Latino_Health_2009_State_Workshop.ppt - Latinos and Latino Health

					Latinos and Latino Health in Maryland

               Olivia Carter-Pokras, Ph.D.
          Associate Professor, Department of
              Epidemiology & Biostatistics
     University of Maryland School of Public Health
     Hispanics in Maryland: 2007
•   347,000 or 6% of population
•   54% are foreign-born
•   22% are Mexican-origin
•   Median Income (16 and older)
     – Hispanics          $25,298
     – Non-Hispanic Whites $40,476
• Poverty Rate (17 and younger)
     – Hispanics         11%
     – Non-Hispanic White 6%
     New Maryland Latino Data
• Focus groups
   – Physical activity, emergency preparedness, tobacco
• Surveys conducted at festivals, health fairs & clinics
  in Baltimore & Montgomery County
• Montgomery County Latino Cancer Survey (503
  adults at least 40 years of age)
• 2006 Maryland Adult and Youth Tobacco Surveys
• Blueprint focus groups & Key Informant Interviews
• Other needs assessments & evaluation for specific
  programs (e.g., asthma)
               Hispanic/Latino Paradox?
   Despite higher poverty, uninsurance, lower use
    of health services, Mexican-origin persons and
    Latinos as a whole tend to have lower mortality
    and morbidity than non-Hispanic Whites
   But, effect is restricted to immigrant Mexicans &
    “Other Hispanics” (Palloni & Arias, 2003)
   OF CONCERN: As Latinos assimilate they adopt
    unhealthy behaviors, the population is aging,
    obesity rates are increasing, increasing lack of

SOURCE: Journal of Immigrant and Minority Health. 2008 Dec;10(6):475-88
    Health Priorities for Maryland Latinos
   • Common issues for MD Latinos: access to care,
     language barriers, low socioeconomic status
   • Interrelatedness of health issues to other
     problems (e.g., employment, stress)
   • Fewer Latino adults have health insurance: only
     31% in Baltimore & 42% in Montgomery County
   • Latinos under-utilize emergency departments
   • Recommend use medical interpreters, U.S.
     healthcare system workshops, licensure of
     foreign-trained nurses, outreach clinics

SOURCE: AJMC 2004;10(1):SP29-SP36; JHCPU 2006;17(4):899-909; JAAMP 2006;17:61-
   67, Montgomery County Latino Cancer Survey; J Transcultural Nursing 2008;19(2)
Fewer Latino women received first trimester prenatal care compared to other women
in Montgomery County, 2006
The adolescent birth rate for Hispanic youth is considerably higher than
the rate for other youth in Montgomery County, 2003 to 2006
   Physical activity among Latina
• Positive concept of exercise & physical activity,
  support development of physical fitness
  programs for Latina adolescents
• Few programs available, cost prohibitive, lack of
  transportation, parental English ability,
  homework, being tired, needing
  encouragement, not having time, program staff
  & neighborhood safety concerns, wanting to
  sleep, lack of a volleyball court, & home chores.

SOURCE: Journal of Latino-Latin American Studies 2006 Dec;2(2):33-47.
Weight, Dietary Practices and Physical

  • 30% obese & 46% overweight
  • More men were overweight (56% vs. 39%),
    more women were obese (24% vs. 35%)
  • 29% consumed 5 or more servings of
    vegetables and fruits per day

SOURCE: Montgomery County Latino Cancer Survey,
  Smoking Variations in Montgomery
         County, Maryland
• Variations by subgroup: 10% CA, 17% SA, &
  25% Other Latinos smoke
• Increase with greater time in U.S.: 12% of
  those 0-4 years, 18% of 5-9 years, 27% of 10-
  19 years were current smokers
• 71% of those with health insurance v.s. 30% of
  uninsured were advised to quit smoking

 SOURCE: Montgomery County Latino Cancer Survey,
 Latino smokers are less likely to be
  offered by healthcare providers
• Advice
• Smoking cessation products
• Programs, or medications

SOURCE: Carter-Pokras O, et al. (2008). Report on Disparities in Tobacco Use
Behaviors by Adult Minority Populations in Maryland, 2006.
     5 Latino Current Smoker & Ex-
         Smoker Focus Groups
• Main reasons to stop smoking: personal health concerns,
  impact on children, & family health & role model pressure
• Barriers to quit smoking: environmental temptation & social
  factors, emotional pressure, addiction & habitual behavior.
• Low use of cessation services is associated with lack of
  awareness of availability of Spanish-language cessation
• Lay health promoters are favored for smoking cessation

SOURCE: Carter-Pokras O, et al. Barriers and Facilitators to Smoking Cessation
among Latino Adult Tobacco Users in Maryland. Manuscript Under Review.
Trust   issues                        problems



             Emergency Preparedness
• Difficulty defining emergency
• Wide range of perceived personal emergency
  risks: immigration problems; crime, personal
  insecurity, gangs; home/traffic accidents; home
  fires; environmental problems; and snipers.
• Few participants had received information on
  emergency preparedness, and most did not
  have an emergency plan.

SOURCE: Journal of Health Care for the Poor and Underserved; 2007;18:465-481.
 Principles of Community-based Research as Applied to
              Maryland Latino Communities
 • Community as a unit of identity
 • Builds on strengths and resources within community
 • Facilitates collaborative, equitable partnerships in all phases
   of research
 • Promotes co-learning and capacity-building
 • Integrates knowledge and action
 • Emphasizes local relevance & multiple determinants of health
 • Implements an iterative process
 • Disseminates findings and knowledge
 • Long-term process and commitment

SOURCE: Martinez IL, Carter-Pokras O, Brown PB. Addressing the Challenges of Latino
Health Research: Community-based approaches in an emergent urban community. Journal
of the National Medical Association (In Press)
Olivia Carter-Pokras, Ph.D.
Associate Professor
Department of Epidemiology & Biostatistics
University of Maryland School of Public Health