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Latina Women’s Latina Women’s HealthHealth
Frances Ashe – Goins, RN, Frances Ashe – Goins, RN, MPHMPH
Deputy Director - Office on Women’s Deputy Director - Office on Women’s Health Health
U.S. Department of Health and Human U.S. Department of Health and Human Services (HHS)Services (HHS)
Racial/ethnic categoriesRacial/ethnic categories 2000 Census 2000 Census
RaceRace – African American/Black; Hispanic/Latino; – African American/Black; Hispanic/Latino; Asian American; American Indian & Alaskan Asian American; American Indian & Alaskan Native; and Native Hawaiian & Other Pacific Native; and Native Hawaiian & Other Pacific IslanderIslanderEthnicityEthnicity – Hispanic or Latino or Not Hispanic – Hispanic or Latino or Not Hispanic or Latinoor LatinoCaucasian/WhiteCaucasian/White – majority population – majority population
(Note – the data in this presentation is not reflected (Note – the data in this presentation is not reflected of the new racial categories) of the new racial categories)
U.S. Population U.S. Population
307 million people in the US, 2009 307 million people in the US, 2009 estimateestimate
15.8% are of persons of Hispanic or 15.8% are of persons of Hispanic or Latino originLatino origin
50.7% are Hispanic/Latina female50.7% are Hispanic/Latina female
Leading Causes of DeathLeading Causes of Death All women All women Hispanic Hispanic
American & American & Latina Latina WomenWomen
1.1. Heart DiseaseHeart Disease2.2. All cancersAll cancers3.3. StrokeStroke4.4. Chronic lower Chronic lower
respiratory diseasesrespiratory diseases5.5. DiabetesDiabetes6.6. Flu & pneumoniaFlu & pneumonia7.7. Alzheimer’s diseaseAlzheimer’s disease8.8. AccidentsAccidents9.9. Kidney DiseaseKidney Disease10.10. SepticemiaSepticemia
1.1. Heart DiseaseHeart Disease2.2. All cancersAll cancers3.3. StrokeStroke4.4. DiabetesDiabetes5.5. AccidentsAccidents6.6. Flu & pneumoniaFlu & pneumonia7.7. Chronic lower Chronic lower
respiratory diseasesrespiratory diseases8.8. Perinatal conditionsPerinatal conditions9.9. Chronic liver disease & Chronic liver disease &
cirrhosiscirrhosis10.10. Kidney diseaseKidney disease
Health Concerns for Health Concerns for Hispanic/Latina WomenHispanic/Latina Women
Heart diseaseHeart disease• 137.1 per 100,000; 34.4% of Mexican-137.1 per 100,000; 34.4% of Mexican-
American women have cardiovascular American women have cardiovascular disease. disease.
Stroke death ratesStroke death rates• 36.4 per 100,00036.4 per 100,000
Cancer Mortality Rates per 100,000Cancer Mortality Rates per 100,000• Lung – 13.1Lung – 13.1• Breast –15.8Breast –15.8
Health Concern: Heart Health Concern: Heart Disease, Cancer, and Disease, Cancer, and
StrokeStroke
232.3 228.2
300.2
160.2
127.6
173.2190.1 188.5
233.3
119.3 113.5126.6
53.5 51.4
74.3
34.645.2 40.5
0
25
50
75
100
125
150
175
200
225
250
275
300
325
All Races White AfricanAmerican
AmericanIndian/ Alaska
Native
Asian/ PacificIslander
Hispanic
Age-A
dju
sted D
eath
Rate
per
100,0
00 P
ers
ons
Heart Disease
Cancer
Stroke
Health Concerns cont.Health Concerns cont.
Maternal Mortality rates - 2000Maternal Mortality rates - 2000• 9.0 per 100,000 live births9.0 per 100,000 live births
Infant MortalityInfant Mortality• 5.6 per 1,000 live births5.6 per 1,000 live births
Low birth rate (<5.5 pounds)Low birth rate (<5.5 pounds)• 6.4% (Puerto Rican 9.3% and 6.4% (Puerto Rican 9.3% and
Mexican 6.1%) Mexican 6.1%)
Health Concern: Infant Mortality Health Concern: Infant Mortality
Rates per 1,000 Live BirthsRates per 1,000 Live Births
6.8
5.7 5.7
13.6 13.5
8.7
4.85.6 5.5
8.2
4.6 5.0
6.7
0
5
10
15
Infa
nt
Mo
rtal
ity
Rat
e p
er 1
,000
Liv
e B
irth
s
Health Concern: Sudden Infant Health Concern: Sudden Infant Death Syndrome (SIDS) Rates per Death Syndrome (SIDS) Rates per
1,000 1,000 Live BirthsLive Births
55.550.4
122.9 124.2
15.5
29.3
0
50
100
150
All Races Non-HispanicWhite
AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: National Vital Statistics Report Nov. 7, 2003, 52(9): 69-77
Health Concerns cont.Health Concerns cont.
HIV/AIDSHIV/AIDS – Hispanic/Latina women – Hispanic/Latina women accounts for 24% of new HIV accounts for 24% of new HIV infections among Hispanic/Latino in infections among Hispanic/Latino in 2006. 2006.
Diabetes Mellitus DeathsDiabetes Mellitus Deaths – 6% – 6%
Tuberculosis RatesTuberculosis Rates – 24% – 24%
Health Concern: Human Health Concern: Human Immunodeficiency Virus (HIV) Immunodeficiency Virus (HIV)
Disease: U.S., 2004Disease: U.S., 2004
4.5
2.3
20.4
2.9
0.7
5.3
0
5
10
15
20
25
All Races White AfricanAmerican
AmericanIndian/ Alaska
Native
Asian/ PacificIslander
Hispanic
Age-A
dju
sted D
eath
Rate
per
100,0
00 P
ers
ons
Health Concern: Diabetes Health Concern: Diabetes MellitusMellitus
24.522.3
48.0
39.2
16.6
32.1
0
5
10
15
20
25
30
35
40
45
50
All Races White AfricanAmerican
AmericanIndian/ Alaska
Native
Asian/ PacificIslander
Hispanic
Age-A
dju
sted D
eath
Rate
per
100,0
00 P
ers
ons
Health Concern: Tuberculosis Health Concern: Tuberculosis (TB): U.S., 2001(TB): U.S., 2001
5.6
1.6
13.8
11.0
32.7
11.9
0
5
10
15
20
25
30
35
All Races non-HispanicWhite
non-HispanicAfrican
American
AmericanIndain / AlaskaNative (AI/ AN)
Asian/ PacificIslander
Hispanic
Age-A
dju
sted C
ase
s per
100,0
00 P
ers
ons
Source: CDC Reported Tuberculosis in the U.S., 2001. Atlanta, GA, U.S. Dept. of Health & Human Services, CDC, September 2002. Table 13. http://www.cdc.gov/nchstp/tb/surv/surv2001/pdf/T12and13.pdf
Health Concerns Cont.Health Concerns Cont.
Mental HealthMental Health Depression – 11% Hispanic/Latina Depression – 11% Hispanic/Latina
reported being depressed.reported being depressed. Suicide – Hispanic/Latina 1.8/100,000 Suicide – Hispanic/Latina 1.8/100,000
Violence Against WomenViolence Against Women 53% Hispanic/Latina and least likely 53% Hispanic/Latina and least likely
to be rapedto be raped
Risk Factors – Hispanic Risk Factors – Hispanic American, Latina womenAmerican, Latina women
• High rate of obesityHigh rate of obesity• High rates of breast and cervical cancers due to High rates of breast and cervical cancers due to
delayed diagnoses, lack of preventive screeningsdelayed diagnoses, lack of preventive screenings• Tobacco use highTobacco use high• Alcohol dependence prevalentAlcohol dependence prevalent• 30% of Hispanic/Latina women uninsured though 30% of Hispanic/Latina women uninsured though
many employed or live with someone who is many employed or live with someone who is employedemployed
• Further barriers to health care: language Further barriers to health care: language barriers, lack of transportation, immigration barriers, lack of transportation, immigration statusstatus
Obesity EpidemicObesity Epidemic
Among Mexican American Among Mexican American women, 73 percent are women, 73 percent are overweight or obese, as overweight or obese, as compared to only 61.6 compared to only 61.6 percent of the general percent of the general female population.1 female population.1
In 2003- 2004 Mexican In 2003- 2004 Mexican American children, American children, between the ages 6-11, between the ages 6-11, were 1.3 times more likely were 1.3 times more likely to be overweight as Non- to be overweight as Non- Hispanic White Children. Hispanic White Children.
Source: OWH http://www.4women.gov/minority/hispanicamerican/obesity.cfm
What Is Obesity?What Is Obesity?
BMI (Body Mass Index) is a measure of body fat based on height and weight. People with a BMI of 25 to 29.9 are considered overweight. People with a BMI of 30 or more are considered obese.
What Are The Health Effects of What Are The Health Effects of Being Overweight or Obese?Being Overweight or Obese?
Heart disease Heart disease Stroke Stroke Type 2 diabetes Type 2 diabetes High blood pressure High blood pressure
Breathing problems Breathing problems Arthritis Arthritis Gallbladder disease Gallbladder disease Some kinds of cancerSome kinds of cancer
Being overweight or obese can increase your risk of:
Risk Factors for Disease Risk Factors for Disease 1999-20001999-2000
Physical Inactivity Physical Inactivity 57% immigrants over 18 years are 57% immigrants over 18 years are
sedentarysedentary
Tobacco UseTobacco Use 12.4 %12.4 %
Alcohol UseAlcohol Use 49% abstained from using alcohol49% abstained from using alcohol
Illicit Drug UseIllicit Drug Use 7.2% drug related deaths7.2% drug related deaths
Vaccinations and Vaccinations and ScreeningsScreenings
Pneumococcal and Influenza – Pneumococcal and Influenza – among adults 65 and older 30.5% among adults 65 and older 30.5% Hispanic/Latina reported no Hispanic/Latina reported no vaccination.vaccination.
Influenza – 55.6% Hispanic/Latina no Influenza – 55.6% Hispanic/Latina no vaccination in the past 12 monthsvaccination in the past 12 months
Cervical cancer – 37% Cervical cancer – 37% Hispanic/Latina not screened Hispanic/Latina not screened
Screenings cont.Screenings cont.
Breast cancer – women over 40 Breast cancer – women over 40 years 33% of Hispanic/Latina women years 33% of Hispanic/Latina women had not been screened in two years.had not been screened in two years.
Blood pressure –26% Blood pressure –26% Hispanic/Latina women had not Hispanic/Latina women had not been screened in the past 12 monthsbeen screened in the past 12 months
Definition of LupusDefinition of Lupus
Widespread chronic autoimmune Widespread chronic autoimmune diseasedisease
Immune system attacks tissue and Immune system attacks tissue and organs within the body organs within the body Joints, kidneys, heart, lungs, brain, Joints, kidneys, heart, lungs, brain,
blood, and/or skinblood, and/or skin Immune system loses ability to Immune system loses ability to
distinguish between itself and distinguish between itself and foreign tissueforeign tissue
Who has Lupus?Who has Lupus?
There are more than 325,000 Americans There are more than 325,000 Americans diagnosed with Lupus--90% womendiagnosed with Lupus--90% women
Limited awareness and knowledge of LupusLimited awareness and knowledge of Lupus Disproportionately affects young women of Disproportionately affects young women of
color (3 times more than whites); color (3 times more than whites); More prevalent during the years of 15 to 45 More prevalent during the years of 15 to 45
Symptoms Symptoms
Fatigue, fever, pain, stiffness, swelling, Fatigue, fever, pain, stiffness, swelling, rednessredness
Common symptoms – painful swollen Common symptoms – painful swollen joints, unexplained fever, extreme joints, unexplained fever, extreme fatigue, red rash or color on the face, fatigue, red rash or color on the face, chest pain with deep breathing, pale or chest pain with deep breathing, pale or purple fingers or toespurple fingers or toes
Additional – mouth sores, headache, Additional – mouth sores, headache, depression, cognitive dysfunction, scalp depression, cognitive dysfunction, scalp hair loss, anemia, kidney diseasehair loss, anemia, kidney disease
TreatmentsTreatments
There is no cureThere is no cure Current therapies Current therapies
Suppress the entire immune systemSuppress the entire immune system Reduction of inflammationReduction of inflammation
Medicines can treat symptoms Medicines can treat symptoms according to organ involvement and according to organ involvement and severity of diseaseseverity of disease
Treatments are based on the Treatments are based on the individual patientindividual patient
Barriers to EngagementBarriers to Engagement
“I don’t have Lupus!” If I don’t acknowledge it then I
won’t get it.
Lupus hits minority women harder and more often?
I don’t believe it!
I’m tired, I ache, I have a migraine…it’s just stress.
I’d rather feed my family than pay for a doctor’s visit.
Additional Information: Additional Information:
Lupus Foundation of America. Lupus Foundation of America. Website: Website: http://www.lupus.org
American College of Rheumatology. American College of Rheumatology. Website: Website: http:///www.rheumatology.org
DHHS/Office on Women’s HealthDHHS/Office on Women’s Health Website: Website: http://www.womenshealth.gov
U.S. National Library of MedicineU.S. National Library of Medicine Website:Website:
http://www.nlm.nih.gov/medlineplus/lupus.html
Strategies for the Task Strategies for the Task AheadAhead
Initially connect to women on an an Initially connect to women on an an emotional levelemotional level
Set up information so that the Set up information so that the women can consume and digest women can consume and digest information at the individuals paceinformation at the individuals pace
Give information through many Give information through many platforms and touch pointsplatforms and touch points
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Internalization of Cultural SensitivityInternalization of Cultural Sensitivity• Integrate cultural influences & language Integrate cultural influences & language
preferences of target communitypreferences of target community• Where is minority group located and Where is minority group located and
concentrated?concentrated?• Address issues of stigmaAddress issues of stigma• Hold events in accessible facilityHold events in accessible facility• Address racial/ethnic variations associated with Address racial/ethnic variations associated with
the incidence, prevalence, morbidity and the incidence, prevalence, morbidity and mortality of health condition/diseasemortality of health condition/disease
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Recognition that Disease is not an Isolated Recognition that Disease is not an Isolated PhenomenonPhenomenon
• Address the societal issues (poverty, Address the societal issues (poverty, welfare, violence, crime) which affect welfare, violence, crime) which affect community healthcommunity health
• Identify and target behaviors that Identify and target behaviors that contribute to increased incidence and contribute to increased incidence and prevalence of health conditionsprevalence of health conditions
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Identification of Disparities between groups Identification of Disparities between groups in obtaining health carein obtaining health care
• What gaps in services exist?What gaps in services exist?• What services are needed?What services are needed?• Do different groups need different Do different groups need different
prevention efforts?prevention efforts?• Are resources reaching all in the Are resources reaching all in the
community?community?
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Honest and Frequent EvaluationsHonest and Frequent Evaluations• Conduct both impact and process evaluationsConduct both impact and process evaluations• Outline clear and timely objectives to show Outline clear and timely objectives to show
achievement and improvement over timeachievement and improvement over time• Produce detailed work plans, quarterly reports, Produce detailed work plans, quarterly reports,
and final reportsand final reports• Obtain input from program participants to Obtain input from program participants to
determine participant benefitdetermine participant benefit
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Building of partnerships Building of partnerships • Partner with community organizations, local Partner with community organizations, local
government agencies, faith-based organizations, government agencies, faith-based organizations, social organizations, educational institutions, social organizations, educational institutions, non-profits, sororities, etc.non-profits, sororities, etc.
• Try to partner with groups that can attract as Try to partner with groups that can attract as many women as possible from the target many women as possible from the target populationpopulation
Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women
Staff who Relate to the Target CommunityStaff who Relate to the Target Community• This includes staff who have grown up in the This includes staff who have grown up in the
community, look like members of the target community, look like members of the target community, or speak the same language as the community, or speak the same language as the target communitytarget community
• Staff must be knowledgeable about health Staff must be knowledgeable about health condition of the program’s focuscondition of the program’s focus
• Staff must have ability to communicate in Staff must have ability to communicate in culturally and individually sensitive mannerculturally and individually sensitive manner
Contact Contact informationinformation
DHHS-OWHDHHS-OWH200 Independence Avenue, SW200 Independence Avenue, SW
Washington, DC 20021Washington, DC 20021202-690-7650; fax 202-401-4005202-690-7650; fax 202-401-4005
www.womenshealth.gov 1-800-994-9662 1-800-994-9662