“More research (and action) is needed”

“Hispanic paradox”

• Higher poverty, less formal education, less healthcare

• Better health; lower mortality rates

“Hispanic paradox”

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“Hispanic paradox”

• “Healthy migrant” hypothesis

• Barrio effect?

• “Salmon bias”?

• Acculturation risk?

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?

Which Latinos?

Which Latinos?

• Mexican, Puerto Rican, Venezuelan, Cuban?

• Immigrant or second-generation?

• Wealthy or poor?

• Urban or rural?

Which Latinos?

• Who decides?

• Researchers don’t 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)

Environment

• NIEHS environmental genome project

- environmental conditions, plus

- genetic susceptibility

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 KawachiThomas A. LaVeist

Brian Smedley, ed.

Leading causes of death among Latinos (2003)

1) Diseases of heart 28,2982) Malignant neoplasms 24,0703) Unintentional injuries h 10,4184) Cerebrovascular diseases 6,6585) Diabetes mellitus 6,1796) Chronic liver disease and cirrhosis 3,3827) Homicide 3,3558) Chronic lower respiratory diseases 3,1749) Influenza and pneumonia 2,94810)Certain conditions originating in the perinatal

period 2,628

Asthma

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)

http://www.calasthma.org/

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)

• Bienestar(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

Evaluating 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

Examples

SPJ Rainbow Sourcebook

and Diversity Toolbox