Not the end of story Higher disability rates? Higher diagnosed Type II diabetes over age 20 and mortality (Mexican Americans) Higher obesity (Mexican Americans) More stomach, liver, gallbladder and cervical cancers Worse asthma (Puerto Ricans) Less asthma (Mexican Americans)
Hispanic paradox Kyriakos S. Markides, University of Texas Medical Branch, Galveston Jeanne Ruiz, Ph.D., R.N., assistant professor at The University of Texas Health Science Center at San Antonio (UTHSCSA) Smith and Bradshaw, University of Texas School of Public Health
Why are Latinos with diabetes twice as likely to die from it as non-Hispanic whites? Genetics? Culture? Environment? Less access to care? Racism?
Mexican, Puerto Rican, Venezuelan, Cuban? Immigrant or second-generation? Wealthy or poor? Urban or rural?
Which Latinos? Who decides? Researchers dont all agree Self-ID can change
Whose genes? Studies to define genetic ancestry Body composition (NY Puerto Ricans) Asthma (SF Mexican-Americans, NY Puerto Ricans)
Psychosocial factors Work environment (job stress, shift work); personality and negative emotions (anger, hostility, anxiety, and depression); protective effects of social networks and support. Hope and curiosity (Ichiro Kawachi on heart disease)
Social determinants Income inequality Social cohesion and mutual trust Inequalities in political participation, civic engagement Residential segregation (Kawachi, Harvard University)
Racism Unequal treatment -- Studies on unconscious decision-making Racialized living -- Allostatic load (stress response) -- Social rank
More research is needed Countries of origin Regional differences (multi-center studies) Lengths of U.S. residence Research in countries of origin
Ichiro Kawachi Thomas A. LaVeist Brian Smedley, ed.
Leading causes of death among Latinos (2003) 1)Diseases of heart 28,298 2)Malignant neoplasms 24,070 3)Unintentional injuries h 10,418 4)Cerebrovascular diseases 6,658 5)Diabetes mellitus 6,179 6)Chronic liver disease and cirrhosis 3,382 7)Homicide 3,355 8)Chronic lower respiratory diseases 3,174 9)Influenza and pneumonia 2,948 10)Certain conditions originating in the perinatal period 2,628
Worst air pollution SHORT-TERM PARTICULATES (soot) Los Angeles-Long Beach-Riverside Bakersfield Fresno-Madera OZONE (smog) Bakersfield,CA Los Angeles-Long Beach-Riverside Visalia- Porterville,CA
Community stories Community organizers City and county health officers Community food assessment (PolicyLink) Center on Alcohol Marketing and Youth Community Action to Fight Asthma (regional project info)
Asthma Who is being counted? Access to medications in school School air safety Air pollution regulations Corporate responsibility Land use laws
AIDS/HIV 14 percent of the population; 20 percent of AIDS diagnoses 32 percent U.S. born; 18 percent Puerto Rican; 17 percent Mexican
AIDS – issues Transmission patterns Education Access to care Community concern
AIDS -resources Kaiser Family Foundation GLAAD (http://www.glaad.org/publications/resource_doc_detail.php?id=3101)http://www.glaad.org/publications/resource_doc_detail.php?id=3101 Bienestar (http://www.bienestar.org)http://www.bienestar.org Proyecto Contra SIDA Por Vida San Francisco AIDS Foundation (http://www.sfaf.org/beta/2005_win/mortality.html)
How to find stories
Consider the source
Evaluating a study Who are the participants (subjects) Number of participants (sample size) Institution P value Standard deviation (SD) Mean, median