hispanics in a biopsychosocial context hispanic neuropsychological society @ national academy of...
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Hispanics in a Hispanics in a Biopsychosocial ContextBiopsychosocial Context
Hispanic Neuropsychological SocietyHispanic Neuropsychological Society
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National Academy of NeuropsychologyNational Academy of Neuropsychology
Seattle, WashingtonSeattle, Washington
November 19, 2004November 19, 2004
Contact Information:Contact Information:
Antonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.Department of PsychologyDepartment of Psychology
University of North Carolina at University of North Carolina at WilmingtonWilmington
[email protected]@uncw.edu
www.uncw.edu/people/puentewww.uncw.edu/people/puente
BackgroundBackground
PurposePurpose Provide Contextual Background Provide Contextual Background
Prior AttemptsPrior Attempts PontonPonton Several chaptersSeveral chapters
US Demographic ContextUS Demographic Context(from various sources especially US Census Bureau, 2004)(from various sources especially US Census Bureau, 2004)
PopulationPopulation US =US =290, 807,770290, 807,770 NC = 8,407,248NC = 8,407,248
US Demographic ContextUS Demographic Context
Income (household)Income (household) MedianMedian = $45,631= $45,631 Mean = $61,587Mean = $61,587
US Demographic ContextUS Demographic Context
EducationEducation Doctoral DegreeDoctoral Degree == 1.0 1.0 Professional DegreeProfessional Degree = = 2.0 2.0 Master’s DegreeMaster’s Degree == 5.9 5.9 Bachelor’s DegreeBachelor’s Degree == 15.515.5 Associate’s DegreeAssociate’s Degree = = 6.3 6.3 High School DegreeHigh School Degree = = 80.480.4 Less than High SchoolLess than High School == 18.218.2 No SchoolingNo Schooling = = 1.4 1.4
Hispanics in the United States: Hispanics in the United States: OverviewOverview
United States TrendsUnited States Trends Is the largest ethnic minority group in USIs the largest ethnic minority group in US Is the fastest growing ethnic group in USIs the fastest growing ethnic group in US Approximating 15% of the populationApproximating 15% of the population Will represent the majority group in 2040Will represent the majority group in 2040 Probably undercounted (hence projections are Probably undercounted (hence projections are
probably off with a wide margin of error)probably off with a wide margin of error)
Demographics:Demographics:Hispanics in the United States Hispanics in the United States
United States StatisticsUnited States Statistics Overall Overall = 12.5% (Vs. 12.1% for AA)= 12.5% (Vs. 12.1% for AA) Before 18 Before 18 = 35%= 35% 18-65 18-65 = 60%= 60% 65 + = 5%65 + = 5% Less Educated than counterpartsLess Educated than counterparts More Fertile than counterpartsMore Fertile than counterparts
US Demographics: US Demographics: PopulationPopulation
Shifting DemographicsShifting Demographics Non-Hispanic WhiteNon-Hispanic White 69.4%69.4% 57.5%57.5% African AmericanAfrican American 12.7%12.7%
13.9%13.9% HispanicHispanic 12.6%12.6% 20.1%20.1%
US Demographics: Work US Demographics: Work ForceForce
Percentage of Work ForcePercentage of Work Force 19801980 5.7% 5.7% 19901990 8.5% 8.5% 20002000 11.7%11.7% 20102010 14.1%14.1% 20202020 16.9%16.9% 20302030 10.9%10.9%
US Demographics: US Demographics: Undergraduate EducationUndergraduate Education
Bachelor’s Degrees Awarded to Bachelor’s Degrees Awarded to Hispanics (%)Hispanics (%) 19801980 2.3%2.3% 19901990 3.4%3.4% 20002000 6.2%6.2% 20102010 7.0%7.0% 20202020 8.0%8.0% 20302030 8.8%8.8%
Demographics: Demographics: Hispanics in North CarolinaHispanics in North Carolina
North Carolina StatisticsNorth Carolina Statistics Overall = 4.7%Overall = 4.7% Migration for Foreign Born = 50%Migration for Foreign Born = 50%
Primarily from California (also from the NE)Primarily from California (also from the NE) Comparison (ND = 282% decrease) Comparison (ND = 282% decrease)
From 1990 to 2000 = From 1990 to 2000 = 394394% increase% increase
Demographics: Demographics: Hispanics in New Hanover Hispanics in New Hanover
CountyCounty New Hanover (Wilmington, NC) New Hanover (Wilmington, NC)
Statistics EstimatesStatistics Estimates Total Population = 147,642 (22.7% Total Population = 147,642 (22.7%
increase)increase) 1980 = 788; 1980 = 788; 1990 = 747; 1990 = 747; 2000 =1,8282000 =1,828 Estimate = severe undercountingEstimate = severe undercounting
Additional Hispanic Additional Hispanic StatisticsStatistics
Percentage of PopulationPercentage of Population
- In US = 12.5%- In US = 12.5% In NC = 4.7%In NC = 4.7%
- 36% are from Latin America- 36% are from Latin America
- 30% are from Mexico- 30% are from Mexico Anticipated GrowthAnticipated Growth
In US = Births will outpace immigrationIn US = Births will outpace immigration In NC = Over 500% growthIn NC = Over 500% growth
North Carolina: More CloselyNorth Carolina: More Closely(partially from Common Sense Foundation, October, (partially from Common Sense Foundation, October,
2004)2004)
University of North Carolina @ University of North Carolina @ WilmingtonWilmington Chancellors or Vice-Chancellors (0 of 6)Chancellors or Vice-Chancellors (0 of 6) Deans (0 of 5)Deans (0 of 5) Faculty (15 out of 705)Faculty (15 out of 705) Students (254 out of 11,327)Students (254 out of 11,327) Issues of Documentation Issues of Documentation Glass Ceiling of Non-Resident TuitionGlass Ceiling of Non-Resident Tuition
Glance (continued)Glance (continued)
High School Students in North High School Students in North CarolinaCarolina One third of all high school graduates by One third of all high school graduates by
the year 2013 will be Hispanicthe year 2013 will be Hispanic Graduation rate for Hispanics nationally Graduation rate for Hispanics nationally
= 54%= 54% Graduation rate for Hispanics in North Graduation rate for Hispanics in North
Carolina = 38%Carolina = 38%
Glance (continued)Glance (continued)
Language Ability Language Ability (in US about 30 million speak (in US about 30 million speak Spanish)Spanish)
US = 22% speak English “poorly”US = 22% speak English “poorly” NC =34% speak English “poorly”NC =34% speak English “poorly”
Governmental RepresentationGovernmental Representation Two Elected OfficialsTwo Elected Officials No High Ranking JudgesNo High Ranking Judges One Executive Level OfficeOne Executive Level Office
Glance (continued)Glance (continued)
Health InsuranceHealth Insurance 37% lack insurance nationally37% lack insurance nationally 54% lack insurance in North Carolina54% lack insurance in North Carolina
Increases to 64% if non-documentedIncreases to 64% if non-documented
Income Income 27% live in poverty 27% live in poverty NC Median family income = $30,529NC Median family income = $30,529
National MFINational MFI = $ 44,468 = $ 44,468 NC MFI for whites = $51,951NC MFI for whites = $51,951
National MFINational MFI = $61,587 = $61,587
Psychological LiteraturePsychological Literature(from PsyInfo, 11.01.04)(from PsyInfo, 11.01.04)
PsychologyPsychology 485,230485,230
HispanicsHispanics 7,7187,718
Hispanics and Mental HealthHispanics and Mental Health 799799
Hispanics and IntelligenceHispanics and Intelligence 172172
Hispanics and NeuropsychologyHispanics and Neuropsychology 5252
What Does Being “Hispanic” What Does Being “Hispanic” Mean?Mean?
Speaking SpanishSpeaking Spanish Being Catholic (or Christian, probably conservative/fundamentalist)Being Catholic (or Christian, probably conservative/fundamentalist) Religion as source of support and socializationReligion as source of support and socialization Family above all (and extended family)Family above all (and extended family) Children are highly desired and valuedChildren are highly desired and valued Friends and social groups are criticalFriends and social groups are critical Cooperation versus competitionCooperation versus competition Keep one’s problems to themselves or familyKeep one’s problems to themselves or family Respect and formalityRespect and formality The important use and knowledge of a name (and title)The important use and knowledge of a name (and title) Hospitality through gifts, food, and drinkHospitality through gifts, food, and drink Smooth interpersonal relations are critical (amabilidad)Smooth interpersonal relations are critical (amabilidad) Time to be enjoyed not conqueredTime to be enjoyed not conquered Modesty (pudor)Modesty (pudor) Less material & consumer focusedLess material & consumer focused More emotionalMore emotional PersonalismoPersonalismo Fatalismo (chance and God explain just about everything)Fatalismo (chance and God explain just about everything)
Sources of Biopsychosocial Sources of Biopsychosocial ProblemsProblems
Culture and Acculturation IssuesCulture and Acculturation Issues Language LimitationsLanguage Limitations Family DysfunctionFamily Dysfunction Ineffective Social SupportIneffective Social Support Low Self EsteemLow Self Esteem Limited EducationLimited Education Financial LimitationsFinancial Limitations Religious AffiliationReligious Affiliation DocumentationDocumentation Health StatusHealth Status Gender IssuesGender Issues Interpretation of EfficiencyInterpretation of Efficiency
Cultural IssuesCultural Issues
Misunderstanding of the Majority Misunderstanding of the Majority Culture’s Unwritten Social Rules and Culture’s Unwritten Social Rules and AgendasAgendas
Isolation to MainstreamingIsolation to Mainstreaming
Language LimitationsLanguage Limitations
EnglishEnglish Variations of SpanishVariations of Spanish Spanish as a Second LanguageSpanish as a Second Language Anxiety Associated with Learning English Anxiety Associated with Learning English
and Losing Your Cultureand Losing Your Culture Non-Verbal Communication is ImportantNon-Verbal Communication is Important Children as TranslatorsChildren as Translators Children Choosing English over SpanishChildren Choosing English over Spanish
FamilyFamily
Defining Family (Familismo)Defining Family (Familismo) NuclearNuclear ExtendedExtended DoubleDouble FunctionalFunctional
Divided FamiliesDivided Families EconomicsEconomics GeographyGeography PoliticsPolitics
Ineffective Social SupportIneffective Social Support
MedicalMedical ReligiousReligious EducationalEducational FinancialFinancial SocialSocial MaritalMarital
Low Self EsteemLow Self Esteem
Productivity and MaterialismProductivity and Materialism ConnectivityConnectivity Self-Effacing PresentationSelf-Effacing Presentation Loss of Respect From OthersLoss of Respect From Others Self-Fulfilling ProphecySelf-Fulfilling Prophecy
EducationEducation
Typical Educational BackgroundTypical Educational Background What it Means to be “Educated”-What it Means to be “Educated”-
the difference between schooling and the difference between schooling and educationeducation
Financial & Related Financial & Related LimitationsLimitations
The Limits and Hazards of Being The Limits and Hazards of Being UndocumentedUndocumented
Type of Vocational Opportunities & Type of Vocational Opportunities & Corresponding PayCorresponding Pay
Banking IssuesBanking Issues Saving for RetirementSaving for Retirement Driver’s LicensesDriver’s Licenses
ReligionReligion
Predominantly Catholic, but not Predominantly Catholic, but not Exclusively (about 25%) Exclusively (about 25%)
Importance of Religion and Related Importance of Religion and Related Social SupportSocial Support
Prayers are Directed to a SaintPrayers are Directed to a Saint A “Milagro” is a Special NeedA “Milagro” is a Special Need Church and Related Services in Church and Related Services in
SpanishSpanish
DocumentationDocumentation
EducationEducation MedicalMedical LegalLegal
Tax ID NumbersTax ID Numbers Social Security NumbersSocial Security Numbers Driver’s LicensesDriver’s Licenses
AliasesAliases
Health StatusHealth Status
Increased and Disproportionate Health Increased and Disproportionate Health ProblemsProblems
Higher Low Birth Weights & Infant MortalityHigher Low Birth Weights & Infant Mortality Increased MorbidityIncreased Morbidity Under-Utilization of Health ServicesUnder-Utilization of Health Services Health Viewed as Absence of PainHealth Viewed as Absence of Pain Women as Primary Care Providers in FamilyWomen as Primary Care Providers in Family Disability is a Family AffairDisability is a Family Affair Hospitals as Last Place for Health Care or Hospitals as Last Place for Health Care or
Possibly a Place One Goes to DiePossibly a Place One Goes to Die
Gender IssuesGender Issues
Males Vs. Female Males Vs. Female Males Males 27%27% Females Females 17%17%
MachismoMachismo False = loss of dignity and respectFalse = loss of dignity and respect True = Protector, supporter True = Protector, supporter
Heterosexual issuesHeterosexual issues Clashing of culturesClashing of cultures Availability of partnersAvailability of partners ProstitutionProstitution STDsSTDs
Sexual Identity IssuesSexual Identity Issues Childhood Sexuality & AbuseChildhood Sexuality & Abuse
Interpretation of EfficiencyInterpretation of Efficiency
Time (enjoyment vs. completion)Time (enjoyment vs. completion) Cooperation (vs. competition)Cooperation (vs. competition) Process (vs. outcome)Process (vs. outcome)
Outcome of ProblemsOutcome of Problems
AnxietyAnxiety 13%13% Substance abuseSubstance abuse 8% 8% DepressionDepression 5% 5% Violence Violence ?% ?% Ethnic identity issues ?%Ethnic identity issues ?% Poverty and marginalization ?%Poverty and marginalization ?%
Hispanics & Hispanics & NeuropsychologyNeuropsychology Presentations (Dates are approximate/estimates)Presentations (Dates are approximate/estimates)
Approximately 1994 Puente NAN WorkshopApproximately 1994 Puente NAN Workshop INS soon thereafter, Ponton Workshop (Galveston?)INS soon thereafter, Ponton Workshop (Galveston?) 2000 HNS/NAN Informal Symposium2000 HNS/NAN Informal Symposium 2002 Ardila NAN Workshop2002 Ardila NAN Workshop 2004 HNS NAN Workshop2004 HNS NAN Workshop
BooksBooks 44 3 Edited; 1 Authored3 Edited; 1 Authored
Non-Empirical PublicationsNon-Empirical Publications 30 30 Mostly ChaptersMostly Chapters
Empirical PublicationsEmpirical Publications 2020 Two DissertationsTwo Dissertations Acculturation/testingAcculturation/testing
Psychology Psychology = 35= 35 NeuropsychologyNeuropsychology = 6 (most non-empirical)= 6 (most non-empirical)
Merging Problems (Outside Merging Problems (Outside Traditional Biopsychosocial Traditional Biopsychosocial
Realm)Realm) Lack of ScienceLack of Science Lack of PersonnelLack of Personnel
HNS as an ExampleHNS as an Example Lack of Tests Lack of Tests
CopyrightCopyright StandardizationStandardization Translation IssuesTranslation Issues Heterogeneity of HispanicsHeterogeneity of Hispanics The Difficulty in Developing TestsThe Difficulty in Developing Tests
A Model for IntegrationA Model for Integration
1.1. IsolationIsolation
2. Acculturation2. Acculturation
3. Assimilation3. Assimilation
4. Mainstream4. Mainstream
In Three GenerationsIn Three Generations(from Hispanic Business, 2003)(from Hispanic Business, 2003)
IsolationIsolation Acculturation Acculturation AssimilationAssimilation
IncomeIncome$20,500 $20,500 $36,100$36,100 $37,000$37,000SizeSize 3.9 3.6 3.1 3.9 3.6 3.1Time in US Time in US 11stst gen. US born gen. US born 44thth Gen. Gen.LocaleLocale Inner CityInner City Suburbs ?Suburbs ? SuburbsSuburbsValuesValues HispanicHispanic Partial HispanicPartial Hispanic AngloAngloLanguageLanguage SpanishSpanish BilingualBilingual EnglishEnglish
The Future The Future
Clashing Curves and CulturesClashing Curves and Cultures 2121stst Century “Slavery” Century “Slavery” Pay Now or Pay LaterPay Now or Pay Later What is the United States Going to What is the United States Going to
Do?Do?
Future?Future?
Demographic Shifts Are ObviousDemographic Shifts Are Obvious Socio-political Shifts Are NotSocio-political Shifts Are Not The Lack of Integration of These Two The Lack of Integration of These Two
Shifts Will Result in Social Shifts Will Result in Social Misunderstanding & UnrestMisunderstanding & Unrest