More research and action is needed

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More research (and action) is needed
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Hispanic paradox

• Higher poverty, less formal education, less
  healthcare
• Better health lower mortality rates

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Hispanic paradox
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Hispanic paradox
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Hispanic paradox

• Healthy migrant hypothesis
• Barrio effect?
• Salmon bias?
• Acculturation risk?

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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)

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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

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Why are Latinos with diabetes twice as likely to
die from it as non-Hispanic whites?

• Genetics?
• Culture?
• Environment?
• Less access to care?
• Racism?

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Which Latinos?
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Which Latinos?

• Mexican, Puerto Rican, Venezuelan, Cuban?
• Immigrant or second-generation?
• Wealthy or poor?
• Urban or rural?

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Which Latinos?

• Who decides?
• Researchers dont all agree
• Self-ID can change

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Whose genes?

• Studies to define genetic ancestry
• Body composition (NY Puerto Ricans)
• Asthma (SF Mexican-Americans, NY Puerto Ricans)

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Environment

• NIEHS environmental genome project
• - environmental conditions, plus
• - genetic susceptibility

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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)

15
Social determinants

• Income inequality
• Social cohesion and mutual trust
• Inequalities in political participation, civic
  engagement
• Residential segregation
• (Kawachi, Harvard University)

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Racism

• Unequal treatment
• -- Studies on unconscious decision-making
• Racialized living
• -- Allostatic load (stress response)
• -- Social rank

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More research is needed

• Countries of origin
• Regional differences (multi-center studies)
• Lengths of U.S. residence
• Research in countries of origin

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Ichiro Kawachi
Thomas A. LaVeist
Brian Smedley, ed.
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Leading causes of death among Latinos (2003)

• Diseases of heart
  28,298
• Malignant neoplasms
  24,070
• Unintentional injuries h
  10,418
• Cerebrovascular diseases
  6,658
• Diabetes mellitus
  6,179
• Chronic liver disease and cirrhosis 3,382
• Homicide
  3,355
• Chronic lower respiratory diseases 3,174
• Influenza and pneumonia 2,948
• Certain conditions originating in the perinatal
  period
  2,628

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Asthma
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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

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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/

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Asthma

• Who is being counted?
• Access to medications in school
• School air safety
• Air pollution regulations
• Corporate responsibility
• Land use laws

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AIDS/HIV

• 14 percent of the population 20 percent of AIDS
  diagnoses
• 32 percent U.S. born 18 percent Puerto Rican 17
  percent Mexican

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AIDS issues

• Transmission patterns
• Education
• Access to care
• Community concern

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AIDS -resources

• Kaiser Family Foundation
• GLAAD
• (http//www.glaad.org/publications/resource_doc_d
  etail.php?id3101)
• Bienestar
• (http//www.bienestar.org)
• Proyecto Contra SIDA Por Vida
• San Francisco AIDS Foundation
• (http//www.sfaf.org/beta/2005_win/mortality.html)
  

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How to find stories
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Evaluating stories
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Consider the source
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Evaluating a study

• Who are the participants (subjects)
• Number of participants (sample size)
• Institution
• P value
• Standard deviation (SD)
• Mean, median

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Examples
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SPJ Rainbow Sourcebook

• and Diversity Toolbox