III.
Implementation
Toward
a culturally competent medical model of
care
|
Outreach
and prevention programs can promote
healthy behaviors and facilitate
early detection of disease and disorders.
However, not all diseases and disorders
can be prevented; therefore, culturally
appropriate and cost effective treatment
must also be available for physical,
mental health, and substance abuse
problems. Treatment of Hispanic
patients/clients must move beyond
the medical model of care and examine
the quality of that care to practice
healing. To respond to the need
for culturally competent treatment
for Hispanic patients/clients, new
service models are being developed.
|
|
Treatment
of Hispanic patients/clients must
move beyond the medical models of
care... |
III.
Implementation Chapter Seven: Outreach
The
only way to reach the Hispanic community
is on a two-way street.
Even
beyond the barriers of language
and culture, attempts at effective
outreach to the Hispanic community
may profoundly challenge health
providers in varied and unexpected
ways. Strategies for developing
and bringing new health models,
education and access to individuals
within their own community settings
are an essential but largely overlooked
component of the health care system
in the United States. Community-based
organizations within Hispanics neighborhoods,
barrios, colonias, and other ethnic
enclaves provide a significant point
of entry and opportunity to expand
on any outreach effort you may be
involved in.
While
the health care system has established
some links to historically black
universities, colleges, and medical
schools, and through health-education
programs and African-American churches;
limited relationships exist with
the Hispanic community. In fact,
the Hispanic community has a completely
different institutional structure
when it comes to issues of health
and health services, a structure
with little organic or historical
connection to mainstream providers.
In America's barrios and colonias
there are no "Historically
Hispanic" colleges and universities
or medical schools and the Catholic
Church, with over three-quarters
of all Hispanics, sees its focus
on the spiritual aspects of life.
As a result, a network of hundreds
of local community-based organizations
have emerged in almost every Hispanic
community in America. For the past
30 years, these organizations have
acted as frontline advocates for
and providers of Hispanic health
care and social services, yet continue
to struggle for existence because
of limited funding.
|
|
Strategies
for bringing new health models,
education and access to individuals
within their own community settings
are an essential but largely overlooked
component of the health care system
in the United States.
...a network of hundreds of local
community-based organizations have
emerged in almost every Hispanic
community in America. |
Many of these organizations, and hundreds
of others like them, trace their origins
to the political upheavals of the late
1960s and early '70s, when Hispanics began
to assert themselves in bold, confrontational
demonstrations linked to anti-Vietnam
war protests, civil rights, and demands
for economic justice. Among the highlights
of the period were the emergence of Cesar
Chavez and the United Farm Workers Union
that organized in the West with a focus
on work-related issues. In the East, there
was the emergence of the Puerto Rican
Young Lords in New York with a focus on
meeting community-based needs.83
Interestingly, one of their first actions
was the seizure of Lincoln Hospital in
Harlem to demand that it become more responsive
to the health needs of the Hispanic community.
Equally interesting was the fact that,
even in the context of highly polarized
times, the New York public hospital system's
response was not to call in the police,
but to agree to some early, tentative
steps towards becoming culturally competent
and more responsive to the Hispanic population
that it served.
| ...community-based
health and social service organizations
have established histories of providing
linguistically and culturally credible
services within their own communities.
|
|
Still,
to a large extent the community-based
health and social service organizations
that grew out of this period of upheaval
were and still are a product of community
frustration at being denied access
to mainstream health services or resources.
Born out of community struggles, they
remain governed by community boards
and have established histories of
providing linguistically and culturally
credible services within their own
communities. It is this national infrastructure
and network that is the most appropriate
and sensible entry point for designing
and implementing health outreach programs
for Hispanic communities. The following
case studies and key concepts are
relevant to other situations. |
Case
Study
The
Latin American Research and Service Agency
(LARASA),
in Denver, Colorado established Project
CORE — Cancer
Control Through Outreach, Research, and
Education. In 1995,
CORE has aimed at increasing the number
of Latinas in
Colorado who are screened for breast and
cervical cancer.84
| CORE
grew out of a needs assessment survey
and focus groups conducted within
the Hispanic community by LARASA.
Among the survey's findings: Latina
women are traditionally the care takers
of the family, but few health studies
focus on women, particularly Latinas.
While Latinas in Colorado were diagnosed
with lower rates of invasive breast
cancer and higher rates of invasive
cervical cancer than white women,
their five-year survival rates were
found to be lower in both cases. The
key program components included: |
|
CORE
grew out of a needs assessment survey
and focus groups conducted within
the Hispanic community by LARASA. |
- Holding
educational forums in both English and
Spanish
on the importance of early screening
and detection of
cancer for Latinas in local neighborhoods
and at a
northwest Denver elementary school.
-
Distributing written educational materials
to 1200 homes,
through 400 mailings, and at a statewide
conference
attended by 200 Latinas.
-
Providing 93 women with a clinical breast
exam or breast
exam and mammogram through use of a
mobile van
operating in targeted neighborhoods
within Denver's
Hispanic community.
-
Initiating a meeting of Latina women
who have survived
breast and/or cervical cancer.
-
Helping to bring the issue "out
of the closet" by
organizing and participating in an interview
with a Latina
breast cancer survivor broadcast on
local Spanish-
language television.
Case
Study
| ...Texas
health educators surveyed Mexican
Americans asking them what was their
primary source for health information.
|
|
In
pre-planning a community outreach
and awareness program on cardiovascular
disease in Houston, Texas health educators
surveyed Mexican Americans asking
them what was their primary source
for health information. Thirty-five
percent identified their physician.
Nearly 50% identified some form of
mass media (TV, newspapers, magazines,
radio). The planners then used the
survey findings to design a Spanish-language
media program, El asesino silencioso
(The Silent Killer) that linked television
programming and other mass media with
credible medical authority.85 |
Case
Study
| The
effectiveness of the program was confirmed
when a number of the kids’ parents
began asking for and receiving instruction
on how to prepare these healthy Hispanic
recipes. |
|
In
1996, in New Mexico, Youth Development,
Inc. (YDI) was able to move a youth
outreach program from a gym-based
after-school setting to its own
community training center, a converted
2,000 square foot residential house
in the south valley section of Albuquerque.
Since many of the twenty-five 9
to12 year-old students YDI worked
with each year were "latchkey"
kids (children who returned home
from school while their parents
were still at work), the organization
was able to utilize this house as
a training facility for home safety
and nutrition. Along with basic
instruction on safety hazards such
as exposed electrical plugs, they
also instructed the children, many
of whom already cooked for themselves
and their younger brothers and sisters,
on how to safely prepare healthy
and nutritious Hispanic meals. Along
with showing them videos on nutrition
and health, and providing recipes,
YDI staff and a volunteer chef also
gave them hands-on cooking instructions
in the center's kitchen. The effectiveness
of the program was confirmed when
a number of the kids' parents began
asking for and receiving instructions
on how to prepare these healthy
Hispanic recipes.86 |
Case
Study
| An
example of positive role-modeling
took place in Chicago where, beginning
in 1992, the Pilsen-Little Village
Community Mental Health Center provided
an after school and summer school
program for children whose families
were in treatment for substance abuse.
The range of activities included drama,
poetry, and art therapy workshops.
Mother's Day poems that the children
composed were read to their mothers
at a special family event. Thirty
9 to12 year-old children also participated
in the Great Chicago River Rescue
Day Clean Up of the I&M canal
in 1996 along with older Hispanic
teens from other parts of the city.
At a subsequent picnic these children
heard a steel band and were taken
on canoe rides by a Hispanic river
guide who became a favorite adventure
career role-model for many of the
children. Other nature-oriented field
trips included bus and van visits
to the Indiana Dunes and Illinois
forest reserves. |
|
...in
Chicago . . . Pilsen-Little Village
Community Mental Health Center provided
an after school and summer school
program for children whose families
are in treatment for substance abuse.
|
Case
Study
In
Los Angeles, youths were taken on
a field trip to Kaiser Permanente's
Sunset Hospital in Hollywood. There
they learned about health care issues,
saw how a hospital works, and met
with physicians, nurses, a physical
therapist, and other health care
professionals. After the tour they
all expressed their desire to work
in health care. After a similar
tour of the UCLA campus, all the
youngsters announced they wanted
to be college students and health
care providers. They were told they
could do both.
As
a result of Kaiser Permanente's
participation in this project, the
East Los Angeles Multicultural Area
Health Education Center (MAHEC)
was granted funds to provide childhood
immunization services, and began
to consider other ways in which
it, as a health care institution,
could participate in preventative
and outreach role-modeling opportunities
for Hispanic and other youths from
underserved communities.87
|
|
In
Los Angeles, youths...learned about
health care issues, saw how a hospital
works, and met with physicians, nurses,
a physical therapist, and other health
care professionals. |
Case
Study
| Hotline
promotion is conducted primarily through
Spanish-language media, including
radio, television, newspapers and
magazines, and by public service announcements
and interviews highlighting the services
provided by the hotline. |
|
The
National Hispanic Prenatal Hotline
(NHPH) (1-800-5047081) provides outreach
to over 3,000 Hispanic consumers a
year interested in information about
pregnancy and prenatal care and offers
referrals to local prenatal care services.
Hotline promotion is conducted primarily
through Spanish-language media, including
radio, television, newspapers and
magazines, and by public service announcements
and interviews highlighting the services
provided by the hotline. NHPH is staffed
by bicultural, bilingual information
specialists who use the language the
caller feels most comfortable speaking.
The information provided, both verbal
and written was free to consumers
and individualized to the callers’
needs.88 |
Important
Points for Developing Outreach Programs
|
Key
Concept
To
earn confianza in a targeted community
find out who is respected in the
community.
Don't
assert your agenda, instead listen
for the community's agenda —
what people are asking for —
and assign your priorities based
on their needs.
...outreach programs must demonstrate
a capacity and willingness to allow
community priorities to guide them.
Spanish-language
signs, educational materials, and
videotapes do not work as well when
they're simply translated directly
from English.
If
a patient feels that the provider
has violated the rules of respeto,
the patient may terminate treatment.
|
|
- To
earn confianza (trust) in a targeted
community find out who is respected
in the community. Ask your patients,
your staff, business owners, clergy,
members of the media, and teachers
who are the respected leaders
and agencies that serve the community's
needs.
- Remember
the value of personalismo (familiarity).
Go to local leaders and ask for
their opinions about what people
in the community most need. Ask
them who is already helping with
that, and what outreach resources
are available. Ask for advice
about who you should work with.
Don't assert your agenda, instead
listen for the community's agenda
— what people are asking
for — and assign your priorities
based on their needs.
- To
work effectively with community-based
organizations, outreach programs
must demonstrate a capacity and
willingness to allow community
priorities to guide them. They
must earn the community's trust
or confianza; reach into the community
through existing, respected groups;
select culturally relevant media
and/or materials to convey their
messages; and, target whole families
with understanding and respect.
- To
effectively meet the needs of
Hispanic communities, health outreach
and promotion programs should
also target the specific community
or Hispanic subgroup they seek
to serve. Spanish-language signs,
educational materials, and videotapes
do not work as well when they're
simply translated directly from
English. They have to be developed
specifically for the target population.
The person(s) developing the materials
should be familiar with the language,
literacy level, and culture of
a specific target group and should
have the materials reviewed by
members of the target audience.
Providers must be open receivers
and listeners of "culture"
and its dynamics in the delivery
of health care.
- Respeto
(respect) dictates appropriate
deferential behavior toward others
on the basis of age, sex, social
position, economic status, and
authority. The provider enters
into a reciprocal interaction
when treating an Hispanic patient.
If a patient feels that the provider
has violated the rules of respeto,
the patient may terminate treatment.
Younger providers, even though
they will be awarded respeto as
authority figures, are expected
to be especially formal in their
interactions with older patients.
Formality is a sign of respect,
but should not be confused with
emotional distance.
|
III.
Implementation Chapter Eight: Prevention
The
great risk is in not making the effort
What
is Prevention?
| Prevention
is important in lifestyle choices
for health behaviors that may reduce
chronic health disorders, eliminate
some infectious disease, and deter
mental health and substance abuse
problems. The purpose of prevention
is ultimately to change behavior,
the social and environmental norms
that support unhealthy behaviors,
and to foster use of systems of care
that can detect health conditions
before problems arise. Prevention
is most effective when the activities
are culturally relevant and address
social norms, attitudes, and values
which may contribute to the targeted
behavior change. |
|
The
purpose of prevention is ultimately
to change the cultural and environmental
norms that support unhealthy behaviors.
|
To
date, many prevention models have been
developed and widely distributed for the
mainstream culture which are egocentric
or individual-oriented in focus. Few prevention
models that are sociocentric or group-oriented
in focus have been developed and validated.
It is essential to understand the differences
in the focus of the orientation because
it helps to understand what is generally
important and how importance is manifested.
Although many of the factors appear to
be similar, the differences are often
found in the emphasis and related behaviors.
For instance, most cultures may value
family; however, the behaviors expected
may be very different.
Egocentric
values tend to place emphasis on autonomy,
success of the individual and independence.
Thus, an eighteen year old daughter from
an egocentric culture may value her family
and go to college across the U.S. with
little familial contact even though she
wants to work in the neighborhood library.
Reflective of the individual-oriented
focus, she may believe her good grades
and a high income job will mark her success
and fulfillment of her family values.
Alternatively,
sociocentric values tend to place emphasis
on the good of the group. An eighteen
year old daughter from a sociocentric
culture may value her family and go to
work in the neighborhood with daily familial
contact even though she wants to go away
to college. The happiness of her family
(because she is close to home) marks her
success and fulfillment of her family
values given that the group is better
because she stayed home. Both daughters
are fulfilling their family values and
neither is better or worse than the other.
Knowledge, as well as, experiences in
the other perspective will enable the
discernment of the complex differences
and foster the value of each culture.
This understanding will enable the development
of prevention models tailored to specific
groups and minimize the ethnocentricism
of mainstream general application of egocentric
models.
| The
public health model supports the notion
that behavior patterns are developed,
maintained, and supported within a
social context. |
|
As
stated earlier, few sociocentric models
have been validated in the U.S. and
egocentric models may not be applicable.
In the absence of science-based group-oriented
models, a public health model which
addresses the individual and the environment
is recommended. The public health
model supports the notion that behavior
patterns are developed, maintained,
and supported within a social context. |
| The
socialization of behaviors falls on
a continuum by which new and old behaviors
are either supported or chastised.
Therefore, it is important to differentiate
between the process for adopting new
behaviors (known as social norming)
and the sustaining of old behaviors
referred to as culture. Culture is
the total lifestyle of people from
a particular social group, including
all the ideas, symbols, preferences,
and material objects they share. Culture
evidences stability over time as beliefs,
traditions, and values are passed
from one generation to the next. However,
social conditions and environmental
changes may impact and change aspects
of culture for any group. The Culture-Value
Theory suggests some cultures are
more likely to bring about risky shifts,
while others are more likely to result
in cautious shifts. In other words,
some aspects of culture shift with
external influences. What causes these
shifts is best understood through
the process of social norming which
is the implicit or explicit rules
a group has for the acceptable behavior,
values, and beliefs of its members.
Social norms can be influenced by
critical events such as AIDS, war,
economic depression, migration, etc.
They are also impacted by purposeful
acts such as media, social marketing,
discrimination, acculturation, basic
science findings, laws, and technological
advances. In order to prevent unhealthy
behaviors and promote healthy ones,
prevention approaches must focus on
both culturally motivated behaviors,
as well as, social norming influences.
|
|
...Culture-Value
Theory suggests some cultures are
more likely to evince risky shifts,
while others are more likely to evince
cautious shifts. |
Understanding
the rules of the culture, how it
functions, and how it is influenced
foreshadows effective prevention
strategies. The prevention strategies
employed must be tailored to the
targeted individual and his/her
environment, including culture and
social norms. Individual change
may be difficult without communal
support or guides. Some of the components
which are more resistive to change
may be assisted with public and
organizational policy changes. |
|
The
prevention strategies employed must
be tailored to the targeted individual
and his/her environment, including
culture and social norms. |
| To
date, there is little to no validated
information to delineate prevention
strategies specifically for Hispanics.
However, it is known that Hispanics
are not an individual-oriented culture;
therefore, the mainstream prevention
approaches focusing on the individual
may not be appropriate because they
do not address the importance of culture,
nor do they provide a social context.
The prevention strategy which may
be more appropriate, until cultural
specific models are developed, is
the |
|
...Hispanics
are not an individual-oriented culture;
therefore, the mainstream prevention
approaches focusing on the individual
may not be appropriate... |
| A
public health model that utilizes
a comprehensive community approach
to include family, school, college,
church, work, community, and health
care-based activities would probably
be the most effective prevention plan
for health promotion and dissipating
high risk social norms with Hispanics.
|
|
public
health model. A public health model
that utilizes a comprehensive community
approach to include family, school,
college, church, work, community,
and health care-based activities would
probably be the most effective prevention
plan for health promotion and dissipating
high risk social norms with Hispanics.
Although there is little scientific
base to date, prevention models which
factor in the influences and impact
of social environment are probably
the most culturally appropriate for
Hispanics. Hispanics, in all areas
of prevention, including prenatal
and pediatric check-ups, inoculations,
adult physicals, HIV/AIDS, abuse of
alcohol and illicit drugs, and smoking
tend to receive fewer benefits and
have significantly limited participation
in behavior-based prevention programs.
Given the low rates of Hispanic use,
the application of current prevention
models seemingly lack cultural competence
which consequently discourages utilization
and misunderstanding of the relevance
of prevention programs. Culturally
appropriate prevention activities
must promote healthy behaviors and
reduce risk behaviors. Each presents
a different challenge, but must be
integrated successfully and efficiently
into merging models of health care
delivery, such as managed care or
care of the uninsured. The remainder
of this chapter examines key concepts
for promoting healthy behaviors and
reducing risk behaviors. |
Promoting
Healthy Behaviors
The
purpose of promoting healthy behaviors
is to foster decisions that will
maintain good health and have early
detection of health problems.
1.
Lifestyle Choices
|
|
Key
Concept |
Diet,
exercise, and weight control appear
to be factors that contribute to
good health. The current standards
for appropriate diet, weight, and
exercise levels are based on mainstream
whites. Based on these standards,
Hispanics report as overweight,
lacking exercise, and falling short
of the recommended daily allowances
of fruits and vegetables. Standards
must be determined specifically
for Hispanics with programs established
that promote good lifestyle choices
and have support systems instituted
to sustain change.
|
|
The
current standards for appropriate
diet, weight, and exercise levels
are based on mainstream whites...standards
must be determined specifically
for Hispanics... |
2.
Mental Health
To
promote good mental health, social
stress and cultural conflict must
be addressed as many Hispanics are
first, second, and third generation
immigrants. Research has shown it
takes approximately three generations
to acculturate. For many others
for which the border moved, social
stress and cultural conflict must
also be dealt with, as the invasion
of the dominant culture forced unwanted
changes in their behaviors. Validation
of cultural strengths and ethnic
heritage are needed in conjunction
with the coping skills to manage
social stress and conflict. |
|
Research
has shown it takes approximately
three generation to acculturate.
|
The
daunting statistics of substance abuse,
violence and suicide reflect coping behaviors
that need new strategies and skills. To
foster good mental health, behaviors must
be promoted that build upon the respectful
values of the Hispanic culture and provide
appropriate strategies for managing the
ill feelings and anger that have resulted
from troubled environments and perceptions
of discrimination.
| The
social, economic, familial, and personal
costs of mental illness are too great
to have ill persons go without treatment.
|
|
Mental health problems are a burden
to the ill person, their family, and
society. The social, economic, familial,
and personal costs of mental illness
are too great to have ill persons
go without treatment.89
Hispanics with diagnosable mental
disorders receive insufficient mental
health care, especially from specialists.
More Hispanics use a medical care
provider for their mental health and
substance abuse problem.90
It was also found that rates of use
were lower for Mexican born in Mexico
and those who are low acculturated.
Much less information is known about
Hispanic children. Leaf et. al. found
fewer children receive services in
the specialty mental health sector
than are in need of these services.91
To ensure good mental health, culturally
appropriate mental health services
must be made available to Hispanics
with mental health problems and mental
health illnesses. |
3.
Disease and Disorder Screening and Other
Preventive Practices
| Many
Hispanics, due to geographic location.
lack of resources, and no insurance,
have limited access to screening and
preventive practices. |
|
To
promote health, culturally appropriate
screening services and preventive
practices, such as immunizations,
must be available, accessible, affordable
and practical. Many Hispanics, due
to geographic location, lack of resources,
and no insurance, have limited access
to screening and preventive practices.
Consequently, care is sought for critical
conditions and later stages of disease
and disorders which often result in
unnecessary death or mutilation. Early
detection and treatment of disease
increases the probability of recovery.92
|
Some
Hispanics, like most other Americans,
may need to be educated about the
value of screening and other preventive
practices. The most effective education
appraisal for prevention and early
diagnosis is often improved outcomes.
Due to the frequent lack of trust
in bureaucratic systems and limited
access to preventive care, cognitive
information may not be enough to persuade
the perception of value or to counter
the negative social norms that have
resulted from inadequate preventive
care. As services are made more available
and the health status improves, conditions
that created a social norm such as
"fatalism" when diagnosed
with cancer may change. If those diagnosed
with cancer typically live, the social
norming process transforms the fatalist
belief that a diagnosis of cancer
equates to death. Combine this experience
with the knowledge that cancer is
mostly curable if detected early through
screening. Ultimately, the benefits
of early detection and improved recovery
could motivate screening and preventive
practices which are reflective of
an improved health status.
|
|
Due
to the frequent lack of trust in bureaucratic
systems and limited access to preventive
care, cognitive information may not
be enough to persuade the perception
of value or to counter the negative
social norms that have resulted from
inadequate preventive care. |
| In
the advocacy for screening and prevention
practices, the social environment
must also be assessed. The negative
consequences of screening and support
for healthy behaviors must also be
addressed. Screening and prevention
should be accompanied by additional
resources and services. For instance,
it is not enough to screen for alcohol
without services for the problem drinker.
It is not enough to screen for cancer
or mental illness without follow-up
treatment. Prevention is best when
there is support and feasible alternative
behaviors. Screening and prevention
are not stand alone practices and
may have negative impacts on communities
where additional resources are unavailable.
|
|
Screening
and prevention should be accompanied
by additional resources and services...it
is not enough to screen for alcohol
without services for the problem
drinker.
|
Reducing
Risk Behaviors
|
Key
Concept
The
motivation foreshadowing risk behaviors
may be individually driven; however,
there appears to be strong social
influences, especially for sociocentric
groups, such as Hispanics. |
|
Accurately
assessing the array of mental processes
that influence behavior is inherently
difficult, primarily because it
relies on that person's subjective
report of how he or she feels, justification
for a particular behavior, and the
often lack of awareness of cues.
Consequently, it is difficult to
determine what prevention or intervention
strategy will actually reduce risk
behaviors. Initial model development
supports the notion of reducing
risk factors and increasing protective
factors across many areas of a person's
life. The motivation foreshadowing
risk behaviors may be individually
driven; however, there appears to
be strong social influences, especially
for sociocentric groups, such as
Hispanics. Consequently, the models
developed and validated for Hispanics
must include the many domains or
social influences surrounding the
person.
In
order to consistently prevent or
reduce risk behaviors, refusal skill
training and life-skill training
programs that are specifically targeted
to Hispanics should be used. As
a sociocentric group with additional
life stressors, such as discrimination
and poverty, the expected models
are more complex than just saying
"no." |
1.
Alcohol and Illicit Drug Abuse
Data
from the past 20 years show that prevention
has succeeded in substantially reducing
the incidence and prevalence of illicit
drug use. Successful substance abuse prevention
also leads to reductions in traffic fatalities,
violence, unwanted pregnancy, child abuse,
sexually transmitted diseases, HIV/AIDS,
injuries, cancer, heart disease and lost
productivity.
Although
few models have been validated specifically
for Hispanics, the current mainstream
models being tested include a comprehensive
approach which reduces risk factors,
increases protective factors, and
addresses use/abuse in all domains
or environments.
Risk
Factors vary considerably according
to an individual's age, psychosocial
development, ethnic/cultural identity,
and environment. However, the impact
of any single risk factor may change
over time with the development of
changes in his or her environment.
Some of the risk factors to consider
include social acceptance, parents
or peer usage, stressors, availability,
accessibility, etc.
Protective
Factors can increase a child's resilience
to substance abuse, since they act
as buffers to initiating or continuing
substance use. The literature on
protective factors and resilience
is more diffuse than that for risk
factors, and there is less clarity
about which factors are most important
in the prevention of substance abuse,
especially for Hispanics. Some protective
factors include group support, knowledge,
laws, etc.
Domains
interact, with the individual at
the core of the framework, primarily
through an individual's risk and
protective factors. The precise
nature of the links between substance
use and each of the risk factors
identified under the six domains
(individual, family, peer, school,
community, and society) are not
yet fully understood. Research must
be directed to understanding the
decision and influence paths to
use/abuse for members of sociocentric
groups, such as Hispanics.93
|
|
...the
current mainstream models being tested
include a comprehensive approach which
reduces risk factors, increases protective
factors, and addresses use/abuse in
all domains or environments. |
2.
Tobacco Use
Each
year, smoking kills more people
than AIDS, alcohol, drug abuse,
car crashes, murders, suicides,
and fires — combined! |
|
An
estimated 48 million adults in the
United States smoke cigarettes, even
though this single behavior will result
in death or disability for half of
all regular users. Tobacco use is
responsible for more than 430,000
deaths each year, or 1 in every 5
deaths. Paralleling this enormous
health toll is the economic burden
of tobacco use: more than $50 billion
in medical expenditures and another
$50 billion in indirect costs. Each
year, smoking kills more people than
AIDS, alcohol, drug abuse, car crashes,
murders, suicides, and fires —
combined! Current smokers were more
likely to be heavy drinkers and illicit
drug users. Among smokers, the rate
of heavy alcohol use (five or more
drinks on five or more days in the
past month) was 12.8 percent and the
rate of current illicit drug use was
14.7 percent. Among nonsmokers, only
2.5 percent were heavy drinkers and
2.6 percent were illicit drug users.
In 1996, current smoking rates were
higher among whites (29.8 percent)
and blacks (30.4 percent) than among
Hispanics (24.7 percent) and those
of other race/ethnic groups (17.2
percent). Both white and black females
in the total population were significantly
more likely than Hispanic females
to be current smokers.
|
| ...there
is an increase in Hispanic smokers,
which may be an indicator of potential
problems. |
|
However,
there is an increase in Hispanic smokers,
which may be an indicator of potential
problems. Among Hispanic high school
seniors, cigarette smoking declined
from 1977 (35.7%) to 1989 (20.6%);
however, smoking prevalence was 25.9%
in1997. Among Hispanic 10th-grade
students, smoking prevalence was 18.3%
in 1992 and 23.0% in 1997. For Hispanic
eighth-grade students, prevalence
was 16.7% in 1992 and 19.1% in 1997.
Current cigarette smoking prevalence
was lower among Hispanic high school
students than white students. There
was a 34% increase in smoking prevalence
among Hispanic students from 1991
(25.3%) to 1997 (34.0%).94 |
Smoking
is responsible for 87% of the lung
cancer deaths in the United States.
Overall, lung cancer is the leading
cause of cancer deaths among Hispanics.
Lung cancer deaths are about three
times higher for Hispanic men (23.1
per 100,000) than for Hispanic women
(7.7 per 100,000).
|
|
Overall,
lung cancer is the leading cause of
cancer deaths among Hispanics. |
Studies
have documented that tobacco products
are advertised and promoted disproportionately
to ethnic communities. Examples
of target promotions include the
introduction of a cigarette product
with the brand name "Rio" and an
earlier cigarette product "Dorado,"
which was advertised and marketed
to the Hispanic community. Thus,
targeted comprehensive Hispanic
community approach is needed to
prevent smoking, including economic
interventions, counter advertising,
retailer-directed interventions,
environmental policies, etc.
In the past, helping people quit
smoking was the primary focus of
efforts to reduce tobacco use at
all ages in order to reduce the
risk of premature death. In recent
years, the focus of tobacco control
has expanded to include strategies
to prevent individuals from ever
starting to smoke — particularly
young people, since the decision
to use tobacco is nearly always
made in the teenage years, and about
one-half of young people who take
up smoking continue to use tobacco
products as adults. Yet, there are
no validated models specifically
for Hispanic youths.95 |
|
Studies
have documented that tobacco products
are advertised and promoted disproportionately
to ethnic communities.
...the decision to use tobacco is
nearly always made in the teenage
years... |
3.
Crime Prevention In 1996, U.S. residents
age 12 or older experienced approximately
36.8 million crimes, according to the
National Crime Victimization Survey. Three
out of four were property crimes; 25 percent
were crimes of violence.
The
nation's law enforcement agencies reported
a four percent decrease in serious crime
during the first six months of 1997. Violent
crime decreased five percent and property
crime fell four percent during the first
half of 1997.96
The juvenile arrest rate for violent crime
in 1996 dropped nine percent from 1995
and 12 percent from 1994.97
| Issues
such as domestic violence, violence
in the workplace, emergency room visits,
homicide, suicide, and assaults are
all public health issues. |
|
Issues
such as domestic violence, violence
in the workplace, emergency room
visits, homicide, suicide, and assaults
are all public health issues. Crime
tends to occur in neighborhoods
with high poverty. People who are
victims of crime often experience
both physical and mental health
problems. There is no data available
to specifically depict Hispanic
health issues and crime; however,
crime prevention and the injuries
and loss due to crime should be
| |
