Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)

Legacy Department

International Family and Community Studies

Committee Chair/Advisor

Kimbrough-Melton, Robin J

Committee Member

McDonell , James R

Committee Member

Holaday , Bonnie

Committee Member

El-Bassel , Nabila

Committee Member

Heidmets , Mati


In 1991, dramatic socio-political changes transformed the Russian-speaking population in Estonia from the governing class to an immigrant minority virtually overnight absent of a relocation or emigration process. New citizenship and language policies, and associated socioeconomic hardships, drove many of the Russian-speaking population to the edges of the society. These processes were amplified by traditional acculturation challenges that led to increased psychological distress, rising indicators of social exclusion and social alienation, and poor health, including HIV/AIDS and substance abuse, in this linguistic group during the past two decades. Given the growing relevance of cultural issues in this group as well as the public health importance of drug abuse and HIV/AIDS epidemics in Estonia, this study aimed to: 1) develop an optimal group classification which adequately represents acculturation to Estonian culture among the Russian-speaking drug users in Estonia and to compare the defined groups in their demographic characteristics, acculturation stress, level of alienation, and HIV drug risk; 2) determine quality and nature of the relationship between acculturation stress, alienation, severity of drug abuse and their predictive strength on the level of HIV drug risk among the Russian-speaking drug users in Estonia.
A convenience sample comprised of 150 Russian-speaking IDUs living in Tallinn was recruited through 'AIDS-i Tugikeskus' (AIDS Information and Support Center) in Tallinn. Participants completed a survey assessing acculturation to Estonian and Russian culture (Language, Identity, and Behavior Scale), acculturation stress (Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale), level of alienation (Alienation scale), HIV drug risk (Risk Assessment Battery), and socio-demographic data. Univariate and bivariate statistics, cluster analysis, discriminant function and factors analyses, and structural equation modeling (SEM) were employed to test the research hypotheses.
The results revealed that two acculturation typologies exist among Russian-speaking drug users in Estonia: Russian and bicultural. Better able to navigate Estonian society, bicultural individuals had significantly higher legal incomes and were more likely to have health insurance. At the same time, this group experienced higher levels of acculturation stress and cultural estrangement, compared to the Russian orientation group. The tenable model, developed in the process of SEM revealed that acculturation stress had a significant positive effect on social alienation. Social alienation, duration of drug injection and polydrug use all predicted a higher level of HIV drug risk. The effect of acculturation stress on HIV drug risk was fully mediated by alienation. Overall, the model explained 25% variance in HIV drug risk. These findings supported the acculturation stress framework that guided the research and pointed to the importance of focusing on socio-cultural factors in developing interventions for immigrant minorities to reduce their vulnerability to HIV infection. The results highlighted the role of social alienation as a measure of adaptation among immigrant minorities and as an important mediator in the relationship between acculturation stress and vulnerability to HIV infection. In addition, significance and implications of the findings, study limitations and suggestions for future research were discussed.



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