Health data issues for Hispanics: implications for public health research.

The limited availability of Hispanic health data has hampered the development of targeted public health policies. Hispanics represent 11.5 percent of the population and are projected to become the largest minority group in the United States by the year 2010. This paper explores current issues in Hispanic health data collection, examines methodological concerns, and presents recommendations for future Hispanic public health data collection. Data are derived from statistical reports of the U.S. Bureau of the Census, National Center for Health Statistics, Bureau of Labor Statistics, and other empirical studies. Recommendations include: collecting both race and ethnic-specific data by Hispanic subgroup, designing appropriate data collection instruments and approaches, and selecting referent groups for comparison purposes. The authors conclude that the renewed national focus on health disparities among underserved populations requires an increased commitment to adequately identify Hispanic subgroups.

Latino child health: need for inclusion in the US national discourse.

The "rediscovery" of poverty, as echoed in concepts of social inequality, has contributed to the goal of eliminating racial/ethnic and social class disparities in the United States. This commentary focuses on what we know about the pressing health care needs and issues relevant to Latino children and families and how extant knowledge can be linked to priority policy recommendations to ensure the inclusion of Latino health issues in the national discourse. A systematic review of the literature on Latino children and of expert opinion revealed 4 evidence-based themes focused on poverty: economic factors, family and community resources, health system factors, and pitfalls in Latino subgroup data collection. Consensus was found on 4 priority policy recommendations: (1) reduce poverty and increase access to health care coverage, (2) increase funding in targeted primary and preventive health care services, (3) provide funds needed to fully implement relevant health legislation, and (4) improve measurement and quality of data collection. If these recommendations are not instituted, the goals of Healthy People 2010 will not be achieved for the Latino population.

Criollo, mestizo, mulato, LatiNegro, indígena, white, or black? The US Hispanic/Latino population and multiple responses in the 2000 census.

Current dialogues on changes in collecting race and ethnicity data have not considered the complexity of tabulating multiple race responses among Hispanics. Racial and ethnic identification--and its public reporting--among Hispanics/Latinos in the United States is embedded in dynamic social factors. Ignoring these factors leads to significant problems in interpreting data and understanding the relationship of race, ethnicity, and health among Hispanics/Latinos. In the flurry of activity to resolve challenges posed by multiple race responses, we must remember the larger issue that looms in the foreground--the lack of adequate estimates of mortality and health conditions affecting Hispanics/Latinos. The implications are deemed important because Hispanics/Latinos will become the largest minority group in the United States within the next decade.

Use of cancer screening practices by Hispanic women: analyses by subgroup.

OBJECTIVES: This study compares the use of three cancer screening practices (Pap smear, mammogram, and clinical breast examination) 3 years prior to interview among five subgroups of Hispanic women, and examines whether sociodemographic; access; health behavior, perception, and knowledge; and acculturation factors predict screening practices for any subgroup. METHODS: Descriptive and multiple logistic regression analyses were conducted with data pooled from the 1990 and 1992 National Health Interview Surveys on women who reported that they were Hispanic. The study sample includes 2,391 respondents: 668 Mexican-American, 537 Mexican, 332 Puerto Rican, 143 Cuban, and 711 other Hispanic women. RESULTS: Subgroup profiles reveal differences in education, health insurance, use of English language, and screening use. Mexican women were the least likely to be screened with any procedure. Logistic regression results for each screening practice show that having a usual source of care was a positive predictor for obtaining each of the three screening practices within the last 3 years. Being married, being more than 50 years of age, and having knowledge of breast self-examination were all predictors of having a Pap smear. Having health insurance and ever having had a clinical breast examination and Pap smear were predictors of having a mammography, while age, knowledge of breast self-examination, ever having had a Pap smear and mammogram, and being a nonsmoker all predicted having a clinical breast examination. CONCLUSIONS: We conclude that access factors and prior screening are more strongly associated with current screening than are language and ethnic factors. Our data confirm that a disproportionate percentage of Hispanic women are low income and at risk of being underscreened. Our findings from a nationally representative sample of Hispanics have implications for provider practices, ethnic-specific community interventions, and future development of measures and data collection approaches.

Mediators of ethnic-associated differences in infant birth weight.

PURPOSE: To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors. METHODS: A prospective, survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk. RESULTS: As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight. CONCLUSION: These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.

Economic and social vulnerability of Latino children and families by subgroup: implications for child welfare.

Approximately 40% of all Latinos are under the age of 20, and close to one-third of all Latino children live in poverty. The Latino population varies considerably, however, a factor that is frequently obscured by data collection methods that either view Latinos collectively or fail to differentiate Latinos at all from within racial groups. This articles describes the social, economic, and family structure variables that place specific Latino subgroups at risk, synthesizes available data on Latino children in the child welfare system, and discusses a direction for research and practice in developing ethnic-specific child welfare policy for vulnerable Latino groups. The authors conclude that services to strengthen families have to promote economic as well as social integration within society and have to consider the unique characteristics of each Latino community.

Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.

OBJECTIVES: This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS: Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS: Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS: Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women.

PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.

The role of Latino/Hispanic communities in health services research: strategies for a meaningful partnership.

This paper critically assesses the important elements of the Latino/Hispanic community's participation in health services research and the known barriers to effective collaboration, and provides suggestions that may contribute toward a meaningful partnership among health care providers, researchers and the community. The discussion focuses on central strategies for community participation to help improve existing health care services' effectiveness, specifically for low-income Latino/Hispanic groups. It reviews current approaches for including communities in health care delivery and health services research and draws examples from the author's experiences of working with Latino/Hispanic communities for almost 20 years. The data implies that mutual benefits can be derived from forging alliances and meaningful partnerships between the health services research community and the Latino/Hispanic community.

The underrepresentation of Hispanic women in the health professions.

Hispanics are severely underrepresented in medicine and the health professions, particularly Hispanic women compared to other women. Hispanics represent only 4.9% of medical and health professionals, with a disproportionate representation in allied health professions, and Hispanic women represent less than 2% of those in health professions that require advanced degrees. The purposes of this paper are to review the available data on Hispanic women in medicine and the health professions, to examine the factors that contribute to their underrepresentation, and to present and discuss recommendations to decrease the barriers to Hispanic women in the health professions. Factors associated with this underrepresentation include high levels of family poverty linked to high secondary school dropout rates, inadequate educational background and work experiences, and lack of information on resources and opportunities. Central recommendations to increase representation of Hispanic women call for institutional changes and commitments in data collection, early math and science preparation, access to financial resources, and improvements in community linkages and the academic environment.

Ethnic minorities, health care systems, and behavior.

This article presents an overview of research on health care use and provider behavior, on doctor-patient relationships, adherence to medical regimens, self-care, practices and avoidance health care behaviors, and attitudes of 4 ethnoracial groups: African Americans, American Indians, Asian Americans, and Latinos. Although issues within the groups varied, common themes between the groups emerged. It became apparent, after discussion, that whatever the issues and health problems, these can be resolved most effectively when addressed within the social contexts of each ethnoracial group.

The relationship between psychosocial status of immigrant Latino mothers and use of emergency pediatric services.

Consistent empirical evidence has shown that low-income Latino populations tend to underutilize health care services and do not have a usual source of care. This article identifies and describes the sociodemographic and psychosocial characteristics of Latino immigrant mothers who use emergency pediatric services, assesses the association of maternal characteristics with perceived barriers to care, and examines key predictors of total number of pediatric visits in a year. A survey was carried out to obtain data on reason for emergency room visit, usual sources of care, child's health, and mother's physical and psychosocial health. The results revealed a clear pattern of delayed care for acute problems in the children, a high number of reported barriers to pediatric care, and high mental distress reported by mothers.

Factors which influence use of prenatal care in low-income racial-ethnic women in Los Angeles County.

There is very limited information on ethnic differences in use of prenatal care services. The purpose of this study was to examine the effect of sociodemographic, health behaviors, medical risk, and psychosocial risk factors on the timing of prenatal care among Black-American, Mexican-American, and recent Mexican immigrant women in Los Angeles. A sample of 107 primiparous women were interviewed using a structured questionnaire. Information obtained included socioeconomic indicators, relationship with baby's father, timing of prenatal care, psychosocial factors, and substance use before pregnancy. Ethnic patterns of timing of prenatal care revealed no significant differences. The relationship with the baby's father was associated with early timing of prenatal care and more prenatal care visits. Substance use before pregnancy was significantly related to total number of visits for this pregnancy.

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles.

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.

Gender and level of training differences in obstetricians' attitudes towards patients in childbirth.

This paper explores male and female obstetricians' attitudes towards their patients in childbirth. Individual interviews were conducted with 50 obstetricians using a semistructured questionnaire. Across gender and level-of-training there were few differences in descriptions of easy patients. The few differences that did emerge reveal that attending physicians see patients as less difficult to handle than do residents and that female residents place more emphasis on compliance and control than do male residents. The results of the study are discussed in terms of sex-role stereotypes, the medical school socialization process and the medical model of health care.

A research agenda on issues affecting poor and minority women: a model for understanding their health needs.

Acquiring data on quality of life indicators such as health, mental health and family roles of poor and minority women remains a low research priority. This paper provides an assessment of current knowledge in this area and an overview of the context in which poor and racial/ethnic women utilize health care services. A model that encompasses the interactive effects of race, gender and class variables is proposed. Such a model is a necessity for understanding the health needs of poor and racial/ethnic women. Suggestions for future research and policy formulation are given.

PIP: Acquiring data on quality of life indicators such as health, mental health and family roles of poor and minority women remains a low research priority. This paper provides an assessment of current knowledge in this area and an overview of the context in which poor and racial/ethnic women utilize health care services. A model that encompasses the interactive effects of race, gender and class variables is proposed. Suggestions for future research and policy formulation include 1) the relationship between occupational hazards and reproductive outcome, 2) the prevalence of Cesarian section and hysterectomy, 3) the effects and context of materials presented in family life/sex education classes in schools, 4) the efficacy of informed consent procedures currently in use, 5) provider and recipients of genetic counseling, and 6) amniocentesis and minorities. In addition, there is a dearth of information about aging in the racial/ethnic subgroup although it is known that these women become poorer earlier and at a greater rate. An inquiry must be made into assessing the nature and extent of chronic stress over time and its impact on health status and functioning. Finally, investigation must be made into health practices such as nutrition, substance use, and exercise, and their relationship to socioeconomic status and influence on health status and functioning.

Alcohol abuse prevention among Latino adolescents: A strategy for intervention.

In spite of what is known about adolescent alcohol use and the need to prevent alcohol abuse, there is a scarcity of information on alcohol use and alcohol abuse among Latino youth. This paper describes the results of a unique prevention program funded by the National Institute of Alcohol Abuse and Alcoholism in 1978 for Latino youth (12-17 years of age) in East Harlem. Existing literature on Latino youth and alcohol use is reviewed, followed by a description of the program, its setting, and its evaluative methodology. The methodological strategy entailed in-depth interviews with 80 program participants and interviews with staff. The results clearly demonstrate changes in alcohol knowledge, attitudes, and behavior among consistent participants, who constituted about one-third of the 752 participants. The changes were most attributable to the intervention strategies used, namely workshops and cultural materials, as well as outreach to parents and role modeling by staff. The most enlightening results were in terms of reasons for participation and attrition. The final section describes the need for the development of creative educational methods and materials, and difficulties in the use of traditional educational curriculum and evaluation materials with low-income Latino youth.

The interactive effect of health status on work patterns among urban Puerto Rican women.

This paper aims to integrate two existing bodies of literature on the sociology of work and health. Using data from a study conducted in New York City in 1980 of 40 Puerto Rican women, a conceptual model is proposed for additional research in the area. The findings are discussed within the context of the larger structural and socioeconomic status of this particular racial/ethnic group. The findings clearly indicate that health status is related to work patterns and economic as well as social resources. Of the respondents who reported a major health event in their lives, 80 percent had a discontinuous work history. Children's health was also a major determinant of work status. The results of this study clearly reveal the need for research that will take into account the interplay between economic conditions, structural work factors, and the process by which women evaluate their roles and fulfill their function as economic and health caretakers of the family.