The document provides a comprehensive health overview of the Latino population in the U.S. and specifically in Northeast Florida, highlighting key health issues such as heart disease, diabetes, obesity, and cancer. It emphasizes the need for culturally appropriate health information and interventions due to the unique health challenges faced by Hispanics. Additionally, it discusses health disparities, access to care, and the importance of addressing these issues through community initiatives and behavior improvements.

1. Latinos in the U.S. and Northeast Florida: A Health Overview Dr. Judith C. Rodriguez, RD, University of North Florida Mr. Daniel Santibanez, MPH Candidate, University of North Florida Mr. Radley Remo, (Duval County Health Department) - Health Data Feb. 25, 2005 This is part 1 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.

2. National, state, and local health data Action Models and Initiatives Discussion

3. National Health Data Why? Health status affects quality of life Poor health is costly for the individual Poor health status is costly for the nation

4. Hispanics/Latinos…and Health Many disease risk factors can be decreased Need culturally appropriate information and approaches

5. Leading Causes of Death – Overall, U.S., 2002 heart disease: 696,947 cancer: 557,271 stroke: 162,672 chronic lower respiratory disease: 124,816 accidents: 106,742 diabetes: 73,249 pneumonia/flu: 65,681 Alzheimer’s disease: 58,866 kidney disease: 40,974 suicide: 33,865

6. Hispanic Health Issues Heart disease Diabetes Overweight and obesity Cancer Environmental health Other health issues

7. Leading Causes of Death for Hispanics, Duval County 2001-03 Heart Disease (n= 71) Cancer (n=57) Injuries (Accidents) (n=27) Source: FDOH, Office of Vital Statistics, 2001-2003 (R.Remo DCHD)

8. Selected Death Rates by Race/Ethnicity, Duval County Source: FDOH, Office of Vital Statistics, 2001-2003 Source Hispanic Population Estimates: Claritas 2003 Source Duval County Population Estimates: Demographic Estimating Conference Database, 4/2004 (R.Remo DCHD)

9. Health Issues - Cardiovascular Disease For Hispanics, too, heart disease the primary cause of mortality/death Heart disease and stroke mortality average about 30% or more each year

10. Health Issues - Cardiovascular Disease Percent of total deaths 28% of male deaths 34% of female deaths For MA: about 29% for men about 27% of women American Heart Association (2004) Heart Facts 2004: Latino/ Hispanic Americans & AHA 2001 Heart & Stroke Statistics; AHA Hispanics and CVD

11. Health Issues - Cardiovascular Disease Death Rates for CVD 1980 1990 1995-97 All ages, age adjusted 40.8 27.7 26.3 Males, age adj 44.9 30.2 28.4 White males, age adj 41.9 27.7 26.1 Black males, age adj 77.5 56.1 50.5 Hispanic males, age adj ---- 22.7 22.4

12. Health Issues - Cardiovascular Disease Serum Cholesterol 1988-94 1988-94 Both sexes 203 203 Males 202 Females 204 White male 202 White f 205 Black male 199 Black f 203 Mexican male 204 Mex f 203

14. Health Issues - Hypertension 1976-80 1988-94 Both sexes, age adj 39.0 23.1 Males, age adj 44.0 25.3 White male, age adj 43.5 24.3 Black male, age adj 48.7 34.9 Mexican male, age adj 25.0 25.2

15. Healthy People 2010 Goals 12-Heart Disease and Stroke 12-1 Reduce coronary heart disease deaths Baseline- 208 deaths per 100,000 Hispanics-145 deaths per 100,000 12-11 Increase the proportion of adults with high blood pressure who are taking action to help control their blood pressure Baseline- 82% of adults aged 18+ Hispanics- 74% of adults aged 18+ 12-15 Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years Baseline- 67% of adults aged 18+ Hispanics- 59% of adults aged 18+ Healthy People 2010; www.health.gov/healthlypeople/

16. Discussion What are your experiences related to Hispanics and CVD in the NE Florida area?

17. Health Issues - Diabetes About one third of total diabetes among Hispanic Americans is undiagnosed (NHANES III; www.niddk.nih.gov)

18. Health Issues - Diabetes

19. Health Issues - Diabetes Based on 1997 American Diabetes Association criteria % of population 20% 12% 10% 12%

20. Healthy People 2010 Goals 5-2 Prevent Diabetes Baseline- 3.5 new cases of diabetes per 1,000 Hispanics- 5.7 new cases of diabetes per 1,000 5-5 Reduce the diabetes death rate Baseline- 75 deaths per 100,000 Hispanics-86 deaths per 100,000 Healthy People 2010; www.health.gov/healthlypeople/

21. Discussion What are your experiences related to Hispanics and diabetes in the NE Florida area?

22. Health Issues - Overweight and Obesity Healthy wt Overwt Obesity Overwt* Both sexes 41.7 54.6 22.6 65.2 Males 39.1 59.4 19.9 68.8 White Male 38.0 60.5 20.3 69.5 Black Male 40.2 57.0 20.9 62.0 Mexican Male 31.6 67.0 23.1 74.1

23. Health Issues - Overweight and Obesity Healthy wt Overwt Obesity Overwt* Both sexes 41.7 54.6 22.6 65.2 Females 39.1 59.4 19.9 68.8 White Female 38.0 60.5 20.3 57.0 Black Female 40.2 57.0 20.9 77.5 Mex. Female 31.6 67.0 23.1 71.4

24. Health Issues - Overweight and Obesity Latinos: higher prevalence than the general population Obesity is prevalent among Hispanics, especially women (Dairy Council Digest, Jan/Feb 2001; www.nationaldairycouncil.org )

25. Health Issues - Overweight and Obesity Among U.S. Groups: Hispanics had the most growth in prevalence of obesity Hispanic ethnicity 11.6% to 20.8% 1991-1999

26. Health Issues - Overweight and Obesity Mexican-American children ages 6-11 were more likely to be overweight (22 percent) than non-Hispanic black children (20 percent) and non-Hispanic white children (14 percent). http://www.cdc.gov/nchs/pressroom/04facts/obesity.htm

28. Health Issues - Overweight and Obesity Overweight Children* 1988-1994 1999-2002 Both sexes 11.3 15.8 Males 11.6 16.9 Mex. Males 17.5 26.5 Female 11.0 14.7 Mex. Females 15.3 17.1

29. Discussion What are your experiences related to Hispanics and overweight or obesity in the NE Florida area?

30. Health Issues - Physical Activity 50% 57% 65% 58% 25% 36% (Mex. American) % of Population

31. Health Issues - Cancer Cancer incidence rates, age adjusted, per 100,000, all sites All persons 457.1 White male 542.2 Black male 642.9 Hispanic male 399.5 White female 418.2 Black female 378.4 Hispanic female 294.3

32. Health Issues - Environmental health http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm

33. Discussion The Hispanic population is scattered throughout the area with little or no data collected beyond some basis census and health information, and even those figures are incomplete, controversial, or questionable. What measures should be taken to better assess the situation? Whose responsibility should it become (i.e., Health Dept. or City)? What can your agency or program do?

34. Other health issues Mental Health HIV/AIDS Osteoporosis Lactose intolerance Food safety Health care access

35. Mental Health Substance abuse Acculturation and self identity Coping strategies

36. Other health issues - HIV/AIDS HIV/AIDS per 100,000 pop. Group, all ages/ adjusted Death rates Cases White male 4.3 13.6 Black male 33.3 109.2 Hispanic male 9.1 37.2 White female 0.9 2.2 Black female 13.4 49.0 Hispanic female 2.6 11.3

37. Where? There are 9 characters in this picture

38. Health Issues - Osteoporosis Minority women are at a higher risk of developing osteoporosis than previously believed

39. Health Issues - Osteoporosis 55.5% of Hispanic, postmenopausal, women have low bone mineral densities and in 4.3% of these women, osteoporosis was identified (Diary council Digest, Jan/Feb 2001; www.nationaldiarycouncil.org )

40. Health Issues - Lactose Intolerance Lactose maldigestion occurs in about 53% Mexican Americans (Dairy Council Digest, Jan/Feb 2001; www.nationaldairycouncil.org ) Prevalence among minority groups is not clear

41. Health Issues - Food Safety Listeriosis occurs at higher prevalence rate among Latinos than in overall population Hispanic infants had a 12 times greater incidence Hispanic women age 30 to 34 had a 13 times greater incidence http://www.fsis.usda.gov/OA/educator/educator7-2.pdf

42. Health Issues - Maternal and Child Care 6-Maternal, Infant, and Child Health 16-6 Increase the proportion of pregnant women who receive early and adequate prenatal care Baseline- a. Care beginning in the first trimester; 83% of live birth b. Early and adequate prenatal care; 74% of live births Hispanics- a. 74% of live births b. 66% of live births Healthy People 2010; www.health.gov/healthlypeople/

43. Health Issues - Maternal and Child Care 6-Maternal, Infant, and Child Health 16-10 Reduce low birth weight and very low birth weight Baseline- a. Low birth weight; 7.6% b. Very low birth weight; 1.4% Hispanics- a. Low birth weight; 6.4% b. Very low birth weight; 1.1%

44. Health Issues - Maternal and Child Care Prenatal care for live births Group % of live births All 83.7 Hispanic/Latino 76.7 Mexican 75.7 Puerto Rican 79.9 Cuban 92.0 Central and South American 78.7 Other/Unknown 76.7

45. Health Issues - Maternal and Child Care Infant, neonatal, and postneonatal mortality rates Group % of live births All 7.0 Hispanic/Latino 5.6 Mexican 5.4 Puerto Rican 8.2 Cuban 3.7 Central and South American 5.1 Other/Unknown 7.1

46. Other health issues - Infant Mortality, Florida: 1997-2001 Note: Five year average number of deaths and death rates per 1,000 live births. Infant deaths by Hispanic mother of origin, rate per 1,000 live births. Source: Florida Department of Health, Office of Vital Statistics, 1997-2001 and Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Health Planning Council of N.E. Fla., Health Plan 2003-2006 12.8 2,916 5.6 4,119 4.7 1,033 7.2 7,133 Rate Num. Rate Num. Rate Num. Rate Num. Black White Hispanic All Races

47. Other health issues - Infant Mortality Region IV, 1997-2001 Note: Five year average number of deaths and death rates per 1,000 live births. Source: Florida Department of Health, Office of Vital Statistics, 1997-2001 and Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Health Planning Council of N.E. Fla., Health Plan 2003-2006 12.4 42 5.6 106 5.8 14 Volusia 17.5 11 6.1 33 0.0 0 St.John’s 13.2 4 5.4 18 0.0 0 Nassau 7.4 2 6.4 10 0.0 0 Flagler 16.4 339 7.1 266 6.2 16 Duval 14.0 11 7.5 60 7.2 3 Clay 8.7 2 6.1 9 0.0 0 Baker Rate Num. Rate Num. Rate Num. Black White Hispanic Area

48. Discussion What do you think contributes to the differences in infant mortality among the different Hispanic groups?

49. Other health issues - Health care access 44.3 million persons lacked health insurance in 1998 (CDC) This represents a continuing increase in the number of uninsured persons (CDC) Latinos (35%) are more likely to report being without health insurance Hispanic vs. Latino Survey by comScore Dec 2002 http://www.ahorre.com/archives/2004/09/hispanic_vs_lat_1.html

51. Other health issues - Duval County (Mr. Radley Remo, DCHD)

52. Leading Causes of Hospitalization for Hispanics, Duval County 2003 Single, live born, w/o cesarean (n=274) Single, live born cesarean (n=107) Pneumonia (n=48)

53. Leading Causes of Ambulatory Care for Hispanics, Duval County 2003 Benign neoplasm of the colon (n=71) Colon screening (n=41) Unspecified cataract (n=40)

54. 2002 Florida Behavioral Risk Factor Surveillance System Statewide Self-Reporting Survey Used to monitor health behavior & health status 18 years & older

55. Behavioral Risk Factors for Hispanics Risk Factors Overweight & Obese Physical Activity Smoking Health Care Coverage & Access

56. Risk Factors by Race/Ethnicity, Florida 2002 Red indicates statistically significant 13.6 40.1 (-) No Health Care Coverage 23.9 21.1 Smoking (current) 22.5 39.2 (-) No Physical Activity 21.4 20.8 Obese % White, Non-Hispanic % Hispanic Risk Factor

57. Behavioral Risk Factor for Hispanics Disease Prevention Annual Flu Shot Mammograms & Pap Tests Colorectal Cancer Screenings Blood Stool Test HIV/AIDS Tests

58. Disease Prevention by Race/Ethnicity, Florida 2002 Red indicates statistically significant (R.Remo DCHD) 44.2 53.0 (+) Ever been tested for HIV 48.8 31.4 (-) Ever had Blood Stool Test 93.5 88.8 Ever had Pap Smear Test 29.9 14.2 (-) Received Flu Shot w/I 12mo. % White, Non-Hispanic % Hispanic Disease Prevention

59. Behavioral Risk Factors for Hispanics Chronic Conditions High Blood Pressure Cholesterol Asthma Diabetes

60. Chronic Conditions by Race/Ethnicity, Florida 2002 Red indicates statistically significant (R.Remo DCHD) 8.0 8.2 Have Diabetes 11.1 11.4 Ever Had Asthma 37.7 30.5 Had High Cholesterol 28.7 20.2 (+) Had High Blood Pressure % White, Non-Hispanic % Hispanic Chronic Condition

61. Discussion With the lack of sufficient specific ethnic data available at the regional and local level, what changes seem appropriate? Knowing the wide range of intragroup diversity, is it appropriate to consider and document acculturation and SES among Hispanics?

62. Examples of Action Models and Initiatives - Research Hispanic/Latino Genetics Community Consultation Network HLGCCN project is a combined effort of Redes En Acción (Networks in Action), which is a major Special Populations Network effort of the NCI, Baylor College of Medicine, the National Institute of General Medical Sciences (NIGMS), and the National Human Genome Research Institute (NHGRI). http://newscenter.cancer.gov/newscenter/pressreleases/HLGCCN

63. Examples of Action Models and Initiatives - Health Orgs American Diabetes Association Programa de Asistencia y Recursos para la Diabetes Diabetes Forecast en Español http://www.diabetes.org/espanol/iniciativas-latinas-dar.jsp

64. Examples of Action Models and Initiatives - Cultural Orgs National Council of La Raza Latino Cancer Education Pilot Project (LCEPP) Salud para su Corazón Comunidad a Comunidad De Casa a Casa: A Diabetes Educational Tool Kit Project http://www.nclr.org/content/programs/detail/27610/

65. National Council of La Raza Latino Cancer Education Pilot Project (LCEPP) Who? NCLR Institute for Hispanic Health National Cancer Institute (NCI), Office of Minority Health and NIH Focus? Identify knowledge, attitudes, and beliefs and barriers to cervical screening, make recommendations for refinement of materials http://www.nclr.org/content/programs/detail/27610/

66. National Council of La Raza Salud para su Corazón Who? NCLR Institute for Hispanic Health National Heart, Lung and Blood Institute (NHLBI) of the NIH Focus? Multilevel strategies outreach model which provides heart health education. Relies on promotores de salud (lay health educators) who disseminate educational and prevention awareness materials. http://www.nclr.org/content/programs/detail/27610/

67. National Council of La Raza Comunidad a Comunidad Who? NCLR Institute for Hispanic Health and Centers for Disease Control and Prevention Focus? Sharing lessons learned and building capacities of parents of youth and community-based organizations (CBOs) to develop culturally competent HIV/AIDS prevention programs. http://www.nclr.org/content/programs/detail/27610/

68. Examples of Action Models and Initiatives - Industry AARP En Español http://www.aarp.org/espanol/salud/ Spanish language web pages with information http://www.elcerdoesbueno.com/

69. Examples of Action Models and Initiatives - Government Healthfinder http://www.healthfinder.gov/news/esdefault.asp Centers for Disease Control http://www.cdc.gov/spanish/

70. Discussion Do you know of any special programs, projects, or resources in NE Florida? What are some specific actions we can take to promote health in the Hispanic community?

71. 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

72. 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

73. For Health Professionals 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/ Resources: Books

74. Thank you! Any questions? This seminar is part 1 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 .