HEALTH NEEDS ASSESSMENT FOR THE LATINO POPULATION OF NEVADASherry Liao, MPH Candidate

University of Nevada, Reno

April 17, 2014

As diversity in the United States continues to increase, a variety of outreach methods are needed to reach all segments of the population.

citizenship.honeywell.com

HEALTH DISPARITIES FACED BY LATINOS

Obesity1

Hypertension2

Diabetes3

HIV/AIDS4

Breast cancer detection, treatment, and follow-up5

Colorectal cancer screening6

Mental health7

growthhormonecanada.ca

LACK OF ACCESS TO CARE

Language Barrier8

Lack of cultural competence9

Mistrust9

Low Educational Attainment8

Unable to navigate system9

Immigration status8

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47% of Hispanics in Nevada lack access to care.8

myfertilitychoices.com

From 2000 to 2011, the Latino population in the United States grew 47.5%.10

bionutritionalresearch.olhblogspace.com

During that same time period, the Latino population in Nevada grew 66.0%.10

Nevada presents unique challenges in accessing healthcare.

pubs.usgs.gov

Community Health Worker Program

CHW Program

METHODS

Latino Health Needs Assessment (LHNA) Survey 76 questions Topics

General demographics Access to healthcare Chronic diseases Health screenings Health behaviors Reproductive health Mental health Community factors

Development

mexicoinstitute.wordpress.commexicoinstitute.wordpress.com

METHODS

Latino Health Needs Assessment Data collection: July 2013 – November 2013 Formats

Paper and Electronic English and Spanish (72.8% Spanish)

Incentives ($25 gift cards) Participant Recruitment Inclusion Criteria

mexicoinstitute.wordpress.com

METHODS

Data Analysis Data cleaning

3 excluded due to age 3 excluded due to ethnicity Invalid and out-of-state zip code excluded from county analysis

Final sample: N = 933 Combining free response answers

Ex. Please specify your type of employment.

Sales

• “bodega”• “retail”

Education

• “maestro de ninos”• “ccsd”• “Education”• “teacher aide”

DEMOGRAPHICS

Ethnicity (N = 908) # %

Mexican, Mexican American, Chicano 753 82.9

Salvadorian 76 8.4

Puerto Rican 22 2.4

Cuban 7 0.8

Mixed Latino Ethnicity 10 1.1

Other Hispanic/Latino Origin 40 4.4

Born in the United States (N = 852) # %

No 658 77.2

Yes 194 22.8

DEMOGRAPHICS

County of Residence (N = 842) # %

Clark 550 65.3

Washoe 138 16.4

Carson City 104 12.4

Elko 27 3.2

Lyon 23 2.7

Language Spoken at Home (N = 882) # %

Spanish 551 62.5

English and Spanish 248 28.1

English 83 9.4

Age (N = 908) # %

18 – 30 years 289 34.6

31 – 40 years 228 27.3

41 – 50 years 191 22.9

51 – 60 years 90 10.8

61 – 70 years 26 3.1

71 – 80 years 10 1.2

Over 80 years 2 0.2

Gender (N = 852) # %

Female 493 56.1

Male 382 43.5

Transgender 2 0.2

Other 2 0.2

Over a quarter of respondents (26.8%) reported an annual household income of less than $10,000 and well over half (62.3%) reported one of less than $30,000.

http://eofdreams.com/photo/money/11/

N = 855

Only 22.2% and 19.0% of respondents reported receiving benefits from WIC and SNAP, respectively, in the past year.

N = 864

Only about one in four respondents had healthcare coverage of any kind.

N = 890

HEALTHCARE COVERAGE BY COUNTY

Total Clark Carson Washoe Rural0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27%22%

33% 35%

55%

Of respondents who have children, 93.6% reported that all their children were up to date on their immunizations.

www.smchealth.org N = 484

Most respondents (61.9%) reported that they had a place to go if sick or needed health advice.

N = 872

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REASONS FOR LACK OF REGULAR PHYSICIAN OR DENTAL VISITS

Not enough providers

Coverage not accepted

Language barrier

Do not have enough time

Not needed, I am healthy

Do not have provider

Costs too much

No healthcare coverage

0% 10% 20% 30% 40% 50%

0.5%

0.8%

1.1%

2.0%

2.7%

7.4%

23.4%

37.4%

0.5%

0.8%

1.0%

3.6%

4.6%

7.6%

15.3%

24.0%

Physician

Dentist

HAVE YOU EVER FELT DISCRIMINATED AGAINST BY A HEALTHCARE PROVIDER DUE TO ANY OF THE FOLLOWING?

Age Gender Language Ethnicity/Race

Sexual Orientation

Physical Appearance

Physical Disability

0%

5%

10%

15%

20%

25%

6.4%

4.7%

19.1%

16.9%

2.8%

8.6%

3.3%

PHYSICAL AND MENTAL HEALTH

Excellent Very Good Good Fair Poor0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

8.2%

19.4%

34.7%32.3%

5.4%

18.2%

24.9%

38.4%

16.4%

2.1%

Physical HealthMental Health

N = 907 & 854, respectively

CALCULATED VERSUS SELF-REPORTED BMI CLASSIFICATIONS

Underweight Normal weight Overweight Obese Very Obese0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2%

25%

39%

20%15%

3%

55%

37%

4%1%

CalculatedSelf-Reported

N = 865 & 688, respectively

About half of respondents (50.35%) reported participating in physical activity in the past month outside of their job.

www.ymcanyc.org

N = 850

AVAILABILITY OF FRESH FRUITS AND VEGETABLES

Excellent Very Good Good Fair Poor0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

11.2%

27.3%

38.6%

20.9%

2.0%

N = 857

Over a third (36.7%) of respondents had cut the size of their or their family’s meals because there was not enough food.

www.sodahead.comN = 842

sathiyam.tv

www.thehealthytrucker.net

About a quarter of respondents (25.4%) said it was difficult for them to eat healthy foods. (N = 839)

Over a third of respondents (36.0%) said it was difficult for them to exercise. (N = 850)

WHAT MAKES IT DIFFICULT FOR YOU TO EXERCISE?

Barrier # %

I am too tired. 150 64.9

I do not have enough time. 135 57.2

The weather makes it difficult. 77 38.7

My health is too poor. 75 34.4

It costs too much 62 30.4

I do not have a safe place to exercise. 56 28.3

WHAT MAKES IT DIFFICULT FOR YOU TO EAT HEALTHY FOODS?

Barrier # %

Health foods cost too much. 119 67.6

I do not know how to prepare healthy foods.

102 56.7

I do not have enough time. 77 49.4

I do not like many healthy foods. 64 43.8

My family members do not want to eat healthy foods.

56 39.2

PREVALENCE OF CHRONIC DISEASE

COPD

Stroke

Cancer

Heart Attack

Coronary Heart Disease

Kidney Disease

Diabetes

Asthma

Arthritis

High Cholesterol

Hypertension

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

4.3%

1.8%

2.7%

2.5%

3.1%

4.0%

8.4%

9.1%

13.3%

33.1%

21.2%

1.6%

1.8%

1.9%

2.1%

2.6%

4.7%

8.3%

8.6%

9.1%

15.5%

16.0%

LHNANV BRFSS-Hispanic

BREAST CANCER SCREENINGS

Clinical Breast Exam

(N = 461)%

Pap Smear (N = 464)

%

Within the past year 36.4 41.4

Within the past 2 years 18.2 20.7

Within the past 3 years 5.2 10.3

Within the past 5 years 6.1 8.2

5 or more years ago 4.3 5.4

No, never had this test before 29.7 14.0

BREAST CANCER SCREENINGS

Mammogram (N = 155*) %

Within the past year 31.6

Within the past 2 years 23.2

Within the past 3 years 7.7

Within the past 5 years 7.7

5 or more years ago 7.7

No, never had this test before 21.9

* Women over age 40

COLORECTAL SCREENINGS

Blood Stool Test (N = 100*)

%

Within the past year 14.0

Within the past 2 years 6.0

Within the past 3 years 4.0

Within the past 5 years 3.0

5 or more years ago 6.0

No, never had this test before 67.0

* All respondents over age 50

COLORECTAL SCREENINGS

Sigmoidoscopy/Colonoscopy

(N = 119*) %

Within the past year 10.9

Within the past 2 years 8.4

Within the past 3 years 3.4

Within the past 5 years 6.7

Within the past 10 years 1.7

10 or more years ago 1.7

No, never had this test before 67.2

* All respondents over age 50

More than two out of five (44.2%) of respondents knew

where to go to get an HIV test.

N = 877

Tobacco products were currently used by 19.3% of respondents on at least some days.

N = 844jagopunjabjagoindia.com

Of respondents who drank alcohol in the past 30 days, 65.1% had two or more

drinks on average on the days they drank and 35.7% had five or more drinks in two

hours on one or more days.

N = 243 & 249, respectively

www.cancercouncil.com.au

(WIC, 2012) N = 872

Of women with children, 77.2% reported they had initiated

breastfeeding, even for a short time.

COMMUNITY FACTORS

Safety (N = 864) Safe or Very safe: 62.5%

Empowerment (N = 846) Empowered or Very empowered: 34.1%

Top sources of health information Television: 12.9% Healthcare provider: 12.3% Family: 12.0% Friends: 12.0%

PERCEIVED COMMUNITY PROBLEMS

Children out of school/dropout

Weapons/firearms

Teen pregnancy

Crime

Gangs

Lack of cleanliness

Domestic violence

Graffiti

Sale of drugs

Drug consumption

Alcoholism

0% 20% 40% 60% 80% 100%

24.1%

26.5%

28.1%

28.3%

28.6%

31.2%

31.9%

32.0%

37.5%

46.9%

50.2%

DISCUSSION

Areas of greatest need Healthcare costs too much for a lot of people WIC and SNAP utilization could possibly be improved There is a need for culturally-competent and language-

specific healthcare and health resources Cancer screening rates are very low Heavy and binge drinking is a problem that needs to be

addressed in the community

SURVEY LIMITATIONS

Sampling method Venues Word-of-mouth Over-representation

Survey length Paper versus electronic Possible solutions

Dedicated training for survey administrators Expand recruitment venues More rigorous data collection and sampling

RECOMMENDATIONS

Public Policy

Society(cultural values, norms)

Community(schools, neighborhoods)

Interpersonal(peers, partners, family)

Individual(behaviors, knowledge,

attitudes)

THANK YOU!

Questions or Comments?

CONTACT INFORMATION

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REFERENCES1. Taveras, E. M., Gillman, M. W., Kleinman, K. P., Rich-Edwards, J. W., &

Rifas-Shiman, S. L. (2013). Reducing racial/ethnic disparities in childhood obesity: the role of early life risk factors. JAMA pediatrics, 167(8), 731–8. doi:10.1001/jamapediatrics.2013.85

2. Sánchez, V., Cacari Stone, L., Moffett, M. L., Nguyen, P., Muhammad, M., Bruna-Lewis, S., & Urias-Chauvin, R. (2014). Process Evaluation of a Promotora de Salud Intervention for Improving Hypertension Outcomes for Latinos Living in a Rural U.S.-Mexico Border Region. Health promotion practice. doi:10.1177/1524839913516343

3. Spanakis, E. K., & Golden, S. H. (2013). Race/ethnic difference in diabetes and diabetic complications. Current diabetes reports, 13(6), 814–23. doi:10.1007/s11892-013-0421-9

4. Grossman, C. I., Purcell, D. W., Rotheram-Borus, M. J., & Veniegas, R. (n.d.). Opportunities for HIV combination prevention to reduce racial and ethnic health disparities. The American psychologist, 68(4), 237–46. doi:10.1037/a0032711

5. Molina, Y., Thompson, B., Espinoza, N., & Ceballos, R. (2013). Breast cancer interventions serving US-based Latinas: current approaches and directions. Women’s health (London, England), 9(4), 335–48; quiz 349–50. doi:10.2217/whe.13.30

REFERENCES6. Liss, D. T. & Baker, D. W. (2014). Understanding Current Racial/Ethnic

Disparities in Colorectal Cancer Screening in the United States: The Contribution of Socioeconomic Status and Access to Care. American Journal of Preventive Medicine, 46(3), 228-236. http://dx.doi.org/10.1016/j.amepre.2013.10.023

7. Molina, Y., Thompson, B., Espinoza, N., & Ceballos, R. (2013). Breast cancer interventions serving US-based Latinas: current approaches and directions. Women’s health (London, England), 9(4), 335–48; quiz 349–50. doi:10.2217/whe.13.30

8. Livingston, G., Minushkin, S., & Cohn, D. (2009). Hispanics and health care in the United States: access, information, knowledge. Pew Hispanic Center, Robert Wood Johnson Foundation. http://pewhispanic.org/files/reports/91.pdf

9. Juckett, G. (2013). Caring for Latino patients. American family physician, 87(1), 48–54. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24326471

10. Pew Hispanic Center. (2013). Statistical Portrait of Hispanics in the United States, 2011. http://www.pewhispanic.org/2013/02/15/statistical-portrait-of-hispanics-in-the-united-states-2011/#2