Submitted!

Please click here if you would like to register for the cash drawing, make comments, or ask for study results. To protect your confidentiality, you will be taken to a different website.

266

Arab American Culture & Mental Health Study #2 Rewards, Comments, & Study Results Page

Thank your for completing my study! This page is hosted on a different webpage from the previous ones, and therefore it will NOT be possible to identify which survey you completed.

1. REWARDS: Twenty checks totaling $1,000 will be awarded to randomly- selected participants at the completion of this study. A minimum of 250 persons will be solicited for this study. The rewards are: ten $50 gifts, three $100 gifts, and one $200 gift. If you would like to be considered for the reward, please include all of the following information so that I may contact you if you are a winner. If you do not include all of the following, you will not be included in the draw. Your information will not be released to anyone, and it will be discarded at the conclusion of the draw:

Name (first name required):

E-mail (required) (?) :

Second e-mail or phone # (required):

2. COMMENTS. If interested, please provide any comments about the topics included in the survey you just completed, or about the survey itself. If you would like a response to your comments, please indicate so below.

Your comments:

Would you like a response to your comments? Yes No I don't mind either way

If you would like a response (or don't mind a response) please indicate your e-mail below:

3. STUDY RESULTS. If you would like to receive a summary of the results of this study, please include your e-mail below: E-mail:

Thanks again for your participation! Don't forget to click "Submit!"

Submit

(?)If you do not have an email, please list a second phone number instead.

267

Your Form Was Successfully Submitted!

[Link to University of Toledo Program for Immigration and Mental Health].

268

Appendix D

SAFE Acculturation Stress Scale (Mena et al., 1987)

SAFE

Below are a number of statements that might be seen as stressful. For each statement that you have experienced, circle only one of the following numbers (1, 2, 3, 4, or 5), according to how stressful you find the situation.

If the statement does not apply to you, circle number 0: Have Not Experienced.

0 = HAVE NOT EXPERIENCED 1 = NOT AT ALL STRESSFUL 2 = SOMEWHAT STRESSFUL 3 = MODERATELY STRESSFUL 4 = VERY STRESSFUL 5 = EXTREMELY STRESSFUL

STATEMENTS ______

1. I feel uncomfortable when others make jokes about or put down people of my ethnic background...... 0 1 2 3 4 5

2. I have more barriers to overcome than most people...... 0 1 2 3 4 5

3. It bothers me that family members I am close to do not understand my new values...... …………………………………………………………….. 0 1 2 3 4 5

4. Close family members have different expectations about my future than I do. .. 0 1 2 3 4 5

5. It is hard to express to my friends how I really feel...... 0 1 2 3 4 5

6. My family does not want me to move away but I would like to...... 0 1 2 3 4 5

7. It bothers me to think that so many people use drugs...... 0 1 2 3 4 5

8. It bothers me that I cannot be with my family...... 0 1 2 3 4 5

9. In looking for a good job, I sometimes feel that my ethnicity is a limitation. . . ..0 1 2 3 4 5

10. I don't have any close friends...... …0 1 2 3 4 5

11. Many people have stereotypes about my culture or ethnic group and treat me as if they are true……………………………………………………………………………..0 1 2 3 4 5

12. I don't feel at home...... …0 1 2 3 4 5

13. People think I am unsociable when in fact I have trouble communicating in English...... ……………………………………………………………...0 1 2 3 4 5

14. I often feel that people actively try to stop me from advancing...... …0 1 2 3 4 5

269

STATEMENTS ______0 = HAVE NOT EXPERIENCED 1 = NOT AT ALL STRESSFUL 2 = SOMEWHAT STRESSFUL 3 = MODERATELY STRESSFUL 4 = VERY STRESSFUL 5 = EXTREMELY STRESSFUL

15. It bothers me when people pressure me to become part of the main culture…..0 1 2 3 4 5

16. I often feel ignored by people who are supposed to assist me...... ……0 1 2 3 4 5

17. Because I am different I do not get the credit for the work I do...... 0 1 2 3 4 5

18. I bothers me that I have an accent...... 0 1 2 3 4 5

19. Loosening the ties with my country is difficult...... …. . . . . ….0 1 2 3 4 5

20. I often think about my cultural background...... …...... …0 1 2 3 4 5

21. Because of my ethnic background, I feel that others often exclude me from participating in their activities...... …0 1 2 3 4 5

22. It is difficult for me to "show off" my family...... …0 1 2 3 4 5

23. People look down upon me if I practice customs of my culture...... 0 1 2 3 4 5

24. I have trouble understanding others when they speak...... 0 1 2 3 4 5

270

Appendix E

BARCS: Initial 62 Pilot Items Ordered by Logit Measure

Meas Infit Infit Outfit Outfit Items Count -ure Error MSNQ ZSTD MSNQ ZSTD Corr.

35. believed devil was responsible 75 1.47 .13 1.94 4.2 2.35 4.5 .23

49. avoided others of nonfaith 75 1.36 .12 1.56 2.8 1.81 3.1 .38

38. bargained with God 75 1.24 .12 1.55 2.8 1.50 2.1 .46

34. wondered why i'm punished 75 .98 .11 2.01 5.0 2.08 4.4 .29

15. got help from religious leaders 76 .86 .11 1.01 0.1 0.88 -0.7 .70

17. prayed to religious figure 74 .81 .11 2.41 6.5 2.52 5.8 .32

21. asked advice of religious leader 75 .80 .11 0.88 -0.8 0.79 -1.2 .74

58. looked spiritual reawakening 73 .77 .11 1.30 1.8 1.28 1.4 .54

45. hoped for spiritual rebirth 76 .75 .11 1.38 2.3 1.36 1.8 .56

53. asked clergy to remember me 74 .73 .11 1.30 1.8 1.23 1.2 .66

37. expected God to solve 75 .59 .11 1.08 0.5 1.17 0.9 .62

59. prayed for transformation 74 .56 .11 1.19 1.2 1.30 1.6 .57

46. sought spiritual connection 75 .56 .11 0.96 -0.3 1.62 2.9 .58

52. looked love from congregation 74 .55 .11 1.09 0.6 1.02 0.1 .67

13. talked to religious leader 75 .54 .11 1.19 1.2 1.20 1.1 .60

4. talked with clergy leaders 76 .50 .11 0.98 -0.2 1.08 0.4 .66

57. asked God to find new purpose 75 .45 .11 1.50 2.9 1.66 3.1 .45

16. used religious story 73 .44 .11 0.80 -1.4 0.71 -1.8 .71

62. attended religious classes 75 .34 .11 0.91 -0.6 0.88 -0.7 .67

25. gave money to organization 76 .19 .11 0.77 -1.6 0.73 -1.6 .70

50. ignored advice nonconsistent 74 .18 .11 1.31 1.9 1.34 1.7 .58

19. donated time to religious cause 75 .18 .11 0.67 -2.5 0.63 -2.3 .73

271

Meas Infit Infit Outfit Outfit Items Count -ure Error MSNQ ZSTD MSNQ ZSTD Corr.

39. prayed for a miracle 76 .15 .11 1.48 2.8 1.76 3.4 .46

20. donated money to charity 74 .13 .11 0.85 -1.1 0.81 -1.1 .67

3. read scriptures 76 .11 .11 0.82 -1.3 0.76 -1.4 .71

23. got involved in activities 76 .11 .11 0.76 -1.8 0.77 -1.3 .70

22. shared religious beliefs 76 .09 .11 0.73 -2.0 0.67 -2.0 .71

28. asked someone to pray for me 76 .08 .11 1.29 1.8 1.18 0.9 .62

5. attended events at church/mosque 76 .06 .11 0.78 -1.6 0.80 -1.1 .71

60. asked to overcome bitterness 74 -.01 .11 1.12 0.7 1.14 0.7 .58

14. recalled religious passage 75 -.09 .11 0.66 -2.4 0.58 -2.5 .72

27. found peace at sanctuary 75 -.12 .11 0.96 -0.3 0.98 -0.1 .60

56. tried to comfort others 75 -.12 .11 0.87 -0.9 0.78 -1.2 .70

1. said supplications 74 -.15 .12 1.25 1.4 1.86 3.7 .46

61. used religious figure as ex 75 -.19 .12 0.76 -1.6 0.72 -1.5 .70

43. prayed to get mind off 76 -.20 .12 0.87 -0.8 0.76 -1.3 .68

47. asked God to be less sinful 75 -.21 .12 1.50 2.7 1.80 3.2 .52

36. did best then turned to God 76 -.23 .12 1. 03 0.2 1.29 1.3 .62

29. asked for a blessing 75 -.29 .12 0.90 -0.6 0.82 -0.9 .66

24. asked God to be forgiving 76 -.33 .12 0.76 -1.6 0.63 -2.0 .71

55. support to family & friends 75 -.35 .12 0.93 -0.4 1.56 2.2 .52

32. tried to see strength 74 -.36 .12 0.49 -3.8 0.51 -2.8 .73

6. looked for lesson from God 76 -.37 .12 0.64 -2.5 0.58 -2.2 .73

26. based decisions on beliefs 76 -.37 .12 0.69 -2.1 0.58 -2.3 .71

33. saw situation as God's plan 74 -.42 .12 0.65 -2.3 0.59 -2.1 .69

31. recited psalm, ayat 76 -.42 .12 1.43 2.2 1.41 1.6 .52

272

Meas Infit Infit Outfit Outfit Items Count -ure Error MSNQ ZSTD MSNQ ZSTD Corr.

7. tried to be less sinful 75 -.42 .12 1.10 0.6 1.12 0.5 .60

2. increased prayers to God 76 -.49 .12 0.78 -1.3 0.95 -0.2 .63

12. counted my blessings 76 -.51 .12 1.01 0.0 1.05 0.2 .59

54. prayed for others wellbeing 75 -.52 .13 0.81 -1.2 0.93 -0.3 .60

51. stuck to religious teachings 75 -.55 .13 0.90 -0.6 1.00 0.0 .60

10. put my problem in God's hands 76 -.59 .13 0.61 -2.5 0.56 -2.2 .71

30. shared problems with God 76 -.59 .13 0.58 -2.8 0.52 -2.5 .73

48. sought stronger God connect 74 -.64 .13 0.52 -3.2 0.54 -2.2 .70

42. overcome negative qualities 76 -.65 .13 0.67 -2.0 0.65 -1.6 .68

8. prayed to God for inspiration 76 -.67 .13 0.47 -3.6 0.55 -2.2 .73

9. tried to make up for mistakes 76 -.74 .13 0.83 -0.9 0.83 -0.7 .61

41. sought God's love & care 75 -.91 .14 0.85 -0.8 0.92 -0.3 .63

40. trusted God would be at side 76 -.96 .15 0.85 -0.8 0.77 -0.9 .60

11. prayed for strength 76 -.98 .15 0.51 -2.9 0.54 -2.0 .70

44. asked forgiveness for sins 76 -1.02 .15 1.13 0.6 0.93 -0.2 .60

18.asked for God's forgiveness 76 -1.12 .16 0.66 -1.8 0.52 -1.9 .66

Mean 75 .00 .12 1.01 -0.2 1.05 0.0

SD .61 .01 0.38 2.1 0.47 2.0

Note. Items in bold were removed.

273

Appendix F BARCS: Piloted Items Removed and Reason for the Removal

Item Count Measure Error Corr. Reason removed

45. hoped for spiritual 76 .75 .11 .56 logit measure and content redundant rebirth with item 58 (.77, +/- .11; looked for spiritual reawakening); participants did not understand item

53. asked clergy to 74 .73 .11 .66 logit measure redundant with item 58 remember me (.77 +/- .11)

59. prayed for 74 .56 .11 .57 logit measure redundant with items transformation 37 (.59, +/- .11) and 52 (.55, +/- .11); participants did not understand item

50. ignored advice 74 .18 .11 .58 logit measure redundant with item 19 nonconsistent with (.18 +/- .11); participants did not faith understand item

23. got involved in 76 .11 .11 .70 logit measure redundant with item 3 activities (.11, +/- .11); content redundant with item 19 (donated time to religious cause)

28. asked someone to 76 .08 .11 .62 logit measure redundant with item 22 pray for me (.09, +/- .11)

60. asked to overcome 74 -.01 .11 .58 content redundant with item 24 bitterness (asked God to be forgiving)

56. tried to comfort 75 -.12 .11 .70 logit measure redundant with item 27 others (-.12, +/- .11)

32. tried to see 74 -.36 .12 .73 logit measure and content redundant strength with item 6 (-.37, +/- .12; looked for lesson from God)

26. based decisions on 76 -.37 .12 .71 logit measure redundant with item 6 beliefs (-.37, +/- .12)

33. saw situation as 74 -.42 .12 .69 logit measure redundant with item 7 God's plan (-.42, +/- .12); item content redundant with item 6 (looked for lesson from God)

12. counted my 76 -.51 .12 .59 logit measure redundant with items 2 blessings (-.49, +/- .12) and 54 (-.52, +/- .13)

274

Item Count Measure Error Corr. Reason removed

51. stuck to religious 75 -.55 .13 .60 logit measure redundant with item 54 teachings (-.52, +/- .13)

30. shared problems 76 -.59 .13 .73 logit measure and content redundant with God with item 10 (-.59, +/- .13; put my problem in God's hands)

42. overcome negative 76 -.65 .13 .68 logit measure redundant with item 48 qualities (-.64, +/- .13)

8. prayed to God for 76 -.67 .13 .73 logit measure redundant with item 48 inspiration (-.64, +/- .13); participants did not understand item

40. trusted God would 76 -.96 .15 .60 logit measure redundant with item 11 be at side (-.98, +/- .15)

44. asked forgiveness 76 -1.02 .15 .60 logit measure redundant with item 11 for sins (-.98, +/- .15); content redundant with item 18 (asked for God's forgiveness)

275

Appendix G BARCS: Revised 28 Pilot Items Ordered by Logit Measure

Meas- Infit Infit Outfit Outfit Items Count ure Error MSNQ ZSTD MSNQ ZSTD Corr.

15. got help from religious leaders 75 1.23 .13 1.28 1.6 1.06 0.3 .72

58. looked spiritual reawakening 72 1.10 .13 1.89 4.3 2.22 4.8 .52

37. expected God to solve 74 .87 .13 1.41 2.2 1.91 3.8 .63

52. looked love from congregation 73 .81 .13 1.31 1.8 1.28 1.4 .69

4. talked with clergy leaders 75 .76 .12 1.17 1.0 1.33 1.6 .69

16. used religious story 72 .67 .13 0.93 -0.4 0.82 -1.0 .74

62. attended religious classes 74 .54 .12 1.09 0.5 1.10 0.5 .69

19. donated time to religious cause 74 .34 .13 0.84 -1.1 0.78 -1.2 .74

20. donated money to charity 73 .27 .13 0.97 -0.2 0.87 -0.7 .71

3. read scriptures 75 .25 .13 0.79 -1.4 0.75 -1.4 .75

22. shared religious beliefs 75 .23 .13 0.81 -1.2 0.72 -1.6 .74

5. attended events at 75 .18 .13 0.81 -1.2 0.81 -1.0 .74 church/mosque

14. recalled religious passage 74 .00 .13 0.69 -2.2 0.59 -2.3 .75

27. found peace at sanctuary 74 -.04 .13 1.30 1.7 1.44 1.8 .57

61. used religious figure as ex 74 -.13 .13 0.84 -1.0 0.76 -1.2 .71

43. prayed to get mind off 75 -.14 .13 1.14 0.8 1.11 0.5 .64

36. did best then turned to God 75 -.18 .13 1.27 1.5 2.07 3.7 .60

29. asked for a blessing 74 -.24 .13 1.19 1.1 1.25 1.0 .61

24.asked God to be forgiving 75 -.30 .13 0.89 -0.7 0.77 -1.1 .69

6. looked for lesson from God 75 -.35 .13 0.72 -1.8 0.68 -1.5 .71

7. tried to be less sinful 74 -.41 .14 1.28 1.5 1.38 1.4 .59

2. increased prayers to God 75 -.50 .14 0.96 -0.2 1.21 0.8 .62

276

Meas- Infit Infit Outfit Outfit Items Count ure Error MSNQ ZSTD MSNQ ZSTD Corr.

54. prayed for others wellbeing 74 -.54 .14 1.11 0.6 1.40 1.5 .55

10. put my problem in God's hands 75 -.62 .14 0.65 -2.2 0.56 -2.0 .70

48. sought stronger God connect 73 -.68 .14 0.65 -2.2 0.68 -1.4 .67

9. tried to make up for mistakes 75 -.80 .15 0.99 -0.1 1.07 0.2 .58

11. prayed for strength 75 -1.08 .16 0.54 -2.8 0.61 -1.5 .67

18. asked for God's forgiveness 75 -1.24 .17 0.63 -2.0 0.53 -1.7 .64

MEAN 74 .00 .13 1.01 -0.1 1.06 0.1

SD .63 .01 0.30 1.7 0.44 1.8

Note. Items in bold were removed.

277

Appendix H BARCS: Revised 18 Pilot Items Ordered by Logit Measure

Meas- Infit Infit Outfit Outfit Items Count ure Error MSNQ ZSTD MSNQ ZSTD Corr.

15. got help from religious leaders 75 1.23 .13 1.28 1.6 1.06 0.3 .72

52. looked love from congregation 73 .81 .13 1.31 1.8 1.28 1.4 .69

16. used religious story 72 .67 .13 0.93 -0.4 0.82 -1.0 .74

62. attended religious classes 74 .54 .12 1.09 0.5 1.10 0.5 .69

19. donated time to religious cause 74 .34 .13 0.84 -1.1 0.78 -1.2 .74

22. shared religious beliefs 75 .23 .13 0.81 -1.2 0.72 -1.6 .74

5. attended events at 75 .18 .13 0.81 -1.2 0.81 -1.0 .74 church/mosque

14. recalled religious passage 74 .00 . 13 0.69 -2.2 0.59 -2.3 .75

27. found peace at sanctuary 74 -.04 .13 1.30 1.7 1.44 1.8 .57

43. prayed to get mind off 75 -.14 .13 1.14 0.8 1.11 0.5 .64

29. asked for a blessing 74 -.24 .13 1.19 1.1 1.25 1.0 .61

6. looked for lesson from God 75 -.35 .13 0.72 -1.8 0.68 -1.5 .71

2. increased prayers to God 75 -.50 .14 0.96 -0.2 1.21 0.8 .62

54. prayed for others wellbeing 74 -.54 .14 1.11 0.6 1.40 1.5 .55

10. put my problem in God's hands 75 -.62 .14 0.65 -2.2 0.56 -2.0 .70

48. sought stronger God connect 73 -.68 .14 0.65 -2.2 0.68 -1.4 .67

9. tried to make up for mistakes 75 -.80 .15 0.99 -0.1 1.07 0.2 .58

11. prayed for strength 75 -1.08 .16 0.54 -2.8 0.61 -1.5 .67

MEAN 74 .00 .13 1.01 -0.1 1.06 0.1

SD .63 .01 0.30 1.7 .44 1.8

Note. Items in bold were removed.

278

Appendix I Example E-mail Invitation for the Present Study

Arab Americans: Join Study & Win Money!

Ahlan! My name is Mona Amer. I‟m inviting you to participate in my Ph.D. study on Arab American culture, stress, and mental health. The questions are easy to understand, and you‟ll have the chance to win one of 20 cash gifts ranging from $10 to $200 (totaling $1,000)!

To participate in the study, you must: 1) be 18 years or older, 2) currently live in the United States, and 3) have both parents from Middle East/North African ancestry. You can be of any religious affiliation, and you can participate even if you don't call yourself “Arab” or “American.” This is the first study of its kind in the U.S., and you will help us develop a better understanding of how to help Arab Americans become happier and less stressed.

You can complete the study at:

WWW.ARABAMERICANSTUDY.COM (or http://fs3.formsite.com/Dissertation/ArabAmericanStudy/secure_index.html)

Thanks for your time and willingness to help me!

Mona Amer, [email protected], 419-530-2721

** Because I need all the participants I can get, please forward this e-mail to internet groups and other potential respondents! **

Mona Amer Program for the Study of Immigration and Mental Health The University of Toledo, Ohio

279

Appendix J Summary of Responses to Arab Acculturative Strategy Scale

Cumulative Response n Percentage Percentage

Total sample (n= 590)

Desired

Assimilation 8 1.3 1.4

Integration 328 53.7 56.9

Separation 180 29.5 87.5

Marginalization 74 12.1 100.0

Current

Assimilation 19 3.1 3.2

Integration 276 45.2 50.0

Separation 227 37.2 88.5

Marginalization 68 11.1 100.0

Christians (n= 132)

Desired

Assimilation 3 2.3 2.3

Integration 91 68.9 71.2

Separation 22 16.7 87.9

Marginalization 16 12.1 100.0

Current

Assimilation 9 6.8 6.8

Integration 78 59.1 65.9

Separation 35 26.5 92.4

Marginalization 10 7.6 100.0

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Cumulative Response n Percentage Percentage

Muslims (n= 423)

Desired

Assimilation 5 1.2 1.2

Integration 217 51.3 52.5

Separation 152 35.9 88.4

Marginalization 49 11.6 100.0

Current

Assimilation 8 1.9 1.9

Integration 185 43.7 45.6

Separation 184 43.5 89.1

Marginalization 46 10.9 100.0

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Appendix K BAI Descriptive Statistics for Select Studies with Different Ethnic Groups

Study and Sample n Mean SD Alpha

Al-Issa, Bakal, & Fung (1999)

Lebanese university students in Beirut, Lebanon 202 16.90 10.30 .89

Canadian university students in Calgary, Canada 557 10.20 _8.20 .89

Al-Issa, Al Zubaidi, Bakal, & Fung (2000)

Arab university students in United Arab Emirates 240 17.10 _9.50 .87

Contreras, Fernandez, & Malcarne (2004)

Undergraduate Latino students in San Diego, CA 1,110 _9.86 _8.50 .89

Undergraduate Caucasian college students 2,703 _9.05 _8.30 .89

Hoyer, Becker, & Neumer (2002)

Randomly-selected females ages 18-24 in Germany 1,872 _4.78 _5.33

Novy, Stanley, Averill, & Daza (2001)

Hispanic immigrant and later-generation persons with 98 19.41 14.18 .95 diagnosed anxiety disorders, in Houston, TX

Ulusoy, Sahin, & Erkmen (1998)

Psychiatric outpatients in Istanbul, Turkey 177 27.02 14.21 .93

Note. All studies used the English version of the BAI, with the exception of Ulusoy et al. (1998), which used a Turkish translation and Al-Issa et al. (2000), which used an Arabic translation.

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Appendix L CES-D Descriptive Statistics for Select Studies with Different Ethnic Groups

Study and Population n Mean SD Alpha

African American

Conerly, Baker, Dye, Douglas, & Zabora (2002)

Survivors of cancer across the U.S. 216 15.70 11.89 .90

Foley, Reed, Mutran, & DeVellis (2002)

Older (ages 59-96) community members in NC 217 _7.99 _7.95

McCallion & Kolomer (2000)

Caregiver grandmothers in New York City 393 15.90 _9.50

Asian American

Gupta & Yick (2001)

Older (ages 56-80) Chinese immigrants in Los 75 11.70 _4.60 Angeles

Noh, Avison, & Kaspar (1992)

Random sample of Korean immigrants to Canada 860 14.71

Native American

Beals, Manson, & Keane (1991)

American Indian college students in Western U.S. 605 16.20

Chapleski, Lamphere, Kaczynski, Lichtenberg, & Dwyer (1997)

Older (above 55) American Indians in Michigan 309 _9.49 _8.53

Manson, Ackerson, & Dick (1990)

American Indian boarding school adolescents 188 19.50 _9.43 .82

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Study and Population n Mean SD Alpha

Latino American

Garcia & Marks (1989)

Mexican American adults 3,084 _7.94

Multi-ethnic American

Chung et al. (2003)

Asian primary care patients in New York City 91 16.60 11.80

Latino primary care patients in New York City 133 17.90 12.95

Iwata, Turner, & Lloyd (2002)a

Randomly-selected White non-Hispanic young adults 463 12.97 from Miami-Dade, Florida, school lists

U.S.-born Hispanic young adults 493 13.20

Hispanic immigrant young adults 395 13.31

African American young adults 434 14.01

Prescott et al. (1998)

High school Hawaiian students (Native, Japanese, 556 14.10 _9.53 Filipino, Caucasian, and other ethnicities)

Arab

Ghubash et al. (2000)

Arab females in the United Arab Emirates 350 15.50 _9.90 .88

Medical students subsample 92 14.10 10.60

Non-medical students subsample 151 15.80 _8.50

Community subsample 107 16.50 10.70

Note: Some participants in Gupta & Yick (2001) completed the CES-D translated to Mandarin and Cantonese. The CES-D administered in Noh et al. (1992) was translated to Korean. The CES-D administered in Ghubash et al. (2000) was translated to Arabic. Some participants in Chung et al. (2003) completed the CES-D translated to Chinese or Spanish. aMeans are gender- and age-adjusted.

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1. Arab i.d. .020 .015 .014 -.004 -.019 -.017 -.053 -.003 -.024 .004 .017 .007 .017 -.009 -.005

2. American i.d. .015 .429 .200 .234 .076 .223 .200 .215 -.004 -.063 -.139 .014 .091 -.109 -.056

3. generation .014 .200 1.346 .963 .480 .535 .203 .333 -.363 -.141 .007 -.039 .122 -.163 -.053

Estimated Covariance for Variables SEM Matrix 4. stay in U.S. -.004 .234 .963 1.797 .440 .675 .208 .712 .085 -.113 -.073 .019 .166 -.507 -.170

5. Arab visit -.019 .076 .480 .440 2.626 .432 .299 -.179 -.223 -.007 .059 -.035 .061 .129 .037

6. language -.017 .223 .535 .675 .432 1.122 .420 .372 -.043 -.090 -.162 -.038 .044 -.135 -.024

7.Arabic TV -.053 .200 .203 .208 .299 .420 1.774 .237 .133 -.089 -.260 -.026 -.004 -.153 -.054

Appendix M 8. income -.003 .215 .333 .712 -.179 .372 .237 4.821 .399 -.212 -.127 .163 .272 -.676 -.266

9. education -.024 -.004 -.363 .085 -.223 -.043 .133 .399 1.266 .012 -.090 .032 .006 -.235 -.091

10. accult. stress .004 -.063 -.141 -.113 -.007 -.090 -.089 -.212 .012 .225 .026 -.069 -.097 .339 .130

11. religious cope .017 -.139 .007 -.073 .059 -.162 -.260 -.127 -.090 .026 .690 .082 .082 .039 -.014

12. family funct. .007 .014 -.039 .019 -.035 -.038 -.026 .163 .032 -.069 .082 .294 .141 -.268 -.122

13. social support .017 .091 .122 .166 .061 .044 -.004 .272 .006 -.097 .082 .141 .309 -.294 -.157

14. anxiety -.009 -.109 -.163 -.507 .129 -.135 -.153 -.676 -.235 .339 .039 -.268 -.294 3.029 .714

15. depression -.005 -.056 -.053 -.170 .037 -.024 -.054 -.266 -.091 .130 -.014 -.122 -.157 .714 .348

Note. 1. Arab i.d.= Arab ethnic identity (VIA-A Arab); 2. American i.d.= American cultural identity (VIA-A American); 3. generation= generational status; 4. stay in U.S.= length of residence in the U.S.; 5. Arab visit= recentness of visit to Arab world (higher scores indicate less recent visitations); 6. language= language use (higher scores indicate more English and less Arabic); 7. Arabic TV= frequency of Arabic TV viewing (higher scores indicate less viewing); 8. income= annual family income; 9. education= highest educational level; 10. accult. stress= acculturation stress (SAFE-R); 11. religious cope= religious coping (BARCS); 12. family funct.= family functioning (FAD-GF); 13. social support= (PRQ85-R); 14. anxiety= (BAI); 15. depression= (CES-D).

284

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1. Arab i.d. -- .16**** .09* -.02 -.08* -.11** -.28**** -.01 -.15**** .06 .15**** .10* .22**** -.037 -.059

2. American i.d. -- .26**** .23**** .07 .32**** .23**** .15**** -.01 -.20**** -.26*** .04 .25**** -.10* -.14****

3. generation -- .62**** .26*** .44**** .13*** .13*** -.28**** -.26**** .01 -.06 .19**** -.08 -.08

Estimated Correlation Matrix for Variables SEM

4. stay in U.S. -- .20**** .49**** .12*** .24**** .06 -.18**** -.07 .03 .22**** -.22**** -.22****

5. Arab visit -- .25**** .14**** -.05 -.12*** -.01 .04 -.04 .07 .05 .04

6. language -- .30**** .16**** -.04 -.18**** -.18**** -.07 .08 -.07 -.04

7.Arabic TV -- .08 .09* -.14**** -.24**** -.04 -.01 -.07 -.07

Appendix N 8. income -- .16**** -.20**** -.07 .14*** .23**** -.18**** -.20****

9. education -- .02 -.10* .05 .01 -.12*** -.14****

10. accult. stress -- .07 -.27**** -.37**** .41**** .47****

11. religious cope -- .18**** .18**** .03 -.03

12. family funct. -- .47**** -.28**** -.38****

13. social support -- -.30**** -.48****

14. anxiety -- .70****

15. depression --

285