1. Hispanics in a Biopsychosocial Context Hispanic Neuropsychological Society @ National Academy of Neuropsychology Seattle, Washington November 19, 2004

2. Contact Information: Antonio E. Puente, Ph.D. Department of Psychology University of North Carolina at Wilmington 910.962.3812 puente@uncw.edu www.uncw.edu/people/puente

3. Background Purpose Purpose Provide Contextual Background Provide Contextual Background Prior Attempts Prior Attempts Ponton Ponton Several chapters Several chapters

4. US Demographic Context (from various sources especially US Census Bureau, 2004) Population Population US =290, 807,770 US =290, 807,770 NC = 8,407,248 NC = 8,407,248

5. US Demographic Context Income (household) Income (household) Median= $45,631 Median= $45,631 Mean = $61,587 Mean = $61,587

6. US Demographic Context Education Education Doctoral Degree= 1.0 Doctoral Degree= 1.0 Professional Degree= 2.0 Professional Degree= 2.0 Masters Degree= 5.9 Masters Degree= 5.9 Bachelors Degree=15.5 Bachelors Degree=15.5 Associates Degree= 6.3 Associates Degree= 6.3 High School Degree= 80.4 High School Degree= 80.4 Less than High School=18.2 Less than High School=18.2 No Schooling= 1.4 No Schooling= 1.4

7. Hispanics in the United States: Overview United States Trends United States Trends Is the largest ethnic minority group in US Is the largest ethnic minority group in US Is the fastest growing ethnic group in US Is the fastest growing ethnic group in US Approximating 15% of the population Approximating 15% of the population Will represent the majority group in 2040 Will represent the majority group in 2040 Probably undercounted (hence projections are probably off with a wide margin of error) Probably undercounted (hence projections are probably off with a wide margin of error)

8. Demographics: Hispanics in the United States United States Statistics United States Statistics Overall = 12.5% (Vs. 12.1% for AA) Overall = 12.5% (Vs. 12.1% for AA) Before 18 = 35% Before 18 = 35% 18-65 = 60% 18-65 = 60% 65 + = 5% 65 + = 5% Less Educated than counterparts Less Educated than counterparts More Fertile than counterparts More Fertile than counterparts

9. US Demographics: Population Shifting Demographics Shifting Demographics Non-Hispanic White69.4%57.5% Non-Hispanic White69.4%57.5% African American12.7%13.9% African American12.7%13.9% Hispanic12.6%20.1% Hispanic12.6%20.1%

10. US Demographics: Work Force Percentage of Work Force Percentage of Work Force 1980 5.7% 1980 5.7% 1990 8.5% 1990 8.5% 200011.7% 200011.7% 201014.1% 201014.1% 202016.9% 202016.9% 203010.9% 203010.9%

11. US Demographics: Undergraduate Education Bachelors Degrees Awarded to Hispanics (%) Bachelors Degrees Awarded to Hispanics (%) 19802.3% 19802.3% 19903.4% 19903.4% 20006.2% 20006.2% 20107.0% 20107.0% 20208.0% 20208.0% 20308.8% 20308.8%

12. Demographics: Hispanics in North Carolina North Carolina Statistics North Carolina Statistics Overall = 4.7% Overall = 4.7% Migration for Foreign Born = 50% Migration for Foreign Born = 50% Primarily from California (also from the NE) Primarily from California (also from the NE) Comparison (ND = 282% decrease) Comparison (ND = 282% decrease) From 1990 to 2000 = 394% increase From 1990 to 2000 = 394% increase

13. Demographics: Hispanics in New Hanover County New Hanover (Wilmington, NC) Statistics Estimates New Hanover (Wilmington, NC) Statistics Estimates Total Population = 147,642 (22.7% increase) Total Population = 147,642 (22.7% increase) 1980 = 788; 1980 = 788; 1990 = 747; 1990 = 747; 2000 =1,828 2000 =1,828 Estimate = severe undercounting Estimate = severe undercounting

14. Additional Hispanic Statistics Percentage of Population Percentage of Population - In US = 12.5% - In US = 12.5% In NC = 4.7% In NC = 4.7% - 36% are from Latin America - 30% are from Mexico Anticipated Growth Anticipated Growth In US = Births will outpace immigration In US = Births will outpace immigration In NC = Over 500% growth In NC = Over 500% growth

15. North Carolina: More Closely (partially from Common Sense Foundation, October, 2004) University of North Carolina @ Wilmington University of North Carolina @ Wilmington Chancellors or Vice-Chancellors (0 of 6) Chancellors or Vice-Chancellors (0 of 6) Deans (0 of 5) Deans (0 of 5) Faculty (15 out of 705) Faculty (15 out of 705) Students (254 out of 11,327) Students (254 out of 11,327) Issues of Documentation Issues of Documentation Glass Ceiling of Non-Resident Tuition Glass Ceiling of Non-Resident Tuition

16. Glance (continued) High School Students in North Carolina High School Students in North Carolina One third of all high school graduates by the year 2013 will be Hispanic One third of all high school graduates by the year 2013 will be Hispanic Graduation rate for Hispanics nationally = 54% Graduation rate for Hispanics nationally = 54% Graduation rate for Hispanics in North Carolina = 38% Graduation rate for Hispanics in North Carolina = 38%

17. Glance (continued) Language Ability (in US about 30 million speak Spanish) Language Ability (in US about 30 million speak Spanish) US = 22% speak English poorly US = 22% speak English poorly NC =34% speak English poorly NC =34% speak English poorly Governmental Representation Governmental Representation Two Elected Officials Two Elected Officials No High Ranking Judges No High Ranking Judges One Executive Level Office One Executive Level Office

18. Glance (continued) Health Insurance Health Insurance 37% lack insurance nationally 37% lack insurance nationally 54% lack insurance in North Carolina 54% lack insurance in North Carolina Increases to 64% if non-documented Increases to 64% if non-documented Income Income 27% live in poverty 27% live in poverty NC Median family income = $30,529 NC Median family income = $30,529 National MFI = $ 44,468 National MFI = $ 44,468 NC MFI for whites = $51,951 NC MFI for whites = $51,951 National MFI = $61,587 National MFI = $61,587

19. Psychological Literature (from PsyInfo, 11.01.04) Psychology Psychology 485,230 485,230 Hispanics Hispanics 7,718 7,718 Hispanics and Mental Health Hispanics and Mental Health 799 799 Hispanics and Intelligence Hispanics and Intelligence 172 172 Hispanics and Neuropsychology Hispanics and Neuropsychology 52 52

20. What Does Being Hispanic Mean? Speaking Spanish Speaking Spanish Being Catholic (or Christian, probably conservative/fundamentalist) Being Catholic (or Christian, probably conservative/fundamentalist) Religion as source of support and socialization Religion as source of support and socialization Family above all (and extended family) Family above all (and extended family) Children are highly desired and valued Children are highly desired and valued Friends and social groups are critical Friends and social groups are critical Cooperation versus competition Cooperation versus competition Keep ones problems to themselves or family Keep ones problems to themselves or family Respect and formality Respect and formality The important use and knowledge of a name (and title) The important use and knowledge of a name (and title) Hospitality through gifts, food, and drink Hospitality through gifts, food, and drink Smooth interpersonal relations are critical (amabilidad) Smooth interpersonal relations are critical (amabilidad) Time to be enjoyed not conquered Time to be enjoyed not conquered Modesty (pudor) Modesty (pudor) Less material & consumer focused Less material & consumer focused More emotional More emotional Personalismo Personalismo Fatalismo (chance and God explain just about everything) Fatalismo (chance and God explain just about everything)

21. Sources of Biopsychosocial Problems Culture and Acculturation Issues Culture and Acculturation Issues Language Limitations Language Limitations Family Dysfunction Family Dysfunction Ineffective Social Support Ineffective Social Support Low Self Esteem Low Self Esteem Limited Education Limited Education Financial Limitations Financial Limitations Religious Affiliation Religious Affiliation Documentation Documentation Health Status Health Status Gender Issues Gender Issues Interpretation of Efficiency Interpretation of Efficiency

22. Cultural Issues Misunderstanding of the Majority Cultures Unwritten Social Rules and Agendas Misunderstanding of the Majority Cultures Unwritten Social Rules and Agendas Isolation to Mainstreaming Isolation to Mainstreaming

23. Language Limitations English English Variations of Spanish Variations of Spanish Spanish as a Second Language Spanish as a Second Language Anxiety Associated with Learning English and Losing Your Culture Anxiety Associated with Learning English and Losing Your Culture Non-Verbal Communication is Important Non-Verbal Communication is Important Children as Translators Children as Translators Children Choosing English over Spanish Children Choosing English over Spanish

24. Family Defining Family (Familismo) Defining Family (Familismo) Nuclear Nuclear Extended Extended Double Double Functional Functional Divided Families Divided Families Economics Economics Geography Geography Politics Politics

25. Ineffective Social Support Medical Medical Religious Religious Educational Educational Financial Financial Social Social Marital Marital

26. Low Self Esteem Productivity and Materialism Productivity and Materialism Connectivity Connectivity Self-Effacing Presentation Self-Effacing Presentation Loss of Respect From Others Loss of Respect From Others Self-Fulfilling Prophecy Self-Fulfilling Prophecy

27. Education Typical Educational Background Typical Educational Background What it Means to be Educated- What it Means to be Educated- the difference between schooling and education the difference between schooling and education

28. Financial & Related Limitations The Limits and Hazards of Being Undocumented The Limits and Hazards of Being Undocumented Type of Vocational Opportunities & Corresponding Pay Type of Vocational Opportunities & Corresponding Pay Banking Issues Banking Issues Saving for Retirement Saving for Retirement Drivers Licenses Drivers Licenses

29. Religion Predominantly Catholic, but not Exclusively (about 25%) Predominantly Catholic, but not Exclusively (about 25%) Importance of Religion and Related Social Support Importance of Religion and Related Social Support Prayers are Directed to a Saint Prayers are Directed to a Saint A Milagro is a Special Need A Milagro is a Special Need Church and Related Services in Spanish Church and Related Services in Spanish

30. Documentation Education Education Medical Medical Legal Legal Tax ID Numbers Tax ID Numbers Social Security Numbers Social Security Numbers Drivers Licenses Drivers Licenses Aliases Aliases

31. Health Status Increased and Disproportionate Health Problems Increased and Disproportionate Health Problems Higher Low Birth Weights & Infant Mortality Higher Low Birth Weights & Infant Mortality Increased Morbidity Increased Morbidity Under-Utilization of Health Services Under-Utilization of Health Services Health Viewed as Absence of Pain Health Viewed as Absence of Pain Women as Primary Care Providers in Family Women as Primary Care Providers in Family Disability is a Family Affair Disability is a Family Affair Hospitals as Last Place for Health Care or Possibly a Place One Goes to Die Hospitals as Last Place for Health Care or Possibly a Place One Goes to Die

32. Gender Issues Males Vs. Female Males Vs. Female Males 27% Males 27% Females 17% Females 17% Machismo Machismo False = loss of dignity and respect False = loss of dignity and respect True = Protector, supporter True = Protector, supporter Heterosexual issues Heterosexual issues Clashing of cultures Clashing of cultures Availability of partners Availability of partners Prostitution Prostitution STDs STDs Sexual Identity Issues Sexual Identity Issues Childhood Sexuality & Abuse Childhood Sexuality & Abuse

33. Interpretation of Efficiency Time (enjoyment vs. completion) Time (enjoyment vs. completion) Cooperation (vs. competition) Cooperation (vs. competition) Process (vs. outcome) Process (vs. outcome)

34. Outcome of Problems Anxiety13% Anxiety13% Substance abuse 8% Substance abuse 8% Depression 5% Depression 5% Violence ?% Violence ?% Ethnic identity issues ?% Ethnic identity issues ?% Poverty and marginalization ?% Poverty and marginalization ?%

35. Hispanics & Neuropsychology Presentations (Dates are approximate/estimates) Presentations (Dates are approximate/estimates) Approximately 1994 Puente NAN Workshop Approximately 1994 Puente NAN Workshop INS soon thereafter, Ponton Workshop (Galveston?) INS soon thereafter, Ponton Workshop (Galveston?) 2000 HNS/NAN Informal Symposium 2000 HNS/NAN Informal Symposium 2002 Ardila NAN Workshop 2002 Ardila NAN Workshop 2004 HNS NAN Workshop 2004 HNS NAN Workshop Books Books 4 3 Edited; 1 Authored 3 Edited; 1 Authored Non-Empirical Publications Non-Empirical Publications 30 30 Mostly Chapters Mostly Chapters Empirical Publications Empirical Publications 20 20 Two Dissertations Two Dissertations Acculturation/testing Acculturation/testing Psychology = 35 Psychology = 35 Neuropsychology= 6 (most non-empirical) Neuropsychology= 6 (most non-empirical)

36. Merging Problems (Outside Traditional Biopsychosocial Realm) Lack of Science Lack of Science Lack of Personnel Lack of Personnel HNS as an Example HNS as an Example Lack of Tests Lack of Tests Copyright Copyright Standardization Standardization Translation Issues Translation Issues Heterogeneity of Hispanics Heterogeneity of Hispanics The Difficulty in Developing Tests The Difficulty in Developing Tests

37. A Model for Integration A Model for Integration 1.Isolation 2. Acculturation 2. Acculturation 3. Assimilation 3. Assimilation 4. Mainstream 4. Mainstream

38. In Three Generations (from Hispanic Business, 2003) IsolationAcculturation Assimilation Income$20,500 $36,100$37,000 Size 3.9 3.6 3.1 Time in US 1 st gen. US born 4 th Gen. LocaleInner CitySuburbs ?Suburbs ValuesHispanicPartial HispanicAnglo LanguageSpanishBilingualEnglish

39. The Future Clashing Curves and Cultures Clashing Curves and Cultures 21 st Century Slavery 21 st Century Slavery Pay Now or Pay Later Pay Now or Pay Later What is the United States Going to Do? What is the United States Going to Do?

40. Future? Demographic Shifts Are Obvious Demographic Shifts Are Obvious Socio-political Shifts Are Not Socio-political Shifts Are Not The Lack of Integration of These Two Shifts Will Result in Social Misunderstanding & Unrest The Lack of Integration of These Two Shifts Will Result in Social Misunderstanding & Unrest