1. Latinos and Latino Health in Maryland Olivia Carter-Pokras, Ph.D. Associate Professor, Department of Epidemiology & Biostatistics University of Maryland School of Public Health

2. Hispanics in Maryland: 2007 347,000 or 6% of population 54% are foreign-born 22% are Mexican-origin Median Income (16 and older) – Hispanics $25,298 – Non-Hispanic Whites $40,476 Poverty Rate (17 and younger) – Hispanics 11% – Non-Hispanic White 6% SOURCE: http://pewhispanic.org/states/?stateid=MD

3. New Maryland Latino Data Focus groups – Physical activity, emergency preparedness, tobacco Surveys conducted at festivals, health fairs & clinics in Baltimore & Montgomery County Montgomery County Latino Cancer Survey (503 adults at least 40 years of age) 2006 Maryland Adult and Youth Tobacco Surveys Blueprint focus groups & Key Informant Interviews Other needs assessments & evaluation for specific programs (e.g., asthma)

4. Hispanic/Latino Paradox? Despite higher poverty, uninsurance, lower use of health services, Mexican-origin persons and Latinos as a whole tend to have lower mortality and morbidity than non-Hispanic Whites But, effect is restricted to immigrant Mexicans & “Other Hispanics” (Palloni & Arias, 2003) OF CONCERN: As Latinos assimilate they adopt unhealthy behaviors, the population is aging, obesity rates are increasing, increasing lack of access SOURCE: Journal of Immigrant and Minority Health. 2008 Dec;10(6):475-88

5. Health Priorities for Maryland Latinos Common issues for MD Latinos: access to care, language barriers, low socioeconomic status Interrelatedness of health issues to other problems (e.g., employment, stress) Fewer Latino adults have health insurance: only 31% in Baltimore & 42% in Montgomery County Latinos under-utilize emergency departments Recommend use medical interpreters, U.S. healthcare system workshops, licensure of foreign-trained nurses, outreach clinics SOURCE: AJMC 2004;10(1):SP29-SP36; JHCPU 2006;17(4):899-909; JAAMP 2006;17:61- 67, Montgomery County Latino Cancer Survey; J Transcultural Nursing 2008;19(2)

6. Fewer Latino women received first trimester prenatal care compared to other women in Montgomery County, 2006

7. The adolescent birth rate for Hispanic youth is considerably higher than the rate for other youth in Montgomery County, 2003 to 2006

8. Physical activity among Latina adolescents Positive concept of exercise & physical activity, support development of physical fitness programs for Latina adolescents Few programs available, cost prohibitive, lack of transportation, parental English ability, homework, being tired, needing encouragement, not having time, program staff & neighborhood safety concerns, wanting to sleep, lack of a volleyball court, & home chores. SOURCE: Journal of Latino-Latin American Studies 2006 Dec;2(2):33-47.

9. Weight, Dietary Practices and Physical Activity 30% obese & 46% overweight More men were overweight (56% vs. 39%), more women were obese (24% vs. 35%) 29% consumed 5 or more servings of vegetables and fruits per day SOURCE: Montgomery County Latino Cancer Survey, http://www.fha.state.md.us/pdf/cancer/MCLCS_2005.pdf

10. Smoking Variations in Montgomery County, Maryland Variations by subgroup: 10% CA, 17% SA, & 25% Other Latinos smoke Increase with greater time in U.S.: 12% of those 0-4 years, 18% of 5-9 years, 27% of 10- 19 years were current smokers 71% of those with health insurance v.s. 30% of uninsured were advised to quit smoking SOURCE: Montgomery County Latino Cancer Survey, http://www.fha.state.md.us/pdf/cancer/MCLCS_2005.pdf

11. Latino smokers are less likely to be offered by healthcare providers Advice Smoking cessation products Programs, or medications SOURCE: Carter-Pokras O, et al. (2008). Report on Disparities in Tobacco Use Behaviors by Adult Minority Populations in Maryland, 2006.

12. 5 Latino Current Smoker & Ex- Smoker Focus Groups Main reasons to stop smoking: personal health concerns, impact on children, & family health & role model pressure Barriers to quit smoking: environmental temptation & social factors, emotional pressure, addiction & habitual behavior. Low use of cessation services is associated with lack of awareness of availability of Spanish-language cessation services. Lay health promoters are favored for smoking cessation interventions. SOURCE: Carter-Pokras O, et al. Barriers and Facilitators to Smoking Cessation among Latino Adult Tobacco Users in Maryland. Manuscript Under Review.

13. Trust issues Trust issues Eligibility/fear Eligibility/fear Immigration problems Logistical problems Language barriers

14. Emergency Preparedness Difficulty defining emergency Wide range of perceived personal emergency risks: immigration problems; crime, personal insecurity, gangs; home/traffic accidents; home fires; environmental problems; and snipers. Few participants had received information on emergency preparedness, and most did not have an emergency plan. SOURCE: Journal of Health Care for the Poor and Underserved; 2007;18:465-481.

15. Principles of Community-based Research as Applied to Maryland Latino Communities Community as a unit of identity Builds on strengths and resources within community Facilitates collaborative, equitable partnerships in all phases of research Promotes co-learning and capacity-building Integrates knowledge and action Emphasizes local relevance & multiple determinants of health Implements an iterative process Disseminates findings and knowledge Long-term process and commitment SOURCE: Martinez IL, Carter-Pokras O, Brown PB. Addressing the Challenges of Latino Health Research: Community-based approaches in an emergent urban community. Journal of the National Medical Association (In Press)

16. Olivia Carter-Pokras, Ph.D. Associate Professor Department of Epidemiology & Biostatistics University of Maryland School of Public Health Opokras@umd.edu