Latinos and the Life Cycle Dr. Judith C. Rodriguez, RD, University of North Florida Mr. Daniel Santibanez, MPH Candidate, University of North Florida April 22, 2005 This is part 3 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.

The Early Years General info Beliefs and Practices Issues Recommendations

General info

Beliefs and Practices

Issues

Recommendations

The Early Years – 0-5 Years General info Mental – Sense of security and bonding determined by care given Physiological – First year is the fastest rate of growth of entire life; growth slows after first year Breast feeding – has physiological and mental benefits

General info

Mental –

Sense of security and bonding determined by care given

Physiological –

First year is the fastest rate of growth of entire life; growth slows after first year

Breast feeding –

has physiological and mental benefits

Beliefs and Practices Children are a gift from God Early introduction of solids common practice A “fat baby is a healthy baby” The Early Years – 0-5 Years

Beliefs and Practices

Children are a gift from God

Early introduction of solids common practice

A “fat baby is a healthy baby”

Issues Inadequate access to or insufficient use of health care In US NTD prevalence highest among Hispanics High level of nutrient needs relative to size and iron-deficiency anemia Inappropriate bottle feeding practices The Early Years – 0-5 Years

Issues

Inadequate access to or insufficient use of health care

In US NTD prevalence highest among Hispanics

High level of nutrient needs relative to size and iron-deficiency anemia

Inappropriate bottle feeding practices

Issues Immunization rates need improvement High levels of dental caries Nearly one in four cases of AIDS reported in children under the age of 13 is among Latinos. http://www.ashastd.org/news/hisp.html The Early Years – 0-5 Years

Issues

Immunization rates need improvement

High levels of dental caries

Nearly one in four cases of AIDS reported in children under the age of 13 is among Latinos.

http://www.ashastd.org/news/hisp.html

The Early Years – 0-5 Years Recommendations Promote prenatal care Promote breastfeeding Provide information on introduction of and benefits of appropriate infant feeding practices Provide information about free and reduced health care options

Recommendations

Promote prenatal care

Promote breastfeeding

Provide information on introduction of and benefits of appropriate infant feeding practices

Provide information about free and reduced health care options

General info Beliefs and Practices Issues Recommendations School Age – 6 - 13

General info

Beliefs and Practices

Issues

Recommendations

School Age – 6 - 13 General info Nutrient needs are relatively stable, but may vary a bit during growth spurts Sense of self and identity are being formed Many health care values and habits are being developed/learned Body must be prepared for upcoming growth and physical changes Physical activity is important

General info

Nutrient needs are relatively stable, but may vary a bit during growth spurts

Sense of self and identity are being formed

Many health care values and habits are being developed/learned

Body must be prepared for upcoming growth and physical changes

Physical activity is important

Beliefs and Practices Children’s food preferences/ idiosyncrasies need to be met “ Milk” is good – but in excess may displace other foods and nutrients Children are allowed to eat unlimited, what they like School Age – 6 - 13

Beliefs and Practices

Children’s food preferences/ idiosyncrasies need to be met

“ Milk” is good – but in excess may displace other foods and nutrients

Children are allowed to eat unlimited, what they like

Issues High risk for behavioral and developmental disorders Dental caries Environmental hazards Overweight – but not perceived as an issue Diabetes Asthma Unintentional injuries Health care insurance/access School Age – 6 - 13

Issues

High risk for behavioral and developmental disorders

Dental caries

Environmental hazards

Overweight – but not perceived as an issue

Diabetes

Asthma

Unintentional injuries

Health care insurance/access

School Age – 6 - 13 http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm

School Age – 6 - 13 “One in three Latino children with a family history of diabetes suffers from pre-diabetes….. this condition does not seem to be associated with the child's weight” Cruz, M. Journal of Clinical Endocrinology & Metabolism . Jan. 2004

“One in three Latino children with a family history of diabetes suffers from pre-diabetes….. this condition does not seem to be associated with the child's weight”

Cruz, M. Journal of Clinical Endocrinology & Metabolism . Jan. 2004

School Age – 6 - 13 Recommendations Determine child rearing values of/and caregivers and use such in health promotion strategies Educate parents on benefits of preventive practices Help children develop/learn coping strategies that promote health in an appropriate cultural, social, and educational context

Recommendations

Determine child rearing values of/and caregivers and use such in health promotion strategies

Educate parents on benefits of preventive practices

Help children develop/learn coping strategies that promote health in an appropriate cultural, social, and educational context

Adolescence 13-18 General info Beliefs and Practices Issues Recommendations

General info

Beliefs and Practices

Issues

Recommendations

Adolescence 13-18 General info Mental/emotional - increased awareness of “sexual self,” body image Behavior standards set by peer group Physiological ranges of growth spurts and peaks, (Females - menses create an increased need for some nutrients) Secondary sex characteristics start to appear body is preparing for physiological changes Limited self exploration, dating and intimacy

General info

Mental/emotional - increased awareness of “sexual self,” body image

Behavior standards set by peer group

Physiological ranges of growth spurts and peaks, (Females - menses create an increased need for some nutrients)

Secondary sex characteristics start to appear body is preparing for physiological changes

Limited self exploration, dating and intimacy

Adolescence 13-18 Beliefs and Practices Caregivers may not discuss sex, reproduction; consider it “taboo” Males may be given more “liberty” and freedom for sexual exploration than females Modesty for women highly valued

Beliefs and Practices

Caregivers may not discuss sex, reproduction; consider it “taboo”

Males may be given more “liberty” and freedom for sexual exploration than females

Modesty for women highly valued

Adolescence 13-18 Issues Overweight Substance abuse Gang violence Intergenerational and peer pressures Low high school completion rates Adolescent pregnancy Accidental deaths HIV/AIDS Mental health, depression, suicide

Issues

Overweight

Substance abuse

Gang violence

Intergenerational and peer pressures

Low high school completion rates

Adolescent pregnancy

Accidental deaths

HIV/AIDS

Mental health, depression, suicide

Adolescence 13-18

Adolescence 13-18 Issues Study by Delva, et al found “Drug use was significantly higher among boys and adolescents of almost all Hispanic ethnicities who did not live with both parents…(and) drug use differed according to ethnic group on language first spoken, parental education, urbanicity, and region.” (AJPH 2005) Erratic or poor eating, iron deficiency anemia

Issues

Study by Delva, et al found “Drug use was significantly higher among boys and adolescents of almost all Hispanic ethnicities who did not live with both parents…(and) drug use differed according to ethnic group on language first spoken, parental education, urbanicity, and region.” (AJPH 2005)

Erratic or poor eating, iron deficiency anemia

Adolescence 13-18 Recommendations Emphasize how quality of health behaviors and nutritional care now will greatly impact reproductive and later years Interventions should tailored to Latino children and be done in school health and pediatric clinics

Recommendations

Emphasize how quality of health behaviors and nutritional care now will greatly impact reproductive and later years

Interventions should tailored to Latino children and be done in school health and pediatric clinics

Reproductive Years General info Beliefs and Practices Issues Recommendations

General info

Beliefs and Practices

Issues

Recommendations

Reproductive Years General info Increased synchrony of physiological, social, financial, and emotional maturity Social roles defined Sexual maturity reached; body in maintenance, then slowing, mode Symptoms of some chronic diseases may start to manifest

General info

Increased synchrony of physiological, social, financial, and emotional maturity

Social roles defined

Sexual maturity reached; body in maintenance, then slowing, mode

Symptoms of some chronic diseases may start to manifest

Reproductive Years General info Hispanics represent 12+% percent of the population and 17+% percent of US AIDS cases Latinos are among the greatest risk for hepatitis C virus. Hispanic women are 7X more likely to contract AIDS and have higher rates of syphilis and the second highest number of cases of gonorrhea

General info

Hispanics represent 12+% percent of the population and 17+% percent of US AIDS cases

Latinos are among the greatest risk for hepatitis C virus.

Hispanic women are 7X more likely to contract AIDS and have higher rates of syphilis and the second highest number of cases of gonorrhea

Reproductive Years Beliefs and Practices Variety of reasons may be ascribed to illnesses Various practices during pregnancy – “antojos” (cravings) must be honored Concepts of “marianismo” and “machismo” will influence prevention and care seeking behaviors

Beliefs and Practices

Variety of reasons may be ascribed to illnesses

Various practices during pregnancy – “antojos” (cravings) must be honored

Concepts of “marianismo” and “machismo” will influence prevention and care seeking behaviors

Reproductive Years Issues Lung cancer mortality is 3X higher for Hispanic men (39.6 per 100,000) than for Hispanic women (14.9 per 100,000). Lung cancer is one of the most common types of cancer in Hispanic men and women. Lung cancer death rates are higher among Cuban-American men than among Puerto Rican and Mexican men Latino women have higher rates of breast and cervical cancers

Issues

Lung cancer mortality is 3X higher for Hispanic men (39.6 per 100,000) than for Hispanic women (14.9 per 100,000).

Lung cancer is one of the most common types of cancer in Hispanic men and women.

Lung cancer death rates are higher among Cuban-American men than among Puerto Rican and Mexican men

Latino women have higher rates of breast and cervical cancers

Reproductive Years Issues Diabetes is particularly common among middle-aged Hispanic Americans Diabetes is twice as common in Mexican American and Puerto Rican adults

Issues

Diabetes is particularly common among middle-aged Hispanic Americans

Diabetes is twice as common in Mexican American and Puerto Rican adults

Health Issues - Obesity Most Growth in Prevalence of Obesity: Hispanic ethnicity (11.6% to 20.8% 1991-1999) Obesity is 1.5 times more common in Mexican American women (reaching 52%) than in the general, female population. http://www.nlm.nih.gov/medlineplus/hispanicamericanhealth.html#children

Most Growth in Prevalence of Obesity:

Hispanic ethnicity (11.6% to 20.8% 1991-1999)

Obesity is 1.5 times more common in Mexican American women (reaching 52%) than in the general, female population. http://www.nlm.nih.gov/medlineplus/hispanicamericanhealth.html#children

Reproductive Years Recommendations - Women Encourage consumption of high folic acid foods Promote wt. management and wt. loss strategies Promote traditional network support systems, especially for child rearing and prenatal care. Educate immigrant families on disease risk

Recommendations - Women

Encourage consumption of high folic acid foods

Promote wt. management and wt. loss strategies

Promote traditional network support systems, especially for child rearing and prenatal care.

Educate immigrant families on disease risk

Reproductive Years Recommendations Promote Seven Principles For Lifetime Diabetes Control Principio 1: Aprenda todo lo que pueda sobre la diabetes (learn all you can) Principio 2: Reciba atención regular para la diabetes (get regular care) Principio 3: Aprenda cómo controlar la diabetes (learn to control)

Recommendations

Promote Seven Principles For Lifetime Diabetes Control

Principio 1: Aprenda todo lo que pueda sobre la diabetes (learn all you can)

Principio 2: Reciba atención regular para la diabetes

(get regular care)

Principio 3: Aprenda cómo controlar la diabetes

(learn to control)

Reproductive Years Recommendations Principio 4: Cuide los factores clave de la diabetes (attend to factors that are important) Principio 5: Vigile los factores clave de la diabetes (watch the key factors related to diabetes) Principio 6: Prevenga las complicaciones de la diabetes (prevent complications) Principio 7: Visite al médico para ver si tiene alguna complicación de la diabetes (see the physician if you have any complications)

Recommendations

Principio 4: Cuide los factores clave de la diabetes (attend to factors that are important)

Principio 5: Vigile los factores clave de la diabetes (watch the key factors related to diabetes)

Principio 6: Prevenga las complicaciones de la diabetes (prevent complications)

Principio 7: Visite al médico para ver si tiene alguna complicación de la diabetes (see the physician if you have any complications)

Reproductive Years Recommendations Increase early screening, prevention, and treatment and access to health care services Minimize language and cultural barriers Use hotlines and bilingual referral services Resources: Protección Es Vida [a popular bilingual fotonovela] and Paso A Paso [an in-depth resource guide for individuals living with HIV]

Recommendations

Increase early screening, prevention, and treatment and access to health care services

Minimize language and cultural barriers

Use hotlines and bilingual referral services

Resources: Protección Es Vida [a popular bilingual fotonovela] and Paso A Paso [an in-depth resource guide for individuals living with HIV]

http://www.nhlbi.nih.gov/health/prof/heart/latino/foto_sp.pdf

Later Years General info Beliefs and Practices Issues Recommendations

General info

Beliefs and Practices

Issues

Recommendations

Later Years General info Changes in family contacts, social roles, and relationships Mental adjustment to new life status Work at maintaining optimal body functions Some cognitive functions affected Increased sense of mortality

General info

Changes in family contacts, social roles, and relationships

Mental adjustment to new life status

Work at maintaining optimal body functions

Some cognitive functions affected

Increased sense of mortality

Later Years Beliefs and Practices Elderly are to be respected and honored Many families are extended – they care for the elderly in the home or have them nearby

Beliefs and Practices

Elderly are to be respected and honored

Many families are extended – they care for the elderly in the home or have them nearby

Later Years Issues Chronic diseases manifested - heart disease, osteoporosis, high blood pressure, diabetes. For Hispanics aged 50 or older, about 25 to 30 percent have either diagnosed or undiagnosed diabetes. Access to health care, financial security and mental adjustment

Issues

Chronic diseases manifested - heart disease, osteoporosis, high blood pressure, diabetes.

For Hispanics aged 50 or older, about 25 to 30 percent have either diagnosed or undiagnosed diabetes.

Access to health care, financial security and mental adjustment

Later Years Issues Activities of daily living likely to be affected. Family members experience conflict related to “respecting” the elderly and getting them to adhere to dietary and medical treatments Diet – coffee/chocolate and toast/cheese Undiagnosed osteoporosis risk Longer life span but in poorer health – and describe health as fair or poor

Issues

Activities of daily living likely to be affected.

Family members experience conflict related to “respecting” the elderly and getting them to adhere to dietary and medical treatments

Diet – coffee/chocolate and toast/cheese

Undiagnosed osteoporosis risk

Longer life span but in poorer health – and describe health as fair or poor

Later Years Issues Twenty-seven percent of Hispanic American households provide informal caregiving to a friend or relative. The typical Hispanic caregiver is a 40 year old female. More than half of all Hispanic caregivers also has a child age 18 and younger living at home. http://www.aoa.dhhs.gov/press/fact/alpha/fact_serving_hispanicamer.asp

Issues

Twenty-seven percent of Hispanic American households provide informal caregiving to a friend or relative.

The typical Hispanic caregiver is a 40 year old female.

More than half of all Hispanic caregivers also has a child age 18 and younger living at home.

http://www.aoa.dhhs.gov/press/fact/alpha/fact_serving_hispanicamer.asp

Later Years Recommendations Seek out community networks e.g., transportation van, congregate meals, etc. Teach simple self monitoring strategies Help empower widows/elderly males living alone to select and prepare healthy foods Provide support networks and strategies for caregivers of elders

Recommendations

Seek out community networks e.g., transportation van, congregate meals, etc.

Teach simple self monitoring strategies

Help empower widows/elderly males living alone to select and prepare healthy foods

Provide support networks and strategies for caregivers of elders

Healthy People 2010 Recommendations The National Alliance for Hispanic Health Reports Forty percent of Healthy People 2010 population-based objectives/sub-objectives do not have Hispanic baseline data. Progress on these objectives cannot be measured for Hispanic communities. Recommendations Release a Hispanic Healthy People 2010 midcourse review to report Hispanic baseline data and identify a tracking system Implement improvements in Hispanic data collection, analysis, and reporting Ensure that baseline data and tracking systems are put into place

Recommendations

The National Alliance for Hispanic Health Reports

Forty percent of Healthy People 2010 population-based objectives/sub-objectives do not have Hispanic baseline data.

Progress on these objectives cannot be measured for Hispanic communities.

Recommendations

Release a Hispanic Healthy People 2010 midcourse review to report Hispanic baseline data and identify a tracking system

Implement improvements in Hispanic data collection, analysis, and reporting

Ensure that baseline data and tracking systems are put into place

CDC Interactive Heart Disease Mortality Maps http://www.cdc.gov/cvh/maps/statemaps.htm CDC Interactive Cancer Mortality Maps http://www3.cancer.gov/atlasplus/charts.html Florida Department of Health http://www.doh.state.fl.us/ Florida Health Charts and Interactive Maps http://www.floridacharts.com/charts/chart.aspx Duval County Health Department http://www.dchd.net/index.htm City of Jacksonville Community Maps http://www.coj.net/default.htm Resources: Data Web Sites

CDC Interactive Heart Disease Mortality Maps

http://www.cdc.gov/cvh/maps/statemaps.htm

CDC Interactive Cancer Mortality Maps

http://www3.cancer.gov/atlasplus/charts.html

Florida Department of Health

http://www.doh.state.fl.us/

Florida Health Charts and Interactive Maps

http://www.floridacharts.com/charts/chart.aspx

Duval County Health Department

http://www.dchd.net/index.htm

City of Jacksonville Community Maps

http://www.coj.net/default.htm

Extension - Spanish language materials http://www.extensionenespanol.net/contact.cfm National Alliance for Hispanic Health www.hispanichealth.org National Council of La Raza Institute for Hispanic Health www.nclr.org/policy/health.html National Dairy Council http://www.nationaldairycouncil.org/ Office of Minority Health http://www.omhrc.gov/omhrc USDA Food and Nutrition Information Center, Ethnic and Cultural www.nal.usda.gov/fnic/etext/000010.html Resources: Web Sites

Extension - Spanish language materials http://www.extensionenespanol.net/contact.cfm

National Alliance for Hispanic Health www.hispanichealth.org

National Council of La Raza Institute for Hispanic Health www.nclr.org/policy/health.html

National Dairy Council

http://www.nationaldairycouncil.org/

Office of Minority Health http://www.omhrc.gov/omhrc

USDA Food and Nutrition Information Center, Ethnic and Cultural www.nal.usda.gov/fnic/etext/000010.html

Health Issues in the Latino Community . By M. Aguirre-Molina, C. Molina, R. E. Zambrana. 2001. Latina Health in the United States . By M. Aguirre-Molina, C. Molina. 2003. Hispanic foodways, nutrition, and health . By Diva Sanjur. 1995. The Health of Latino Communities in the South: Challenges and Opportunities. Available at: http://www.nclr.org/content/publications/detail/26898/ Contemporary Nutrition for Latinos. Judith C. Rodriguez. 2004. Resources: Books

Health Issues in the Latino Community . By M. Aguirre-Molina, C. Molina, R. E. Zambrana. 2001.

Latina Health in the United States . By M. Aguirre-Molina, C. Molina. 2003.

Hispanic foodways, nutrition, and health . By Diva Sanjur. 1995.

The Health of Latino Communities in the South: Challenges and Opportunities. Available at:

http://www.nclr.org/content/publications/detail/26898/

Contemporary Nutrition for Latinos. Judith C. Rodriguez. 2004.

Any questions? Thank you This seminar is part 3 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Dept. For more information or register for the seminars, please call 620-1289 .

Any questions?

Thank you