IMPLICATIONS OF MEASURES OF HISPANIC ETHNICITY FOR STD PREVENTION AND TRANSMISSION Mary B. Adam, MD and the Informatics and Decision Making Laboratory, University of Arizona College of Medicine

How do you measure ethnicity? Skin color/race Skin color/race Country of birth/continent of origin Country of birth/continent of origin Parents/Grandparents national origin Parents/Grandparents national origin Surname/name analysis Surname/name analysis Self perception Self perception Shared language Shared language

Hispanic Origin Form US Census 2000 “NO” Box if Not Spanish/Hispanic/Latino No, Not Spanish/Hispanic/Latino No, Not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Puerto Rican Yes, Cuban Yes, Cuban Yes, Other Spanish/ Hispanic/Latino______ Yes, Other Spanish/ Hispanic/Latino______ _____________, Salvadoran, Dominican etc _____________, Salvadoran, Dominican etc

Heterogeneity in Hispanic Populations Recent immigrant-legal/illegal Recent immigrant-legal/illegal Family could have lived in this region for hundreds of years and under several different flags Family could have lived in this region for hundreds of years and under several different flags English speakers English speakers Spanish speakers Spanish speakers Retain strong ties with country of origin or may had adopted attitudes values and beliefs of the dominant culture. Retain strong ties with country of origin or may had adopted attitudes values and beliefs of the dominant culture.

NIH Project Aims: (1) to evaluate measures of Hispanic Ethnicity (Phase I) (1) to evaluate measures of Hispanic Ethnicity (Phase I) (2) to measure differences in sexual beliefs/values/attitudes in Hispanic versus Anglo teens and in high risk versus low risk teens (Phase I). (2) to measure differences in sexual beliefs/values/attitudes in Hispanic versus Anglo teens and in high risk versus low risk teens (Phase I). (3) To measure differences in reasons for risky sexual decisions in Hispanic versus Anglo teens and in high risk and low risk teens (Phase I) (3) To measure differences in reasons for risky sexual decisions in Hispanic versus Anglo teens and in high risk and low risk teens (Phase I) (4) to use the data from (1) and (2) in a new curriculum for reducing and avoiding sexual risk in teens (Phase II). (4) to use the data from (1) and (2) in a new curriculum for reducing and avoiding sexual risk in teens (Phase II).

Measures of Hispanic Ethnicity Self-reported Ethnicity Self-reported Ethnicity Subjects birth country Subjects birth country Parent’s and Grandparent's birth country Parent’s and Grandparent's birth country Language Use Scales Language Use Scales Religion Religion

Description of sample 255 Adolescents age Adolescents age Gender Gender –45% male; 55% female Ethnicity Ethnicity –45% Mexican American/Hispanic –40% Anglo –14% Mixed ethnicity –1% Black –<1% Central/South American –<1%Native American –<1% Asian

Description of Sample Anglo –98% speak English –99% Born in the United States –27% Protestant –16% Catholic Hispanic Hispanic –41% speak English, 20% speak Spanish –78% born in the United States –18% Protestant –70% Catholic

Factor Analysis Language Use54% variance Language Use54% variance Country born8% variance Country born8% variance Spanish media6% variance Spanish media6% variance Religion importance6% variance Religion importance6% variance Self born4% variance Self born4% variance Catholic/nonCatholic3% variance Catholic/nonCatholic3% variance

Hierarchical Cluster Analysis Generation born Generation born English language use English language use Spanish language use Spanish language use

Rates of Sexual Activity by Gender and Ethnicity 49% of males reported sexual activity 49% of males reported sexual activity 49% of females reported sexual activity 49% of females reported sexual activity 48% of Anglos reported sexual activity 48% of Anglos reported sexual activity 44% of Hispanics reported sexual activity 44% of Hispanics reported sexual activity

Rates of Sexual Activity by Country of Birth 38% of foreign born Hispanics reported being sexually active 38% of foreign born Hispanics reported being sexually active 48% of US born Hispanics reported being sexually active 48% of US born Hispanics reported being sexually active 48% of US born Anglos reported being sexually active. 48% of US born Anglos reported being sexually active.

Rates of Sexual Activity by Language Use: How often do you speak Spanish in general? 34% of Hispanics who “almost always” spoke Spanish were active 34% of Hispanics who “almost always” spoke Spanish were active 45% of Hispanics who “often” or “sometimes” spoke Spanish were active 45% of Hispanics who “often” or “sometimes” spoke Spanish were active 55% of the Hispanics who reported “almost never” were sexually active 55% of the Hispanics who reported “almost never” were sexually active

Rates of Sexual Activity by Religious Affiliation 40% of Catholics reported being sexually active 40% of Catholics reported being sexually active 54% of non Catholics reported being sexually active 54% of non Catholics reported being sexually active

Individuals within ethnic groups are not homogenous in their beliefs, values, experiences, or behavior.

Culture vs Context Family structure Family structure Availability of family members Availability of family members Social economic status Social economic status Educational attainment Educational attainment Discrimination Discrimination Access to health care Access to health care Language barriers Language barriers Religiosity Religiosity Perceptions about illness, treatment, physician-patient roles Perceptions about illness, treatment, physician-patient roles Value of maternal role Value of maternal role Acculturation Acculturation