1. Haner Hernández, Ph.D., CPS, CADCII, LADCI
Hispanics and Latinos in the U.S.: Statistics, Health Disparities and Definitions
Module 1
Haner Hernández, Ph.D., CPS, CADCII, LADCI

2.  Disclosures
The development of these training materials were supported by grant  H79 TI080209  (PI: S. Becker) from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services. The views and opinions contained within this document do not necessarily reflect those of the US Department of Health and Human Services, and should not be construed as such.

3. Objectives
Provide an overview, including current statistics of the Hispanic and Latino populations in the U.S.
Define terms that are useful in the treatment of culturally diverse populations. 3

4. Trainer’s note
The intent of this training is to provide a description and understanding of Hispanics and Latinos who may use substances, not malign the Hispanic and Latino community or promote the stereotyping and profiling of Hispanics and Latinos.

5. Hispanic and Latino Populations
53,986,412
Hispanic and Latinos
17.1%
of the total
US population
Source: US Census Bureau, 2013 American Community Survey 5

6. Hispanic or Latino by Origin United States, 2011-2013
Source: US Census Bureau (2014). FactFinders, American Community Survey 3- Year Estimates

7. Percent of Hispanic Population in the United States: Trends and Projections
Between 2000 and 2010 Hispanic population grew by 43%, from 35.3 million. With a growth rate of 37.3% -almost 3 times the rate (14%) of the total U.S. population, accounted to half (51.4%) of the Nation´s population growth over the same period.
Source: US Census Bureau. (2013) National population projections.

8. More National Statistics
$39,005 median income for Hispanics vs. $51,017 for total U.S. population (2012)
25.6% poverty rate in 2012 vs. 9.7% for total U.S. population
74% speak Spanish at home
19.5% over the age of 5 speak English “not well’ or “not at all”
Source: DeNavas-Walt, Carmen, Bernadette D., Proctor, and Jessica C. Smith,
U.S. Census Bureau, 2013
Estimate Margin of Error
Total: 47,831,246 +/-4,090
Speak only English 12,312,025 +/-56,167
Speak Spanish: 35,309,091 +/-55,478
Speak English "very well" 19,585,476 +/-48,592
Speak English "well" 6,390,308 +/-27,371
Speak English "not well" 6,053,938 +/-32,176
Speak English "not at all" 3,279,369 +/-24,997
Speak other language 210,130 +/-7,160
47,831,246 Total – over age 5
Speak English "not at all" 3,279,369
Hispanics (5yrs and older) were much more likely to speak a language other than English at home (76% vs.) compared to non-Hispanics (10%)
With regards to children, 61% of all Hispanic children live in low-income families: 8.8 million Hispanic children, compared to 26% of white children. For these children and youth there are wide disparities in access and outcomes for mental health services. Furthermore, children and youth of Hispanic descent are less likely to receive mental health services than any other group and language barriers further exacerbate access problems.

9. Health Insurance
The percentage of uninsured Hispanics decreased in 2012 to 29.1 percent, down from 30.1 percent in The number of uninsured Hispanics in 2012 was not statistically different from 2011, at 15.5 million

10. Health Uninsured Percentage by Race/Ethnicity United States, 2013
Sources: Krogstad, J. M., & Lopez, M. H. (2014). Hispanic immigrants more likely to lack health insurance than U.S.-born. Retrieved from
Smith, J. C., & Medalia, C. (2014). Health Insurance Coverage in the United States: Washington, DC: U.S. Government Printing Office.

11. The Name Game Hispanic versus Latino
In the early 1970s, the Federal government established “Hispanic” as the government’s word of choice for people of Spanish origin — a term that made it onto the official U.S. census form in It and has since been used in local and federal employment, mass media, academia, and business market research.
Due to the popular use of "Latino" in the western portion of the United States, the government adopted this term as well in 1997, and it was used in the 2000 census.
For the U.S. government and others, Hispanic or Latino identity is voluntary, as in the US Census, and in some market research. Neither term refers to race, as a person of Latino or Hispanic origin can be of any race.

12. The Federal Standard
The Census Bureau defines "Hispanic or Latino" as a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race.
The Federal government of United States has mandated that "in data collection and presentation, federal agencies are required to use a minimum of two ethnicities: "Hispanic or Latino" and "Not Hispanic or Latino.   
The new federal standard for identifying “Hispanic or Latino” individuals and for reporting aggregate data is Hispanic/Latino. This term represents ethnicity, whereas American Indian or Alaska Native, Black or African American, White, Asian and Native Hawaiian or Other Pacific Islander represent race categories.
Source: US Census Bureau, 2010

13. Culture Loaded with meaning Not a “freeze frame” cultural portrait
The word “culture” is loaded with meaning and has many potential implications, so the ideas expressed in this brief overview are not exhaustive nor intended to provide a “freeze frame” cultural portrait of all Latinos that pretends they are all the same or unchanging.

14. Acculturation
The process in which members of one cultural group adopt the beliefs and behaviors of another group.
Acculturation can be reciprocal- that is, the dominant group also adopts patterns typical of the minority group.
Although acculturation is usually in the direction of a minority group adopting habits and language patterns of the dominant group,

15. Acculturation
Acculturation is mostly concerned with the individual and how they relate to their own group as a subgroup of the larger society.
Source: Hazuda; Stern & Haffner, 1988

16. Assimilation
Changes in language preference, adoption of common attitudes and values, membership in common social groups and institutions, and loss of separate political or ethnic identification of one group as they come in contact with their host society.
Source: Alba & Nee, 1997
The focus is on the group rather than the individual, and on how minority or immigrant groups relate to the dominant or host society.

17. Americanization
Used initially in the latter part of the 19th century and early part of the 20th century.
Referred to a social movement whose goal was to fully
assimilate immigrants into American society.
Referred to the process by which “immigrants are transformed into Americans”.
Americanization describes the influence the United States of America has on the culture of other countries on such matters like technology, culture and lifestyle among others. It also describes the process whereby the immigrant in the United States is induced to assimilate American speech, ideals, traditions, and ways of life
Source: Graham & Koed, 1993; Huebner, 1906

18. Bicultural or Biculturalism
Is defined as the integration of two or more cultural identities.
The identification and measurement of indigenous and universal personality constructs can be a tremendous strength-based asset in the treatment process.  In the context of Hispanic/Latinos, providers can highlight and use the strengths and values of both cultures; the dominant culture and the native culture to build a participant’s self-efficacy, self-esteem and sense of empowerment.

19. Immigration Statistics
53.9 million Hispanics living in the U.S. in 2013:
18.7 million were foreign born
an estimated 12.7 million were undocumented residents (24.2%)
Source: American Community Survey, 2012

20. Health Equity
Individuals from diverse cultural backgrounds are unable to attain their highest level of health.
OMH, 2011
Health equity is the highest level of health for all people (USDHHS, OMH, 2011). Currently, individuals for various backgrounds are unable to attain their highest level of health due to several reasons:
social determinants of health
conditions in which they were born, grow, live work and age (WHO, 2012), including: socioeconomic status, education level, availability of health services (HHS Office of Disease Prevention and Health Promotion, 2010). 20

21. Health Disparities
Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage”.
Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion
What is a "health disparity"?
The first attempt at an official definition for "health disparities" was developed in September 1999, in response to a White House initiative. The National Institutes of Health (NIH), under the direction of then-director Dr. Harold Varmus, convened an NIH-wide working group, charged with developing a strategic plan for reducing health disparities. That group developed the first NIH definition of "health disparities":
“Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”
In 2000, United States Public Law , also known as the "Minority Health and Health Disparities Research and Education Act," which authorized the National Center for Minority Health and Health Disparities, provided a legal definition of health disparities:
“A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.” Minority Health and Health Disparities Research and Education Act United States Public Law (2000), p. 2498
Since the passage of U.S. Public Law , many agencies have incorporated this definition into their own materials, such as this excerpt from the U.S. Department of Health and Human Services' Office of Minority Health website:
“Different public and private agencies may have different definitions of a 'health disparity' for their own program-related purposes, but these definitions tend to have several things in common. In general, health disparities are defined as significant differences between one population and another. The Minority Health and Health Disparities Research and Education Act of 2000, which authorizes several HHS programs, describes these disparities as differences in "the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates." There are several factors that contribute to health disparities. Many different populations are affected by disparities including racial and ethnic minorities, residents of rural areas, women, children, the elderly, and persons with disabilities.”
So we strive to achieve health equity
Source:

22. Health Disparities
To address the issue of health disparities in the U.S., Healthy People 2020 has set a goal to not only reduce health disparities, but to achieve health equity, eliminate disparities, and improve the health of all groups.
Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” (HHS, Office of Minority Health)
Source:

23. Disparities
Hispanics and Latinos are underrepresented in professions related to behavioral health.
Access is hindered by the fact that a significant number of Hispanics and Latinos are uninsured.
Source: Chapa & Acosta, 2010; Clemens-Cope, Kenney, Buettgens, Carroll & Blavin, 2012
However, are underrepresented in professions related to behavioral health such as medicine, nursing, psychology and social work. Statistical data sustain this underrepresentation where Hispanic/Latino physicians comprise less than 3%; clinical psychologists 1%, social workers 4.3% and registered nurses 1.7%. Unfortunately, these numbers may be lower as they don’t take into consideration issues such as levels of cultural competency and if providers are bilingual. (Chapa & Acosta, 2010).
This disparity has remained significant throughout the years with examples pointing to limited access to meaningful care, linguistic and cultural barriers and poverty The U.S. Hispanic and Latino population is facing a public health crisis due to poor or unmet behavioral health needs (Chapa & Acosta, 2010).
Access is hindered by the fact that one of every three Hispanics (16 million) is health-uninsured, as compared to 11% of Whites (Non-Hispanics) and 20% of Afro-Americans. However, Health Reform is expected to provide to increase coverage of health insurance to at least 6 million Hispanics and Latinos. In fact, Hispanics and Latinos are poised to experience the largest increase in insurance coverage (18.2%) as compared to other ethnic groups and to the overall U.S. population (10.9%) (Clemans-Cope, Kenney, Buettgens, Carroll, & Blavin, 2012 23

24. Mismatch between Needs and the Service Models Available
Reduced access
Low retention rates
Absence of effective community strategies
Reduced access to and participation in drug treatment programs;
Low retention rates in programs; and
Absence of effective community strategies to help diminish cultural barriers and promote the use of culturally-appropriate, science-based treatment models in drug use services to Hispanics and Latinos.
(Caribbean Basin and Hispanic ATTC, 2006)
Source: Caribbean Basin and Hispanic ATTC, 2006 24

25. Culturally and Linguistically Appropriate Services in Health Care
The enhanced National Standards for Culturally and Linguistically Appropriate Services in Health Care are issued by the USDHHS’ Office of Minority Health to advance health equity, improve quality and eliminate health care disparities by establishing a blueprint to implement culturally and linguistically appropriate services.
The enhanced CLAS standards are built upon the groundwork laid by the original National CLAS Standards developed in 2000.
The OMH undertook the National CLAS Standards Enhancement Initiative from 2010 to 2012 to recognize the nation’s increasing diversity, to reflect the tremendous growth in the fields of cultural and linguistic competency over the past decade, and to ensure relevance with new national policies and legislation.
Source: OMH, 2013

26. Enhanced CLAS Standards
Currently 15 standards:
Principal Standard:
Provide effective, equitable, understandable and respectful quality care and servies that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.
This standard frames the essential goal of all the Standards, and if the other 14 Standards are adopted, implemented and maintained the Principal Standard will be achieved.

27. Enhanced CLAS Standards
Three broader themes:
Theme 1: Governance, Leadership and Workforce (Standards 2-4).
Theme 2: Communication and Language Assistance (Standards 5-8).
Theme 3: Engagement, Continuous improvement and Accountability (Standards 9-15).

28. Distribution of Hispanics by ATTC Region
This map provides the distribution of participants by ATTC region
For your reference the fill boxes indicates regions in which Spanish and English surveys were completed. Otherwise only English. Based on distribution the majority of participants are form Pacific Southwest ATTC region, Central Rockies and South Southwest.
R6: 30.3%
Source: US Census Bureau (2014). FactFinders, American Community Survey 3- Year Estimates

29. Substance use by ATTC Region
This map provides the distribution of participants by ATTC region
For your reference the fill boxes indicates regions in which Spanish and English surveys were completed. Otherwise only English. Based on distribution the majority of participants are form Pacific Southwest ATTC region, Central Rockies and South Southwest.
R6: 27.0%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, and 2010 to 2011). ICPSR Retrieved from:

30. Treatment Admissions by Hispanic Population and ATTC Region
This map provides the distribution of participants by ATTC region
For your reference the fill boxes indicates regions in which Spanish and English surveys were completed. Otherwise only English. Based on distribution the majority of participants are form Pacific Southwest ATTC region, Central Rockies and South Southwest.
R6: 20.2%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), ICPSR Retrieved from:

31. References
Alba, R. and Nee, V. (1997). Rethinking Assimilation Theory for a New era of Immigration. International Migration Review, 31(4)
Caribbean Basin and Hispanic ATTC. (2006). Hispanic Initiative: dialogue on science and addiction. Bayamón, PR: Universidad Central del Caribe.
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set [TEDS]. (2012, October). Based on administrative data reported by States to TEDS. Retrieved from
Chapa, T. & Acosta, H. (2010). Movilizándnos por nuestro futuro: Strategic development of a mental health workforce for Latinos. National Resource Center for Hispanic Mental Health
Clemans-Cope, L. Kenney, G.M., Buettgens, M., Carroll, C. & Blavin, F. (2012). The affordable care act’s coverage expansions will reduce differences in insurance rates by race and ethnicity. Health Affairs, 31(15), doi: /hlthaff
Ennis, S. R., Ríos-Vargas, M., & Albert, N. G. (2011, May). The Hispanic population: Retrieved from
Graham, O. & Koed, E. (1993). Americanizing the Immigrant, Past and Future: History and Implications of a Social Movement. Public Historian. 15(4) Retrieved from: Accesed June, 2013
Grover G. Huebner Annals of the American Academy of Political and Social Science , Vol. 27, The Improvement of Labor Conditions in the United States (May, 1906), pp
Hazuda, HP; Atern, MP; Haffner, SM (1988) Acculturation and assimilation among Mexican Americans: scales and population-based data. Soc Sc Q(69)

32. References
National Hispanic and Latino ATTC. (2013, January). Average estimate of Hispanics working in treatment facilities by ATTC regions. Vital signs: Taking the pulse of the addiction treatment profession: Data Set [Preliminary Data]. Addiction Technology Transfer Center under a cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT).
U.S. Department of Health and Human Services, Office of Minority Health. (2013). National Standards for CLAS in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice. Retrieved from:
Pew Research Hispanic Center (2011). Statistical Portrait of Hispanics in the U.S.
retrieved from:
S th Congress: Minority Health and Health Disparities Research and Education Act of (1999). In Retrieved January
23,2013, from
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2013, January). Substance abuse treatment services locator. Retrieved from
United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,.Center for Behavioral Health Statistics and Quality. (2012a, October). National Survey on Drug Use and Health: 8-Year R-DAS (2002 to 2009). Retrieved from
Substance Abuse and Mental Health Services Administration, Leading Change: A Plan for SAMHSA’s Roles and Actions HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

33. References
United States Census Bureau / American FactFinder. “Poverty status in the last 12 months.” American Community Survey. U.S. Census Bureau’s American Community Survey Office, Web. 1 December, 2014 <
United States Census Bureau / American FactFinder. “ACS Housing and Demographics Estimates.” American Community Survey. U.S. Census Bureau’s American Community Survey Office, Web. 1 December, 2014 <
United States Census Bureau / American FactFinder. “Ability to speak English.” American Community Survey. U.S. Census Bureau’s American Community Survey Office, Web. 1 December, 2014 <
United States Census Bureau / American FactFinder. “Hispanics by place of origin.” American Community Survey. U.S. Census Bureau’s American Community Survey Office, Web. 1 December, 2014 <
United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality . (2012b, December). National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, and 2010 to 2011). Retrieved from
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2012). National healthcare disparities report. (AHRQ Publication No ). Retrieved from
U.S. Department of Health and Human Services, Office of Minority Health. (2005). What is cultural competency? Retrieved from
U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for Phase I report: Recommendations for the framework and format of Healthy People Section IV. Advisory Committee findings and recommendations. Available at: