CLC NUR 427, hispanic community

The Hispanic Community Grand Canyon University
Concepts in Community and Public Health
NRS-427V-O104
October 27, 2013

The Hispanic Community
Based on the United States (U.S.) Census Bureau in 2011, there were roughly 52 million Hispanics living in the nation, which represented about 16.7% of the total population (Zepeda, 2011). People of Hispanic origin are the nation's largest ethnic minority group (Zepeda, 2011). Arizona's Hispanic population grew faster than other groups over the past decade (Zepeda, 2011). Arizona had nearly 1.9 million Hispanic residents as of April 2010, an increase of 46% over the previous decade (Zepeda, 2011). By tradition, the Hispanic family is dependent on one another and possesses the most important social unit (Zepeda, 2011). In the Hispanic culture, it is customary to be morally responsible for other family members and help them in their time of need when they are experiencing financial problems, unemployment, poor health conditions, and other life issues (Zedpeda, 2011). Respect for the elderly and authority is a major point of teaching as well as preserving the Spanish language within the family (Zepeda, 2011). The Hispanic population have low rates of educational attainment, family income, insurance coverage, and a higher rate of poverty compared to non-Hispanic Whites (“Summary health statistics”, 2012). Value/Belief Pattern The Hispanic community is predominately Catholic (“Transcultural nursing”, n.d.). Hispanics consider health to be “a gift from God and should not be taken for granted” (“Transcultural nursing”, n.d., para.1). Illness prevention is practiced through prayer, wearing religious medals or amulets, and by keeping certain home artifacts (“Transcultural nursing”, n.d.). They are present-oriented and thus may fail to seek preventive care (“Transcultural nursing”, n.d.). They may arrive late or not go to appointments (“Transcultural nursing”, n.d.). Their culture emphasizes family interdependence over independence (“Transcultural nursing”, n.d.). In times of illness, they depend on family and friends for assistance as opposed to social workers. (“Transcultural nursing”, n.d). Health Perception/Management Pattern The Hispanic culture emphasizes wellness rather than illness and holistic ideologies pertaining to health (Young, 2001). Decisions to seek medical assistance and treatment are often based upon cost, which frequently results in utilizing a licensed physician as a last resort (Young, 2001). They mostly rely on home treatments and community healers (Young, 2001). Many barriers exist for Hispanics to obtain high quality healthcare, including lack of insurance, socioeconomic status, language, and communication challenges. The most frequent minority health issues in Tucson, Arizona are heart disease, diabetes, obesity, hypertension, and HIV/AIDS. The top three leading causes of Hispanic deaths in Arizona are from cardiovascular disease, heart disease, and cancer (ADHS, 2009). Nutrition/Metabolic Pattern The Hispanic population has a low intake of vitamins A, D, E, B2, B6, folic acid, and minerals (Ortega, Lopez, & Serra, 2004). According to a 2009 report on emergency food distribution in the U.S., Hispanic children had a higher rate of food assistance (29%) compared to Whites (11%) (Feeding America, 2010). The obesity rate among Hispanics in Arizona (33.1%) is disproportionately high and exceeds the national Hispanic obesity average of 30.6%. The three sources of water supply in Tucson are groundwater, Colorado River water, and recycled water . Specific foods and drinks like beverages, caffeine/energy drinks, carbonated beverages, whole fat milk, sport drinks, fried food and fruit/vegetable drinks are prohibited in school campuses. Elimination Pattern (Environmental Health Concerns) Hispanics are environmentally friendly. According to research, Latino Americans (Hispanics) “are the greenest population in the U.S.” (Arsian, 2011, para. 1) as they tend to look for greener products for their daily use. Many environmental issues affect Hispanics. Research shows that Hispanic children of low-income families are “more likely to live in unsafe areas with poor street environments” (Zhu & Lee, 2008, p. 282). In 2009, Hispanics had the second highest percentage of those residing in inadequate housing (CDC, 2011). In 2006, about 25% of Hispanics resided in counties that exceeded fine particulate matter standards for air - representing the highest percentage of any ethnic group (CDC, 2011). Activity/Exercise Pattern Hispanics have a low physical activity level which has contributed to their elevated obesity rate (Lee & Laffrey, 2008). In a survey, over 67% of Hispanics did not exercise at least 150 minutes per week as national guidelines recommend (Bautista, Reininger, Gay, Barroso, & McCormick, 2011). More men than women and more single individuals than married individuals exercise (Lee & Laffrey, 2008). The three most preferred methods of exercise are walking/running, stretching and resistance activities, and aerobics (Lee & Laffrey, 2008). Sleep/Rest Pattern Research shows that Hispanics are at greater risk for reduced sleep hours and sleep disorders like apnea (Loredo et al., 2010). Tucson’s Children’s Assessment of Sleep Apnea Study compared Hispanic and Caucasian children residing in Tucson, Arizona. Hispanics were found to have a 3% increase of sleep disorders compared to Caucasians of the same age group residing within the same geopolitical area (Quan, Goodwin, Babar, Kaemingk, & Morgan, 2003). A hypothesis for differences is unclear; it is possible that socioeconomic variables with the ability to speak limited English may have had a reflection on this study (Quan, Goodwin, Babar, Kaemingk, & Morgan, 2003). Cognitive/Perceptual Pattern Disparity exists among the Hispanic population in Tucson, which is growing into a majority status while lagging in educational attainment (Tucson Hispanic Chamber of Commerce, n.d.). Low educational attainment is linked to low earning power and poverty. Educational and social deficits in perception/cognition may be based on the inability for many Hispanic residents to effectively assimilate to Western society. This is a border community in which many residents continue to reside in Mexico while maintaining a home in Tucson. This appears to decrease acculturation, education, and communication by minimizing the use of English as a second language. Self-Perception/Self-Concept Pattern Hispanics usually place a great importance on their look and appearance as it is viewed as a sense of honor, dignity, and pride (Zepeda, 2011). They prefer to dress formally for church attendance, parties, and other social gatherings, but recently jeans and tennis shoes are becoming more popular among the women (Zepeda, 2011). Another cultural habit is that they are flexible about time when attending social events - they tend to be less punctual than other populations in the nation (Zepeda, 2011). Lastly, Hispanics are shy about public speaking because of their heavy accent (Zepeda, 2011). Role/Relationship Pattern The Hispanic family usually lives as an extended family, playing an important role in the life of each family member (“Understanding the Hispanic/Latino”, n.d.). They place family needs ahead of their own (“Understanding the Hispanic/Latino”, n.d.). Children are taught to be respectful of authority, the elderly, and of members of the extended family (“Understanding the Hispanic/Latino”, n.d.). Most often the father is the head of the family and the mother has responsibilities for the home (Zepeda, 2011). They also believe in order to succeed and advance in life, a child or individual needs the whole family’s support ("Understanding the Hispanic/Latino", n.d). Sexuality/Reproductive Pattern Hispanics have one of the highest birth rates in the United States - yet they face prenatal health care disparities that predispose them to pregnancy related complications (Jarvis, 2012). Hispanic women are not as likely to receive family planning services (Martinez, Chandra, Febo-Vazquez, & Mosher, 2013). In Southern Arizona, they have the highest birth, teen pregnancy, abortion, and birth to unwed mother rates (“Abortions”, 2013; AZDHS, 2011). They were also the highest user of the state’s Medicaid program to pay for births (AZDHS, 2011). Coping/Stress Pattern Violent crime is up 16.6% compared to 2011 and crime over all is up 15.6% compared to the previous year. Tucson’s poverty rates remained among the nation’s highest last year, with 1 in 5 living below the poverty threshold. Between October 1, 2012 and March 31, 2013 there were 22,161 incoming communications to the Child Abuse Hotline that met the criteria for a report of abuse or neglect. Compared to one year ago there has been an 8.3 % increase in reports received by the CPS Hotline. Statistics have shown that there are approximately 25,043 marijuana users, 10,967 prescription drug and 4,103 cocaine addicts, 1,862 abusing hallucinogens, 1,046 people that use inhalants, and 232 heroin addicts. About 145 people will die from alcohol and 29 lives will be lost to illicit drug use. Conclusion The Hispanic population of Southwestern Arizona has increased exponentially in the last decade. Hispanics in the Tucson area take great pride in their cultural heritage. They are family and spiritually oriented. They take pride in their appearance and honor family by caring for one another in time of need. Several factors facilitating unhealthy lifestyle habits were identified for this community. One hypothesis is relative to the geographical area of Tucson, Arizona. Being a border community could cause resistance to acculturation and assimilation of mainstream society. “Hispanics residing in U.S border communities tend to be less acculturated and have higher poverty rates” (Ghaddar, Brown, Paggan, & Diaz, 2010, p. 191). Poverty rates in the Tucson area remained among the highest in the nation for 2012. Socioeconomic disparities, lack of educational attainment, and communication challenges compounded by lack of access to affordable health care have left this community with many opportunities for community intervention and health care promotion. Specific areas of concern are unplanned pregnancies, nutritional deficiencies with a disproportionately high rate of obesity, diabetes, and heart disease. Additional health care preventative programs assimilated to the unique needs of this population will assist to provide improved health outcomes for a community in need.

References
Abortions in Arizona: 2012 Abortion Report. (2013). Retrieved from Arizona Department of Health Services: http://azdhs.gov/diro/reports/pdf/2012-arizona-abortion-report.pdf Anderson, J. L., Warren, C. A., Perez, E., Louis, R., Phillips, S., Wheeler, J., ... Misra, R. (2008, June). Gender and ethnic differences in hand hygiene practices among college students. AJIC, 36(5), 361-368. http://dx.doi.org/10.1016/j.ajic.2007.09.007 Arizona Department of Education. (2013). Health and Nutrition Services. Retrieved on October 22, 2013, from http://www.azed.gov/health-nutrition/ Arizona Department of Health Services. (AZDHS). (2009). Mortality from natural causes. Retrieved from, http://www.azdhs.gov/plan/report/dhsag/dhsag09/pdf/measures5.pdf Arizona Department of Health Services (AZDHS). (2011). Natality: Maternal characteristics and newborn’s health. Retrieved from http://www.azdhs.gov/plan/report/ahs/ahs2011/5b.htm Arsian, A. (2011). Green Revolution. Retrieved October 24, 2013 from, http://latinbusinesstoday.com/2011/09/green-revolution/ Bautista, L., Reininger, B., Gay, J. L., Barroso, C. S., & McCormick, J. B. (2011, September 1). Perceived barriers to exercise in Hispanic adults by level of activity. Journal of Physical Activity & Health, 8, 916-925. Retrieved from http://ehis.ebscohost.com.library.gcu.edu Centers for Disease Control and Prevention (CDC). (2011). CDC health disparities and inequalities report – United States, 2011. Retrieved from, http://www.cdc.gov/mmwr/pdf/other/su6001.pdf

References
Centers for Disease Control and Prevention (CDC). (2013). Communities putting prevention to work. Retrieved on October 22, 2013, from http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/communities/profiles/obesity-az_pima-county.htm. City of Tucson. (2013). Tucson Water. Retrieved on October 22, 2013, from http://cms3.tucsonaz.gov/water/water_quality. Feeding America. (2010). When the pantry is bare: Emergency food assistance and Hispanic Children [Report]. Retrieved from, http://feedingamerica.org/hunger-in-america/hunger-studies/~/media/Files/research/ExecutiveSummaryHispanicBriefs.ashx?.pdf Ghaddar, S., Brown, C. J., Paggan, J. A., & Diaz, V. (2010). Acculturation and healthy lifestyle habits among Hispanics in the United States-Mexico border communities. Original Research, 28, 190-197. Retrieved from http//ehis.ebscohost.com Health Power for Minorities. (2013). Health information and promotion for multicultural or minority health. Retrieved on October 22, 2013, from http://healthpowerforminorities.com/cities/Tucson-AZ.html Jarvis, C. (2012). Physical examination & health assessment (6th ed.). [Elsevier Saunders]. Retrieved from http://evolve.elsevier.com Lee, Y., & Laffrey, S. C. (2008). Exercise and self-efficacy among employed Hispanic men and women. Hispanic Health Care International, 6(1), 21-26. http://dx.doi.org/10.1891/1540-4153.6.1.21

References
Loredo, J.S., Soler, X., … Palinkas, L. (2010). Sleep health in U.S. Hispanic population. Sleep. 33(7), 962-967. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894438/ Martinez, G., Chandra, A., Febo-Vazquez, I., & Mosher, W. (2013). Use of family planning and related medical services among women aged 15-44 in the United States: National survey of family growth, 2006-2010. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/nchs/data/nhsr/nhsr068.pdf Ortega, R.M., Lopez, S., & Serra, J. (2004). Are there any nutritional deficiencies in the mediterranean diet. Retrieved from, http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=15584480 Quan, S. F., Goodwin, J. L., Babar, S. I., Kaemingk, K. L., & Morgan, W. J. (2003). Sleep architecture in normal Caucasian and Hispanic children aged 6-11 years recorded during unattended polysomnography: Experience from the Tucson children’s assessment of sleep apnea study (TuCASA). Sleep Medicine, 4, 14-19. http://dx.doi.org/10.1016/s1389-9457 (02) 00235-6 Summary health statistics for the U.S. population: National health interview survey, 2011. (2012). Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_255.pdf Transcultural nursing: Basic concepts & case studies - the Hispanic American community. (n.d.). Retreived on October 19, 2013, from http://www.culturediversity.org/hisp.htm Tuscon Hispanic Chamber. (n.d.). http:/tucsonhispanicchamber.org Understanding the hispanic/latino culture. (n.d). Retrieved from http://www.coedu.usf.edu/zalaquett/hoy/culture.html

References
Valorie, H. Rice, and J. Vest Marshall. (2013). The University of Arizona/poverty measures rank Arizona poorly. Retrieved on October 22, 2013, from http://azeconomy.eller.arizona.edu/AZE13Q1/poverty_measures_Arizona.asp Young, M. Maldonado. (2001). Hispanic health information outreach/health belief practices. Retrieved from http://nnlm.gov/evaluation/tools/hispanicoutreach.pdf. Zepeda, A. (2011). Arizona’s hispanic population grows in 2010 census. Retrieved from www.insidetucsonbusiness.com/news/top_stories/arizona-s-hispanic-population-grows-in census/article_2c0b0a18-50dd-11e0-bff5-001cc4c002e0.html Zhu, X., & Lee, C. (2008, April). Walkability and safety around elementary schools and economic and ethnic disparities. American Journal of Preventive Medicine, 34(4), 282-290. http://dx.doi.org/10.1016/j.amepre.2008.01.024

Table 1

Functional Health Patterns of the Hispanic Community

Value/Belief Pattern
Health Perception/Management Pattern
Nutrition/Metabolic Pattern
Predominantly Catholic
Health is “a gift from God”
Prayer, religious medals/amulets, and home artifacts prevent illness Present oriented Emphasize family interdependence

Attains poor quality healthcare due to lack of insurance and poverty Common health issues are cardiovascular disease, obesity, and diabetes due to sedentary lifestyle and food habits

Increase in obesity rate and nutritional deficiency
Adequate nutritional programs and assistance for poverty level residence Adequate and good quality of water School programs provide good, healthy habits

Elimination Pattern
(Environmental Health Concerns)
Activity/Exercise Pattern
Sleep/Rest Pattern
Environmentally friendly
More likely to live in unsafe areas
Have a high percentage of inadequate housing
Have a high percentage of living in areas with increased air pollution

Low physical activity levels
Women are more sedentary than men
Married individuals are more sedentary than single individuals Prefer walking/running, stretching and resistance activities, and aerobics

Hispanics at greater risk for reduced sleep hours and sleep disorders Hispanic children in Tucson suffer more sleep deprivation than Caucasians of the same community

Cognitive/Perceptual Pattern

Self-Perception/Self-Concept Pattern
Role/Relationship Pattern
Hispanics in Tucson have decreased levels of educational attainment Living close to the border may adversely affect education and communication

Take pride in personal appearance
Shy about public speaking
Flexible about time and attendance to appointments

Nation’s largest ethnic minority group
The father is the head of the family
Interdependent culture

Sexuality/Reproductive Pattern

Coping/Stress Pattern
High birth rates
High teen pregnancy and abortion rates in Southern Arizona
Prenatal and family planning health care disparities
Increase in crime rate and poverty rate
Increase in substance abuse and child abuse