1. Recent sexual risk & health care access among Latinos in the US: Acculturation & health disparities
JS Leichliter,1 FR Bloom,1 SD Rhodes2
1Centers for Disease Control & Prevention
2Wake Forest University School of Medicine
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the CDC. 1

2. Background
Latinos/Hispanics in the US are disproportionately affected by STDs including HIV
Latino immigrants face unique challenges placing them at risk for STDs
Living apart from wife/partner
Language and other barriers
Recent political attention to documentation status could further limit access to health care for a group that is already disenfranchised
Several studies have examined the sexual risk of Latino MSM and adolescents, but fewer have examined heterosexual men
Latinos/Hispanics in the US are disproportionately affected by STDs including HIV
E.g., In 2005, for Latinos there were 459 cases of CT per 100,000 as compared to for non-Hispanic whites
Latino immigrants face unique challenges placing them at risk for STDs
-Living apart from wife/partner
-Language and other barriers (interacting day-to-day & with health care system)
-Recent political attention to documentation status could further limit access to health care for a group that is already disenfranchised
Several studies have examined the sexual risk of Latino MSM and adolescents, but fewer have examined heterosexual men

3. Purpose
To compare Latino/Hispanic and White non-Latino men in recent sexual risk & health care access using data from a national survey
Purpose:
To compare Latino/Hispanic and non-Hispanic White men in recent sexual risk & health care access using data from a national survey

4. Methods I
We used data from the National Survey of Family Growth (NSFG)
National probability sample of non-institutionalized population age yrs (4,928 males)
Data collection: March March 2003
Over-sample: Latino/Hispanic
Interviews conducted in English or Spanish
Survey administration
Face-to-face interviews with one person per household
Portion of interview is collected via ACASI
Response rate (males): 78%
We used data from the National Survey of Family Growth (NSFG)
-National probability sample of non-institutionalized population age yrs in the United States (4,928 males)
-Data collection: March March 2003; all 50 states
-Over-sample: Latino/Hispanic (areas live)
-Interviews conducted in English or Spanish
-Face-to-face interviews with one person per household
-Portion of interview is collected via ACASI
audio computer assisted self interview
**all sexual behavior data that I will presented today was from ACASI
-Response rate for men: 78% (79% overall) 4

5. Methods II
Measures
Acculturation – interview language
Acculturation scales were not included
Sexual behavior (ACASI data)
Health care access & other measures (face-to-face interview data)
3 categories of men based on ethnicity & language
Spanish-speaking Latino, English-Speaking Latino, non-Latino white
SUDAAN used for data analyses to account for complex sampling
Measures:
-Measure of acculturation – interview language
Acculturation scales were not included
-Sexual behavior (ACASI data)
-Health care access & other measures (face-to-face interview data)
-3 categories of men based on ethnicity & language
Spanish-speaking Latino, English-Speaking Latino, non-Latino white
-SUDAAN used for data analyses to account for complex sampling 5

6. Sample Demographics I (%)
Latino/ Hispanic
White, non-Latino
Language
Spanish
English
Age, yr*
15-19
7.1
22.1
16.7
20-24
17.6
20.3
15.2
25-34
41.7
33.0
29.7
35-44
33.6
24.7
38.4
Marital Status*
Married
54.2
34.8
43.9
Cohabiting
18.1
11.1
8.1
Formerly married
3.9
6.1
7.5
Never married
23.8
48.0
40.4 N
360 (10%)
763 (21%)
2478 (69%)
We compared demographics for our three categories of men:
There were significant differences between the 3 groups for age and marital status (*)
For age, <click>
There were fewer Spanish-speaking Latinos that were adolescents (7% vs 17-22% for other 2 groups of men)
<click>
There were more Spanish-speaking Latinos that were yrs (42% vs 30-33% for other 2 groups)
<click> For marital status,
Approx half of Spanish-speaking Latinos were married as compared to 35-44% of the other men

7. Sample Demographics II (%)
Latino/ Hispanic
White, non-Latino
Language
Spanish
English
Time in US, yr*
10.1 (0.5)
16.1 (1.5) --
mean (SD)
Poverty Level Income*
0-149%
53.1
30.0
16.0 %
34.2
34.3
26.8
≥ 300%
12.8
35.8
57.2
Education*
< high school
62.3
26.6
18.5
high school/GED
27.1
36.6
31.1
some college
8.6
24.6
27.8
≥ Bachelor’s
2.0
12.2
22.6 N
360 (10%)
763 (21%)
2478 (69%)
Additional dem factors include time in the US, poverty level income & education
There were significant differences between the groups for all three factors (*) <click>
1st, we compared the 2 groups of Latino men on the mean amount of time they spent in the US … limiting the analyses to men who were born outside of the US.
English-speaking Latinos had been in the US for a significantly longer time – 16 yrs vs 10 yrs.
<click>
We also looked at poverty using the census variable poverty level income (compares income to the poverty level)
Half of Spanish-speaking Latinos had an income at 0-150% of the poverty level (compared to only 16% of NH whites and 30% of ES Latinos
<click> Finally, the majority of SS Latinos had less than a high school degree

8. Sexual Risk Behavior (past 12 months): Opposite-sex partners
Our primary outcomes were recent sexual risk (with opposite-sex partners) & health care access…
For recent sexual risk behaviors (in past 12 months), we examined 1) having 2 or more partners, 2) having sex while “high”, and 3) gave money or drugs for sex
Differences btw the 3 groups of men were statistically significant for all 3 sexual behaviors
For 2+ partners in past 12 months:
29% of ES Latinos (gold) had mult parts vs 22% SS Latinos (grey) and 18% of NL whites (orange)
For had sex while high:
Reports of had sex while high were highest for NL whites (44%) and lowest for SS Latinos (26%)
Exchange sex:
5% of ES Latinos, 4% of SS Latinos and 2% of NL whites

9. Condom Use (last sex): Opposite-sex partners
Additionally, we examined condom use at last vaginal sex, fellatio, and anal sex
All diffs were significant
ES Latinos had highest reports of condom use at last vaginal sex (41%) compared to only 28-29% of SS Latino and NL white
Conversely, SS Latinos had highest reports of condom use at last fellatio
And, SS and ES Latinos had the highest reports of condom use at last anal sex (37-38% vs only 19% of NL whites)

10. Health Care Access (past 12 months)
For health care access, we examined 3 variables: 1)has usual place to go when sick, 2) lacked health insurance, and 3) received STI treatment in past year.
All diffs were significant
Not surprisingly, SS Latinos had lowest reports of having a usual place to go when sick (48%)
AND, the overwhelming majority of them lacked health insurance in the past 12 months (66% vs 32% ES Latinos and 24% NL whites
4% of SS and ES Latinos reported receiving STI treatment in the past year vs 2% of NL whites

11. Logistic Regression Models
Conducted separate logistic regression models to determine if Spanish- and English-speaking Latinos differed from whites for:
2 sexual risk behaviors
2 condom use behaviors
2 health care access variables
All 6 models were adjusted for demographics
Age, marital status, poverty level income, education
Finally…
We conducted 6 separate mult log regs to compare SS and ES Latinos to NL whites
In all 6 models, we adjusted for age, marital status, poverty level income & education
The next slide shows adjusted odds ratios from these 6 models…

12. Logistic Regression Models: AOR (95% CI)
Spanish-speaking Latino
English-speaking Latino
White (non-Latino)
≥ 2 partners
2.1 ( )
1.6 ( ) --
Gave $/drugs for sex
1.2 ( )
2.0 ( )
Used condom: vaginal sex
1.6 ( )
1.2 ( )
Used condom: anal sex
3.1 ( )
2.6 ( )
Has usual place to go when sick
0.5 ( )
0.8 ( )
Lacked health insurance
3.2 ( )
1.1 ( )
Many of the differences between the 3 groups held even when adjusting for the demographics:
<click> Both SS and ES Latinos were more likely to report having 2+ partners in the past year (as compared to NL whites)
ES Latinos were two times as likely to have given money/drugs for sex than NL whites
<click> For condom use,
ES Latinos were slightly more likely to have used a condom at last vaginal sex than NL whites, &
SS and ES Latinos were as likely to use a condom at last anal sex
<click> Finally,
SS Latinos were half as likely as whites to have a usual palce for health care and were 3 times as likely to lack health insurance

13. Summary Latino men often engage in more sexual risk than white men
English-speaking Latinos tend to have a higher risk than Spanish-speaking Latinos
Latino men were more likely to use condoms for anal sex than white men
Only English-speaking Latinos were more likely to use condoms for vaginal sex
Spanish-speaking Latinos were half as likely to have a usual place for care and were 3 times as likely to lack health insurance
In summary, we found that:
Latino men often engage in more sexual risk than white men
English-speaking Latinos tend to have a higher risk than Spanish-speaking Latinos
Latino men were more likely to use condoms for anal sex than white men
Only English-speaking Latinos were more likely to use condoms for vaginal sex
-(not shown) 1/3 of all three groups had anal sex in their lifetimes
Spanish-speaking Latinos were half as likely to have a usual place for care and were 3 times as likely to lack health insurance 13

14. Limitations Acculturation measure was simplistic
Limited to one language variable rather than a scale of language use or cultural issues
Sample of Spanish-speaking Latinos was small – doesn’t allow a closer examination of:
Time spent in US
Recent sex partners
characteristics & condom use
There are several limitations to these analyses.
Acculturation measure was simplistic
Limited to one language variable rather than a scale of language use or cultural issues
Sample of Spanish-speaking Latinos was small – doesn’t allow a closer examination of:
Time spent in US
Recent sex partners
characteristics & condom use 14

15. Implications
Findings are somewhat supportive of previous studies on Latinos & acculturation
Those with higher acculturation (English-speaking) had higher sexual risk than those with lower acculturation (Spanish-speaking)
STD/HIV prevention interventions that focus on the unique needs of Latinos are needed
Reduce sexual risk
Increase health care access
HoMBReS & HoMBReS 2
Deportation fears may increase health care access problems
Implications:
Findings are somewhat supportive of previous studies on Latinos & acculturation
Those with higher acculturation (English-speaking) had higher sexual risk than those with lower acculturation (Spanish-speaking)
STD/HIV prevention interventions that focus on the unique needs of Latinos are needed
-Reduce sexual risk:
-Increase health care access
HoMBReS “Men Maintaining Wellness and Healthy Relationships”
-CDC funded eval of a pilot LHA intervention designed to increase preventive sexual behaviors & HIV testing in immigrant Latino men
-preliminary outcome data: sign increase in condom use
HoMBReS 2
-NIH funded small group intervention for immigrant Latinos