Hispanics in a Hispanics in a Biopsychosocial ContextBiopsychosocial Context

Hispanic Neuropsychological SocietyHispanic Neuropsychological Society

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National Academy of NeuropsychologyNational Academy of Neuropsychology

Seattle, WashingtonSeattle, Washington

November 19, 2004November 19, 2004

Contact Information:Contact Information:

Antonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.Department of PsychologyDepartment of Psychology

University of North Carolina at University of North Carolina at WilmingtonWilmington

910.962.3812910.962.3812puente@uncw.edupuente@uncw.edu

www.uncw.edu/people/puentewww.uncw.edu/people/puente

BackgroundBackground

PurposePurpose Provide Contextual Background Provide Contextual Background

Prior AttemptsPrior Attempts PontonPonton Several chaptersSeveral chapters

US Demographic ContextUS Demographic Context(from various sources especially US Census Bureau, 2004)(from various sources especially US Census Bureau, 2004)

PopulationPopulation US =US =290, 807,770290, 807,770 NC = 8,407,248NC = 8,407,248

US Demographic ContextUS Demographic Context

Income (household)Income (household) MedianMedian = $45,631= $45,631 Mean = $61,587Mean = $61,587

US Demographic ContextUS Demographic Context

EducationEducation Doctoral DegreeDoctoral Degree == 1.0 1.0 Professional DegreeProfessional Degree = = 2.0 2.0 Master’s DegreeMaster’s Degree == 5.9 5.9 Bachelor’s DegreeBachelor’s Degree == 15.515.5 Associate’s DegreeAssociate’s Degree = = 6.3 6.3 High School DegreeHigh School Degree = = 80.480.4 Less than High SchoolLess than High School == 18.218.2 No SchoolingNo Schooling = = 1.4 1.4

Hispanics in the United States: Hispanics in the United States: OverviewOverview

United States TrendsUnited States Trends Is the largest ethnic minority group in USIs the largest ethnic minority group in US Is the fastest growing ethnic group in USIs the fastest growing ethnic group in US Approximating 15% of the populationApproximating 15% of the population Will represent the majority group in 2040Will represent the majority group in 2040 Probably undercounted (hence projections are Probably undercounted (hence projections are

probably off with a wide margin of error)probably off with a wide margin of error)

Demographics:Demographics:Hispanics in the United States Hispanics in the United States

United States StatisticsUnited States Statistics Overall Overall = 12.5% (Vs. 12.1% for AA)= 12.5% (Vs. 12.1% for AA) Before 18 Before 18 = 35%= 35% 18-65 18-65 = 60%= 60% 65 + = 5%65 + = 5% Less Educated than counterpartsLess Educated than counterparts More Fertile than counterpartsMore Fertile than counterparts

US Demographics: US Demographics: PopulationPopulation

Shifting DemographicsShifting Demographics Non-Hispanic WhiteNon-Hispanic White 69.4%69.4% 57.5%57.5% African AmericanAfrican American 12.7%12.7%

13.9%13.9% HispanicHispanic 12.6%12.6% 20.1%20.1%

US Demographics: Work US Demographics: Work ForceForce

Percentage of Work ForcePercentage of Work Force 19801980 5.7% 5.7% 19901990 8.5% 8.5% 20002000 11.7%11.7% 20102010 14.1%14.1% 20202020 16.9%16.9% 20302030 10.9%10.9%

US Demographics: US Demographics: Undergraduate EducationUndergraduate Education

Bachelor’s Degrees Awarded to Bachelor’s Degrees Awarded to Hispanics (%)Hispanics (%) 19801980 2.3%2.3% 19901990 3.4%3.4% 20002000 6.2%6.2% 20102010 7.0%7.0% 20202020 8.0%8.0% 20302030 8.8%8.8%

Demographics: Demographics: Hispanics in North CarolinaHispanics in North Carolina

North Carolina StatisticsNorth Carolina Statistics Overall = 4.7%Overall = 4.7% Migration for Foreign Born = 50%Migration for Foreign Born = 50%

Primarily from California (also from the NE)Primarily from California (also from the NE) Comparison (ND = 282% decrease) Comparison (ND = 282% decrease)

From 1990 to 2000 = From 1990 to 2000 = 394394% increase% increase

Demographics: Demographics: Hispanics in New Hanover Hispanics in New Hanover

CountyCounty New Hanover (Wilmington, NC) New Hanover (Wilmington, NC)

Statistics EstimatesStatistics Estimates Total Population = 147,642 (22.7% Total Population = 147,642 (22.7%

increase)increase) 1980 = 788; 1980 = 788; 1990 = 747; 1990 = 747; 2000 =1,8282000 =1,828 Estimate = severe undercountingEstimate = severe undercounting

Additional Hispanic Additional Hispanic StatisticsStatistics

Percentage of PopulationPercentage of Population

- In US = 12.5%- In US = 12.5% In NC = 4.7%In NC = 4.7%

- 36% are from Latin America- 36% are from Latin America

- 30% are from Mexico- 30% are from Mexico Anticipated GrowthAnticipated Growth

In US = Births will outpace immigrationIn US = Births will outpace immigration In NC = Over 500% growthIn NC = Over 500% growth

North Carolina: More CloselyNorth Carolina: More Closely(partially from Common Sense Foundation, October, (partially from Common Sense Foundation, October,

2004)2004)

University of North Carolina @ University of North Carolina @ WilmingtonWilmington Chancellors or Vice-Chancellors (0 of 6)Chancellors or Vice-Chancellors (0 of 6) Deans (0 of 5)Deans (0 of 5) Faculty (15 out of 705)Faculty (15 out of 705) Students (254 out of 11,327)Students (254 out of 11,327) Issues of Documentation Issues of Documentation Glass Ceiling of Non-Resident TuitionGlass Ceiling of Non-Resident Tuition

Glance (continued)Glance (continued)

High School Students in North High School Students in North CarolinaCarolina One third of all high school graduates by One third of all high school graduates by

the year 2013 will be Hispanicthe year 2013 will be Hispanic Graduation rate for Hispanics nationally Graduation rate for Hispanics nationally

= 54%= 54% Graduation rate for Hispanics in North Graduation rate for Hispanics in North

Carolina = 38%Carolina = 38%

Glance (continued)Glance (continued)

Language Ability Language Ability (in US about 30 million speak (in US about 30 million speak Spanish)Spanish)

US = 22% speak English “poorly”US = 22% speak English “poorly” NC =34% speak English “poorly”NC =34% speak English “poorly”

Governmental RepresentationGovernmental Representation Two Elected OfficialsTwo Elected Officials No High Ranking JudgesNo High Ranking Judges One Executive Level OfficeOne Executive Level Office

Glance (continued)Glance (continued)

Health InsuranceHealth Insurance 37% lack insurance nationally37% lack insurance nationally 54% lack insurance in North Carolina54% lack insurance in North Carolina

Increases to 64% if non-documentedIncreases to 64% if non-documented

Income Income 27% live in poverty 27% live in poverty NC Median family income = $30,529NC Median family income = $30,529

National MFINational MFI = $ 44,468 = $ 44,468 NC MFI for whites = $51,951NC MFI for whites = $51,951

National MFINational MFI = $61,587 = $61,587

Psychological LiteraturePsychological Literature(from PsyInfo, 11.01.04)(from PsyInfo, 11.01.04)

PsychologyPsychology 485,230485,230

HispanicsHispanics 7,7187,718

Hispanics and Mental HealthHispanics and Mental Health 799799

Hispanics and IntelligenceHispanics and Intelligence 172172

Hispanics and NeuropsychologyHispanics and Neuropsychology 5252

What Does Being “Hispanic” What Does Being “Hispanic” Mean?Mean?

Speaking SpanishSpeaking Spanish Being Catholic (or Christian, probably conservative/fundamentalist)Being Catholic (or Christian, probably conservative/fundamentalist) Religion as source of support and socializationReligion as source of support and socialization Family above all (and extended family)Family above all (and extended family) Children are highly desired and valuedChildren are highly desired and valued Friends and social groups are criticalFriends and social groups are critical Cooperation versus competitionCooperation versus competition Keep one’s problems to themselves or familyKeep one’s problems to themselves or family Respect and formalityRespect and formality The important use and knowledge of a name (and title)The important use and knowledge of a name (and title) Hospitality through gifts, food, and drinkHospitality through gifts, food, and drink Smooth interpersonal relations are critical (amabilidad)Smooth interpersonal relations are critical (amabilidad) Time to be enjoyed not conqueredTime to be enjoyed not conquered Modesty (pudor)Modesty (pudor) Less material & consumer focusedLess material & consumer focused More emotionalMore emotional PersonalismoPersonalismo Fatalismo (chance and God explain just about everything)Fatalismo (chance and God explain just about everything)

Sources of Biopsychosocial Sources of Biopsychosocial ProblemsProblems

Culture and Acculturation IssuesCulture and Acculturation Issues Language LimitationsLanguage Limitations Family DysfunctionFamily Dysfunction Ineffective Social SupportIneffective Social Support Low Self EsteemLow Self Esteem Limited EducationLimited Education Financial LimitationsFinancial Limitations Religious AffiliationReligious Affiliation DocumentationDocumentation Health StatusHealth Status Gender IssuesGender Issues Interpretation of EfficiencyInterpretation of Efficiency

Cultural IssuesCultural Issues

Misunderstanding of the Majority Misunderstanding of the Majority Culture’s Unwritten Social Rules and Culture’s Unwritten Social Rules and AgendasAgendas

Isolation to MainstreamingIsolation to Mainstreaming

Language LimitationsLanguage Limitations

EnglishEnglish Variations of SpanishVariations of Spanish Spanish as a Second LanguageSpanish as a Second Language Anxiety Associated with Learning English Anxiety Associated with Learning English

and Losing Your Cultureand Losing Your Culture Non-Verbal Communication is ImportantNon-Verbal Communication is Important Children as TranslatorsChildren as Translators Children Choosing English over SpanishChildren Choosing English over Spanish

FamilyFamily

Defining Family (Familismo)Defining Family (Familismo) NuclearNuclear ExtendedExtended DoubleDouble FunctionalFunctional

Divided FamiliesDivided Families EconomicsEconomics GeographyGeography PoliticsPolitics

Ineffective Social SupportIneffective Social Support

MedicalMedical ReligiousReligious EducationalEducational FinancialFinancial SocialSocial MaritalMarital

Low Self EsteemLow Self Esteem

Productivity and MaterialismProductivity and Materialism ConnectivityConnectivity Self-Effacing PresentationSelf-Effacing Presentation Loss of Respect From OthersLoss of Respect From Others Self-Fulfilling ProphecySelf-Fulfilling Prophecy

EducationEducation

Typical Educational BackgroundTypical Educational Background What it Means to be “Educated”-What it Means to be “Educated”-

the difference between schooling and the difference between schooling and educationeducation

Financial & Related Financial & Related LimitationsLimitations

The Limits and Hazards of Being The Limits and Hazards of Being UndocumentedUndocumented

Type of Vocational Opportunities & Type of Vocational Opportunities & Corresponding PayCorresponding Pay

Banking IssuesBanking Issues Saving for RetirementSaving for Retirement Driver’s LicensesDriver’s Licenses

ReligionReligion

Predominantly Catholic, but not Predominantly Catholic, but not Exclusively (about 25%) Exclusively (about 25%)

Importance of Religion and Related Importance of Religion and Related Social SupportSocial Support

Prayers are Directed to a SaintPrayers are Directed to a Saint A “Milagro” is a Special NeedA “Milagro” is a Special Need Church and Related Services in Church and Related Services in

SpanishSpanish

DocumentationDocumentation

EducationEducation MedicalMedical LegalLegal

Tax ID NumbersTax ID Numbers Social Security NumbersSocial Security Numbers Driver’s LicensesDriver’s Licenses

AliasesAliases

Health StatusHealth Status

Increased and Disproportionate Health Increased and Disproportionate Health ProblemsProblems

Higher Low Birth Weights & Infant MortalityHigher Low Birth Weights & Infant Mortality Increased MorbidityIncreased Morbidity Under-Utilization of Health ServicesUnder-Utilization of Health Services Health Viewed as Absence of PainHealth Viewed as Absence of Pain Women as Primary Care Providers in FamilyWomen as Primary Care Providers in Family Disability is a Family AffairDisability is a Family Affair Hospitals as Last Place for Health Care or Hospitals as Last Place for Health Care or

Possibly a Place One Goes to DiePossibly a Place One Goes to Die

Gender IssuesGender Issues

Males Vs. Female Males Vs. Female Males Males 27%27% Females Females 17%17%

MachismoMachismo False = loss of dignity and respectFalse = loss of dignity and respect True = Protector, supporter True = Protector, supporter

Heterosexual issuesHeterosexual issues Clashing of culturesClashing of cultures Availability of partnersAvailability of partners ProstitutionProstitution STDsSTDs

Sexual Identity IssuesSexual Identity Issues Childhood Sexuality & AbuseChildhood Sexuality & Abuse

Interpretation of EfficiencyInterpretation of Efficiency

Time (enjoyment vs. completion)Time (enjoyment vs. completion) Cooperation (vs. competition)Cooperation (vs. competition) Process (vs. outcome)Process (vs. outcome)

Outcome of ProblemsOutcome of Problems

AnxietyAnxiety 13%13% Substance abuseSubstance abuse 8% 8% DepressionDepression 5% 5% Violence Violence ?% ?% Ethnic identity issues ?%Ethnic identity issues ?% Poverty and marginalization ?%Poverty and marginalization ?%

Hispanics & Hispanics & NeuropsychologyNeuropsychology Presentations (Dates are approximate/estimates)Presentations (Dates are approximate/estimates)

Approximately 1994 Puente NAN WorkshopApproximately 1994 Puente NAN Workshop INS soon thereafter, Ponton Workshop (Galveston?)INS soon thereafter, Ponton Workshop (Galveston?) 2000 HNS/NAN Informal Symposium2000 HNS/NAN Informal Symposium 2002 Ardila NAN Workshop2002 Ardila NAN Workshop 2004 HNS NAN Workshop2004 HNS NAN Workshop

BooksBooks 44 3 Edited; 1 Authored3 Edited; 1 Authored

Non-Empirical PublicationsNon-Empirical Publications 30 30 Mostly ChaptersMostly Chapters

Empirical PublicationsEmpirical Publications 2020 Two DissertationsTwo Dissertations Acculturation/testingAcculturation/testing

Psychology Psychology = 35= 35 NeuropsychologyNeuropsychology = 6 (most non-empirical)= 6 (most non-empirical)

Merging Problems (Outside Merging Problems (Outside Traditional Biopsychosocial Traditional Biopsychosocial

Realm)Realm) Lack of ScienceLack of Science Lack of PersonnelLack of Personnel

HNS as an ExampleHNS as an Example Lack of Tests Lack of Tests

CopyrightCopyright StandardizationStandardization Translation IssuesTranslation Issues Heterogeneity of HispanicsHeterogeneity of Hispanics The Difficulty in Developing TestsThe Difficulty in Developing Tests

A Model for IntegrationA Model for Integration

1.1. IsolationIsolation

2. Acculturation2. Acculturation

3. Assimilation3. Assimilation

4. Mainstream4. Mainstream

In Three GenerationsIn Three Generations(from Hispanic Business, 2003)(from Hispanic Business, 2003)

IsolationIsolation Acculturation Acculturation AssimilationAssimilation

IncomeIncome$20,500 $20,500 $36,100$36,100 $37,000$37,000SizeSize 3.9 3.6 3.1 3.9 3.6 3.1Time in US Time in US 11stst gen. US born gen. US born 44thth Gen. Gen.LocaleLocale Inner CityInner City Suburbs ?Suburbs ? SuburbsSuburbsValuesValues HispanicHispanic Partial HispanicPartial Hispanic AngloAngloLanguageLanguage SpanishSpanish BilingualBilingual EnglishEnglish

The Future The Future

Clashing Curves and CulturesClashing Curves and Cultures 2121stst Century “Slavery” Century “Slavery” Pay Now or Pay LaterPay Now or Pay Later What is the United States Going to What is the United States Going to

Do?Do?

Future?Future?

Demographic Shifts Are ObviousDemographic Shifts Are Obvious Socio-political Shifts Are NotSocio-political Shifts Are Not The Lack of Integration of These Two The Lack of Integration of These Two

Shifts Will Result in Social Shifts Will Result in Social Misunderstanding & UnrestMisunderstanding & Unrest