assistant professor con ukassistant professor, con, uk...

Diana A. Rodriguez, PhD, RNAssistant Professor CON UKAssistant Professor, CON, UK

Nurse Researcher, KCH

By the end of the presentation, the attendees will be By the end of the presentation, the attendees will be able to:

Understand the changing demographics of g g g pLatinos

Describe the influencing factors in Latino gchildren & their health status

Implement competent cultural practices with Latino children and their families

Both are used interchangeably Hispanic refers to someone who can trace origins to areas

colonized by Spain Spanish speakersp p Persons w/ Spanish heritage by birth location Who self-identify w/ Spanish ancestry or descent

Latino/a generally refers to someone from Latino America main Latino/a generally refers to someone from Latino America – main difference – would not include those with Spanish ancestry

Usually, individuals have a preference – ask themN ith fl t th t di it f d /i th Neither reflects the true diversity found w/in these groups

Latinos are the largest, fastest growing, and Latinos are the largest, fastest growing, and youngest minority group in U.S - 1/3 of Latinos are under age 18 Among Latinos, Mexicans have the largest

proportion of people under age 18 (38%)Th L ti l ti i th th The Latino population is younger than the non-Latino White population

Source: Current Population Survey, March 2000, PGP-4

Total Native Born Foreign Born % Foreign Born

Mexican 29,189,334 17,554,022 11,635,312 39.9Puerto Rican 4,114,701 4,067,060 47,641 1.2All Other Spanish/Hispanic/ Latino

2,880,536 2,371,908 508,628 17.7

Other Latinos include Cuban, Salvadorian, Guatemalan, Colombian, Honduran, Ecuadorian, Peruvian, Spaniard,

A l CNicaraguan, Argentinean, Verezuelan, Panamanian, Costa Rican, Other Central American, Chiliean, Bolivian, Other South American, Uruguayan, Paraguayan,

Ten Fastest Growing States in Latino Population g pBetween 1990 and 2000. North Carolina (394%) Arkansas (337%)( ) Georgia (300%) Tennessee (278%) Nevada (217%)( %) South Carolina (211%) Alabama (208%) Kentucky (173%)Kentucky (173%) Minnesota (166%) Nebraska (155%)

(Saenz 2004)(Saenz,2004)

In 2000 – Estimated –8,561 (3.3%)

In 2006 - Estimated –14,376 (5.3%) (U.S. C 2006)Census 2006)

Latino population p pgrew by 10.2 million from 2000 to 2007.

Growth widespread –2991/3 141 ti 2991/3,141 counties across the U.S. demonstrated an increased of the Hispanic population

P l d h Population projections and the increasing Latinoization of the U.S.

2000 12 6% 2000: 12.6% 2010: 15.5% 2020: 17 8% 2020: 17.8% 2030: 20.1% 2040: 22.3% 2050: 24.4%

Source: U.S. Census Bureau. 2004. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Washington, DC: U.S. Census Bureau.

More adult male Latinos in comparison to females

Tend to be more foreign bornborn

Less likely to be citizens 1 in 3 Latinos are children ~1/3 report speaking

English with difficulty ~4/10 have not completed 4/10 have not completed

high school ~1/5 live in poverty

Has been negative & pejorative Has been negative & pejorative Lacking in empirical evidence Was primarily exploratory & w/o theoretical Was primarily exploratory & w/o theoretical

grounding Has evolved to current family theory & Has evolved to current family theory &

research Needs to be concerned w/ understanding / g

accommodations, vulnerability, & resilience of Latino family

Immigration – not always a uni-directional Immigration not always a uni directional movement, very stressful

Acculturation & assimilation – measurement usually is language usage based

Acculturative stress or crisis – occurs as a result of acculturation process, includes language conflicts, cultural conflicts, perceived discrimination, depression, social anxiety, l li & i t li i blloneliness, & internalizing problems

Concept not fully understoodp y No agreement on definition of construct & how to

measure, very complex concept Measurement seems like a snapshot rather than

evaluating the process Limitations w/ measurement – primarily language Limitations w/ measurement – primarily language

usage Has been associated w/ social status No good measurements for children Implied negative outcome w/ low levels of

lt tiacculturation

However, in spite of pimperfections in understanding and measuring measuring acculturation, it is still important to consider pb/c it can be a predictor of negative h lth thealthcare outcomes

"Immigrant parents send their children to school Immigrant parents send their children to school (simply, they think) to acquire the skills to 'survive' in America. But the children return home as American."

~Richard Rodriguez, 1992

Perceived social support Perceived social support Self-concept Non-adherence to medical tx w/ asthmatic Non adherence to medical tx w/ asthmatic

children Low birth wt. infants Low birth wt. infants Family dysfunction Higher rates of adolescent pregnancy Higher rates of adolescent pregnancy Difficulties with self esteem

Additional effects of acculturative stress Additional effects of acculturative stress, discrimination, and prejudice may present as poor performance in school or present as poor performance in school or as health complaints in the healthcare system system

61% of Latino children receive preventative 61% of Latino children receive preventative dental care

22% with mouth/teeth in fair/poor condition/ /p 13.2% have been told they have asthma 29.3% are at risk of or are overweight 29.3% are at risk of or are overweight Latino children are more likely to be diagnosed

w/ Type II diabetes/ yp

~1/4 2yr old Latinos are not fully immunized 1/4 2yr old Latinos are not fully immunized(immunization rate in Mexico - >95%)

Latino children are more than 3x as likely as White children to have gone more than 2 yrs w/o seeing a doctor

Latino children are 50% more than White children to have an unmet medical need

Latino children are such a diverse group that differences exist amongst sub-groupse.g., There is a difference in the

health status between Mexican-American & Puerto-Rican American & Puerto Rican children, but minimal difference between M.A. children & children in children & children in dominant population

poverty lack regular source of p y low parental

education

gcare

cultural differences transportation excessive waiting

receipt of fewer prescriptions

decreased screening language problems

geography - suburban vs. rural

residency status lack of insurance residency status

45% of non-U.S. citizens lacked insurance in

2006 vs. 16.4% of naturalized citizens

35% of Latinos under 65 years of age were w/o health

insurance in 2005

58% of foreign born Latinos report having health 58% of foreign-born Latinos report having health

insurance vs. 75% of native-born Latinos

Bilingual Latinos or predominantly English speaking,

are 1.5 times more likely to have health insurance than

predominantly Spanish speaking

Latinos earning less than g$30,000/yr are 4x as likely to lack health insurance as those making >$50,000/yrg $ , /y

>70% of California, farmworker population lacks health insuranceinsurance

~22.1% of Latino children did not have any health insurance,

d t 7 3% f Whit compared to 7.3% of White, 14.1% of Black & 11.4% of Asian children

Preference for Preference for curanderos

Latinos are fatalistic Latinos are fatalistic

“I will do everything in my power to not say “Si Dios quiere!”Si Dios quiere!

Have to keep moving ahead!Have to keep moving ahead!A very positive outlook on life in spite of life’s difficult circumstances. A conscious decision to keep moving forward: Select healthier cooking options, even if it means

changing how one cooks traditional foods Returning to school after a separation, so the kids

can see mom move forwardcan see mom move forward Moving to the U.S. for a better life

(Rodriguez, 2002)( g , )

1st generation of U.S. Latino children have several 1 generation of U.S. Latino children have several excellent health outcomes & indicators that deteriorate with acculturation & each successive generation, e.g.

Less depression & suicidal ideation Lower rates of low birth rate Higher immunization rates Less cigarette smoking Less illicit drug useg Older age of first sex

Miss opportunities for screening• Miss opportunities for screening• Fail to take into account differing responses to

medication• Lack knowledge about traditional remedies,

leading to harmful drug interactions M k di ti b/ f i i ti• Make diagnostic errors b/c of miscommunication

• As result of not understanding or believing the patient’s description of sx, doctor’s may order p p , yfewer diagnostic tests or may order more diagnostic tests to compensate for not understanding understanding

Not adhere to medical advice b/c they do not understand or do not trust

Choose not to go to providers b/c of fear of Choose not to go to providers b/c of fear of being misunderstood or disrespected

Cultural and linguistic competence in health care Cultural and linguistic competence in health care is one of the overarching goals of Healthy People 2010 so that health care disparities can be eliminated.

As U.S. population becomes even more diverse, this priority will continue to be an important

!one!

Cultural & linguistic competence requires Cultural & linguistic competence requires that a set of congruent behaviors, attitudes, & policies come together that enables effective healthcare services to be provided in a cross-cultural setting.

Culturally diverse staff, reflecting the Culturally diverse staff, reflecting the consumers & communities

Providers or translators who speak the clients’ planguages

Training for providers about the culture & g planguage of the clients they serve

Signs & educational literature in the clients’ language, consistent w/ their cultural norms

Culturally specific healthcare settings

Should not be done! Should not be done! Gives the children a position of power over

their parents that may not be acceptablep y p Not appropriate in healthcare settings

w/confidential, potentially private, difficult, / p y pand complicated information

Can’t really be sure of the fluency the child has

Identify your cultural background & values Identify your cultural background & values Convey an attitude of respect Convey an attitude of genuine interest Convey an attitude of genuine interest Obtain the best interpreter skills that you can It is okay to ask It is okay to ask Never assume

In closing – Latino families and their children, can In closing Latino families and their children, can potentially, have significant barriers in accessing healthcare. There are also issues with acculturation and

lt ti t th t i fl th i h lth d acculturative stress that can influence their health and health status. By virtue of their presence in our healthcare systems, with or without insurance, evidence has demonstrated they generally prefer medical health care to folk medicine &/or home remedies. Much of what has been attributed to cultural remedies. Much of what has been attributed to cultural preference, may actually be of a result of access and availability. Although there is pride in their heritage, their preference is for medical health care Culturall their preference is for medical health care. Culturally appropriate health care will not only benefit the families, but society as well.

Anderson, L.M., Scrimshaw, S.C., Fulilove, M.T., Fielding, J.E. Normand, J., Task Force on Anderson, L.M., Scrimshaw, S.C., Fulilove, M.T., Fielding, J.E. Normand, J., Task Force on Community Preventive Services. (2003). Culturally competent healthcare systems: A systemic review. American Journal of Preventive Medicine, 24(3S), 68-79.

Castañeda, X. & Ojeda, G.. (2008). Health insurance coverage of Latinos in the United States. Health Initiative of the Americas: UCB: Berkley CA HTTP://HIA BERKELEY EDUHealth Initiative of the Americas: UCB: Berkley, CA, HTTP://HIA.BERKELEY.EDU.

Children’s Defense Fund. (2008). Latino child health fact sheet. Children’s Defense Fund. (2009). Disparities in children’s health and health coverage fact

sheet. Children’s Defense Fund, Washington, D.C., www.childrensdefense.org/healthdisparities.

Children’s Defense Fund. (2008). Improving children’s health: Understanding children’s health disparities and promising approaches to address them. Children’s Defense Fund: Washington, D.C., www.childrensdefense.org/healthdisparities. g g/ p

Flores, G., Fuentes-Afflick, E., Barbot, O, Carter-Pokras, O., Claudio, L., & Lara, M. (2000). The health of Latino children: Urgent priorities, unanswered questions, and a research agenda. JAMA, 288,(1), 82-90.

Flores, G. & Vega, L.R. (1998). Barriers to health care access for Latino children: A review. Family Medicine. 30(3), 196-205.

Fry, R. (2008). Latino settlement in the new century. Pew Hispanic Center: Washington, DC, Fry, R. (2008). Latino settlement in the new century. Pew Hispanic Center: Washington, DC, www.pewhispanic.org.

U.S., Department of Health and Human Services. (2000). Healthy people 2010, 2nd edition. Washington, D.C.: U.S. Government Printing Office.

P l J S & D’V C (2008) T d i th i d i i ti U d t d i fl Passel, J.S. & D’Vera, C. (2008). Trends in unauthorized immigration: Undocumented inflow now trails legal inflow. Pew Hispanic Center: Washington, DC, www.pewhispanic.org.

Passel J.S. & Cohn. (2009). A portrait of unauthorized immigrants in the U.S. Pew Hispanic Center . Washington, D.C. ., www.pewhispanic.org .

Polo, A.J. & López, S.R. (2009). Culture, context, and the internalizing distress of Mexican American youth. Journal of Clinical Child & Adolescent Psychology, 38(2), 273-285.

Rodriguez, D.A. (2002). Conceptualizations of health and illness in Mexican-American children, Ages 8-12: An ecological perspective. University of California, an unpublished dissertation.8 12: An ecological perspective. University of California, an unpublished dissertation.