1

Behavior Risk Factors Among Hispanics in Idaho(BRFSS Aggregate Data 1998-2000 and YRBS 2001)

and Results from the Migrant and Seasonal Farm Worker Study (2003)

Dr. Galen LouisBureau of Community and Environmental HealthTobacco Prevention and Control

2

Purpose of Presentation Comparison of health behaviors between Idaho

Hispanics and Non-Hispanics in Idaho

Comparison of smoking behaviors of Idaho’s Migrant and Seasonal Farm Worker population to Idaho Hispanics and general Idaho population

Point out the gaps in state data and come up with ideas to address these issues.

3

Disparities Pilot Project Idaho is one of 14 states selected to look

at a process of identifying and elimination of disparities among populations in regard to tobacco use.

Improve Data Collection Strengthen Community Infrastructure Policy Advocacy Assure Cultural Competency Increase Funding and other Resources

4

Identified Priority Populations in IdahoWhere Data or Literature Supports Disparate Status

Communities(Identified through Idaho

Data)

Strata(Identified through Idaho

Data)

Currently Unidentified Through Idaho Data

(Inferred through Literature and National

Data)

Native American Communities

Age Group 18-24 GLBT

WIC Women Low SES Migrant and Seasonal Farm Workers

Medicaid Population Low Educational Attainment

Bosnian (Refugee)

Pregnant Women African-American

Note: While these communities may also be considered “strata,” they are unique in that they have more defined routes of intervention, either geographically or programmatically.

Note: “Strata” can and in many cases do include ethnic groups. These are different than “communities” in that distribution of population may not be geographically or programmatically bound.

Note: These populations exist in Idaho, however little is known about specific Idaho prevalence or behavior. Literature and other national studies indicate that they may be at high risk and exhibit high prevalence of use.

5

Demographics: Age (Adults)

Hispanic

18-2424.1% 25-3429.9% 35-4421.4% 45-5411.9% 55-64 6.1% 65+ 6.6%

Non-Hispanic

18-2412.4% 25-3417.3% 35-4420.4% 45-5419.1% 55-6412.7% 65+ 18.1%

6

Hispanic and Non Hispanic Population Pyramid2000

2.9

10.4

12.4

10.3

10.5

10.3

9.4

8.2

7.2

5.7

4.2

3.0

2.0

1.3

1.0

0.6

0.4

0.2

0.2

1.4

5.7

7.4

7.9

8.4

7.0

6.3

6.4

7.3

7.7

7.4

6.3

4.9

3.9

3.3

2.9

2.5

1.8

1.5

15 10 5 0 5 10 15

< 1 year

1-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Percent of Population

Non-Hispanic or Latino

Hispanic or Latino

Population Distribution by Age of Hispanic and Non-Hispanics in Idaho

7

Demographics: Income Hispanic

<$15 K 11.1% $15-25 36.0% $25-35 20.9% $35-50 18.2% $55 K+ 13.9%

Non-Hispanic

<$15 K 11.2% $15-25 20.3% $25-35 18.6% $35-50 22.5% $55 K+ 27.4%

8

Comparing Household Incomes In Idaho Between Hispanics and Non-Hispanics

0

5

10

15

20

25

<$10k

10-14.9

15-19.9

20-24.9

25-34.9

35-49.9

50-74.9 >7

5

HispanicNon-Hispanic

9

Demographics: Employment and Education Hispanic

Employed70.7%

Unemployed 7.7% Other 21.6%

K-11th 27.7% 12th/GED

32.7% Some College 29.9% College Grad 9.7%

*Includes homemakers, students, retired or unable to work

Non-Hispanic

Employed64.8%

Unemployed 3.3% Other 31.9%

K-11th 9.0% 12th/GED

31.6% Some College 33.4% College Grad 26.0%

10

Health Outcomes: Leading Causes of Death in Idaho (1999-2001)

Hispanic

1. Unintentional Injury 2. Cancer 3. Heart Disease 4. Diabetes 5. Perinatal 6. Stroke 6. Congenital 8. Homicide 9. Respiratory 9. Suicide

Non-Hispanic

1. Heart Disease 2. Cancer 3. Stroke 4. Respiratory 5. Unintentional Injury 6. Diabetes 7. Influenza/pneumonia 8. Alzheimer 9. Suicide 10. Liver and Cirrhosis

11

Percent Total Deaths by Age Cumulative

0

20

40

60

80

100

<1 1014

20-29

40-49

60-69

80-84

Hispanic Non-Hispanic

12

Health Outcomes: Access to Healthcare

Hispanic

Insured76.9%*

None in last 1210.5%

Non-Hispanic

Insured85.7%

None in last 12 6.6%

13

Health Behavior: Women Who Have Had a Mammography/CBE in Past Two Years

Hispanic

Mammography (70% HP 2010)

All Women 28.6%* Women over 40 50.6% Women over 50 68.1%

Clinical Breast Exam All Women 68.7%* Women over 40 58.2% Women over 50 73.7%

Non-Hispanic

Mammography All Women 42.1% Women over 40 50.6% Women over 50 70.7%

Clinical Breast Exam All Women 75.4% Women over 40 56.1% Women over 50 73.2%

14

Health Behavior: Diabetes and Body Mass Index and Exercise

Hispanic

Adults over 18 Diabetic Diagnosis 6.1% Overweight 63.5% Obese 25.3%* Exercise 67.3%*

9th – 12th Grade Overweight 8.8% Exercise 3 of 7 59.7%* Exercise 5 of 7 22.7%* TV 3 hrs day 35.7%*

Non-Hispanic

Adults over 18 Diabetic Diagnosis 5.0% Overweight 56.4% Obese 19.5% Exercise 79.3%

9th – 12th Grade Overweight 7.0% Exercise 3 of 7 68.1% Exercise 5 of 7 29.9% TV 3 hrs day 22.1%

15

Overweight and Obesity Trends Between Hispanic and Non-Hispanic Adults

0

10

20

30

40

50

60

70

1997 1998 1999 2000 2001

HispanicOverweight

Non-HispanicOverweight

Hispanic Obesity

Non-HispanicObesity

16

Health Behavior: Drug Use and Abuse

Hispanic

Adults over 18 Ever Illicit Drug 27.8% Ever marijuana19.6% Binge last 301 33.7% 9th – 12th Grade Drank last 30 40.0% Binge last 30 24.2% Marijuana last 30 22.6% Cocaine last 30 5.1%

1from 2001 BRFSS

Non-Hispanic

Adults over 18 Ever Illicit Drug

26.7% Ever marijuana19.3% Binge last 301 25.9%

9th – 12th Grade Drank last 30 40.3% Binge last 30 27.2% Marijuana last 30

16.4% Cocaine last 30

2.7%

17

Health Behavior: Violence/Intentional Injury

Hispanic

9th – 12th Grade Weapon/school 12.6% Physical Fight 36.3% Hit by S.O. 13.3% Forcible Sex 8.4% Suicide Ideation 19.2% Suicide Attempt 11.2% Suicide/Doctor 3.1%

Non-Hispanic

9th – 12th Grade Weapon/school 9.7% Physical Fight 27.3% Hit by S.O. 9.1% Forcible Sex 7.5% Suicide Ideation 16.0% Suicide Attempt 7.3% Suicide/Doctor 1.9%

18

Health Behavior: Sexual Behavior

Hispanic

9th – 12th Grade Ever Had Sex 35.9% Sex Before 13 4.7% Taught about AIDS

72.6%

Non-Hispanic

9th – 12th Grade Ever Had Sex 35.9% Sex Before 13 4.5% Taught about AIDS

86.8%

19

Health Behavior: Tobacco Use

Hispanic

Adults over 18 Current Smoker 21.0%

9th – 12th Grade Ever Tried 71.2% Smoked Before 13 23.5% Current Smoker 18.0% Chew Tobacco 4.3% Live with Smoker 37.8% Smoke next year? 24.0% Smoke 5 years? 13.7%

Non-Hispanic

Adults over 18 Current Smoker 21.2%

9th – 12th Grade Ever Tried 52.0% Smoked Before 13 18.4% Current Smoker 18.7% Chew Tobacco 8.8% Live with Smoker 28.5% Smoke next year? 21.8% Smoke 5 years? 7.9%

20

MSFW Survey: Smoking Rates for Total Survey Population

Total Population of Survey

29

71

0 20 40 60 80

Non-Smokers

Smokers

Smoker ?

%

21

MSFW Survey: Smoking Rates for Total Survey Population

Total Population of Survey

29

71

0 20 40 60 80

Non-Smokers

Smokers

Smoker ?

%

22

MSFW Survey: Smoking Rates by Gender

Current Smokers by Gender

42

5.6

0 10 20 30 40 50

Women

Men

Gender

% of Current smokers

23

MSFW Survey: Smoking Rates for Total Survey Population

Total Population of Survey

29

71

0 20 40 60 80

Non-Smokers

Smokers

Smoker ?

%

24

MSFW Survey: Smoking Rates by Gender

Current Smokers by Gender

42

5.6

0 10 20 30 40 50

Women

Men

Gender

% of Current smokers

25

MSFW Survey: Age

4147

3843

9

0

10

20

30

40

50

% of Current Smokers within

Age Group

18-24 25-34 35-44 45-54 55+

Age

Male Smokers as % of Age Group

26

MSFW Survey: Education

33

44 4146

0

10

20

30

40

50

% of current smokers

None Elementary Middle High

Last year of School completed

Male Smokers as % of Education level

27

MSFW Survey: Income of All Survey Respondents

Income Distribution of Total Survey Population

32

21

34

9 305

10152025303540

Less than$10,000

$10,000-14,999

$15,000-24,999

$25,000-34,999

$35,000+

Annual Household Income

% d

istr

ibutio

n

28

MSFW Survey: Income of Male Smokers

29

17

42

93

05

1015202530354045

Current Smokers

Less than$10,000

$10,000-14,999

$15,000-24,999

$25,000-34,999

$35,000+

Annual Household Income

Income of Male Smokers

29

MSFW: Citizenship or Legal Status

23

77

0

10

20

30

40

50

60

70

80

Current Smokers

US citizen or PermanentResident

Other

Type of Legal Status

Males Smokers as % of "Legal Status"

30

Social Capital Defined

Social Capital - Interconnections between people Obligations and Expectations Information flow (Communication) Norms and sanctions (Reciprocity) Bonding and Bridging Trust

31

Social Capital Definitions Continued

“Features of social organization such as networks, norms and trust that facilitate coordination and cooperation for mutual benefit.” Robert Putnam

“Capability that arises from the prevalence of trust in a society.” Fukuyama

“Generalized and Particularized trust” Uslaner and Conley

32

Social Capital Community Bench Mark Survey

Ethnicity/Race

54

2723

40

65 68

6 8 9

0

10

20

30

40

50

60

70

80

Whites Blacks Hispanics

Racial/Ethnic Group

% o

f T

rus

t

Most People canbe trusted

You can't be toocareful

Depends

33

Social Capital Community Bench Mark Survey

36

56

8

48 46

6

63

31

6

0

10

20

30

40

50

60

70

% of Trust

<=High School Some College College Degree +

Education Completed

Trust by Level of Education

Most people can be trusted

You Can’t be too careful

Depends

34

Hypotheses

H1: MSFW will exhibit lower levels of trust than Latinos nationally.

H2: MSFW will exhibit lower levels of trust towards whites (Americanos) than they will towards Mexican Americans.

35

Findings: MSFW: Trust other People

5

55

37

4

0

10

20

30

40

50

60

%

Most Peoplecan be trusted

You can't be toocareful

Depends Don't Know

Level of Trust

MSFW survey: General levels of trust

36

MSFW Survey: Trust of Whites or “Americanos”

3

23

41

23

9

05

1015202530354045

%

Trust thema lot

Trust themsome

Trust thema little

Trust themNot at all

Don'tKnow

Level of Trust

MSFW Survey: Trust of Whites or "Americanos"

37

MSFW Survey: Trust of Mexican Americans

523

46

18 7

0102030

4050

%

Trustthem a lot

Trustthemsome

Trustthem a

little

Trustthem Not

at all

Don'tKnow

Type of Trust

MSFW Survey: Trust of Mexican Americans

38

Quote from Marsing Focus Group

“El que es mecanico sabe de el trabajo que hace el campesino. Y el Chicano que es de cobarta no sabe de lo que sufrimos.”

 “The guy that is a mechanic understands the

kind of work that farmworkers do. And the Chicano (Mexican-American) that wears a tie doesn’t know of our suffering.”

39

Main Findings:

(1) Variation in characteristics associated with smoking:

Gender Income Education

(2) Extremely low levels of trust Low levels of trust of people (including government

officials, health care workers, employers) Surprisingly, equally low levels of trust in Mexican

Americans and Whites

40

Initial Policy Implications

1. Gender specific outreach campaigns2. Education materials should be provided in

Spanish and at “less than High School” reading levels

3. Public policy efforts should be directed towards adults because the average age of initiation is 15 but average age of entry to US is 21.

41

Initial Policy Implications, cont.

1. Health campaigns need to assure individuals that they will not face threats due to legal status

2. Low levels of trust suggest that MSFWs will likely be suspicious of government officials and, perhaps, health care workers.

3. The MSFW population surveyed has few ties to the broader white or Mexican American communities. Finding the appropriate outreach organizations is vital.

42

Cultural Sophistication Framework

Dimensions

CognitiveAffective

SkillsOverall

CulturallyIncompetent

ObliviousApatheticUnskilled

Destructive

Culturally Sensitive

AwareSympatheticLacking Skill

Neutral

Culturally Competent

KnowledgeableCommitted to Change

Highly SkilledConstructive

Butterfoss and Francisco