Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino Community

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Recognizing and Overcoming the Barriers to Health
Care in the Hispanic/Latino Community

• Rebeccah L Brown, MD
• Associate Professor of Clinical Surgery and
  Pediatrics
• Associate Director of Trauma Services
• Cincinnati Childrens Hospital Medical Center

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Texas
Total Population 21,325,018 Hispanic
Population 6,824,006 (32) 2nd Largest Hispanic
Population
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New Mexico The Land of Enchantment
Total Population 1,829,146 Hispanic
Population 770,070 (42)
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The Latino Explosion
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The Latino Explosion
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Population Growth in USA

• Over 40 million Hispanics in USA today
• Unprecedented growth
• Fastest growing racial/ethnic minority group
• Increasing 7x faster than rest of US population
• Almost 60 ? since 1990
• Have surpassed African-Americans as largest
  minority (16.5)
• Hispanic children are the largest minority group
  of children (11.6 million 16 of population lt 18
  yrs)
• By 2050, an estimated 102 million Hispanics will
  reside in the US - 1 of every 4 Americans will be
  of Hispanic/Latino heritage

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Population Growth in Greater Cincinnati/Northern
Kentucky

• Hispanic population is escalating in the Greater
  Cincinnati/Northern Kentucky area
• 435 ? Boone County (KY)
• 140 ? Campbell County (KY)
• 137 ? Kenton County (KY)
• 83 ? Hamilton County (OH)
• 113 ? Dearborn County (IN)
• Largest Hispanic populations in Cincinnati
  -Springdale, Hamilton, Sharonville, Norwood, and
  Fairfield
• Largest Hispanic populations in Northern
  KY-Covington, Florence

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Barriers to Hispanic Health Care

• Cultural differences
• Language
• Lack of health insurance
• Education
• Poor understanding of US health care system
• Poverty
• Transportation
• Immigration status
• Cultural insensitivity/racism

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Health Foundation of Greater Cincinnati 2005
Hispanic/Latino Health Survey

• Based on interviews with 535 men and women at the
  Su Casa Hispanic Festival in Sept 2005
• 75.6 had come to live in Greater Cincinnati
  since 2000
• 49.1 reported personal (not household) incomes lt
  20,000
• 78.8 were not acculturated, meaning they had a
  strong preference for the Spanish language and
  social environment
• 32.9 reported Spanish as their preferred or only
  language
• 60 have no health insurance coverage, including
  Medicaid (compared to 13.1 percent for overall
  region)
• 55.6 felt Hispanics receive lower-quality
  health-care than others

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Health Foundation of Greater Cincinnati 2005
Hispanic/Latino Health Survey

• Top barriers to accessing health care services
• High cost of care (40.4)
• No insurance (39.1)
• Wait for an appointment (36.4)
• Not speaking English (35.9)
• Provider not speaking Spanish (31.4)
• No interpreter available (21.5)
• Finding a doctor (21.3)
• Transportation (20)

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Cultural Differences

• Rely more on home remedies and over-the-counter
  meds
• Rely on advice from family members
• Seek professional advice only if problems persist
  
• Less compliant with routine check-ups and
  preventive/screening measures
• More apt to trust health care providers who speak
  their language or share similar cultural
  background

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The Language Barrier

• Hispanics who speak primarily Spanish
• 61 are uninsured
• Most do not have a regular doctor
• 1/3 rely on public or community clinics (compared
  to 12 English-speaking Hispanics, 10 Blacks,
  and 7 Whites)
• Of 600 uninsured Spanish-speaking Hispanics
  surveyed, almost 60 responded that interpretive
  language assistance was not available from their
  health care provider

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Immigration Status
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The Health Insurance Crisis

• About 44 million Americans are uninsured (1 out
  of every 7)
• of uninsured increased by 2.4 million from
  2001-2002
• 12 of all children are uninsured
• Hispanics are the least insured of all nearly
  40 of adults and 31 of children are uninsured

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Disparity in Health Insurance Coverage
White Non- Hispanic
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10
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Hispanic FB - Naturalized
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55
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Uninsured Hispanics Benefit US Economy But Do Not
Reap Health Benefits
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lt
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Barriers to Health Insurance

• Work for small, low wage businesses that do not
  offer insurance
• Individual insurance is prohibitively expensive
• Not poor enough to qualify for Medicaid, but too
  poor to buy private health insurance
• Uninformed about existing assistance programs
  (ie. CHIP)
• Cultural, educational, and language barriers
  limit interactions with physicians and ability to
  complete paperwork required for assistance
• Concerned about being labeled a public charge
• Immigrant, non-citizens

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Access to Primary Care The Importance of Having
a Regular Doctor

• About 30 of Hispanics lack a usual source of
  health care compared with lt 16 of whites
• Hispanic children are nearly 3x as likely as
  non-Hispanic white children to have no usual
  source of health care
• Hispanics are twice as likely to rely on
  hospitals or clinics for health care than whites
• Decreased chance of receiving adequate preventive
  care and other important health services

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The Double Burden

• Lack of insurance ?? poor access to health care
• Limited English ?? poor communication with health
  care providers ?? disparity in quality of health
  care ?? decreased quality of life, loss of
  economic opportunities, and perceptions of
  injustice/social inequity

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Disproportionate Health Care Problems Among
Hispanics

• Asthma
• Chronic obstructive pulmonary disease
• Diabetes
• HIV/AIDS
• Obesity
• Suicide
• Teenage pregnancy
• Alcoholism
• Tuberculosis

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Breaking Down The Barriers

• Master the language
• Train bilingual staff (receptionists, nurses,
  technicians, physicians)
• Provide skilled medical interpreters
• Medical interpreters should be recognized as
  allied health professionals, who bill for their
  services, which should be just as reimbursable as
  lab services.
• Elena Rio, President, National Hispanic Medical
  Association
• Schedule Spanish-speaking clinic hours
• Provide signage and written instructions in
  Spanish
• Teach patients English
• Aim for perfect communication/understanding

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Breaking Down The Barriers

• Develop child care programs in Latino communities
  so parents can take time to go to physician
• Provide child care at health care facility
• Provide information on importance of preventive
  care, especially for children
• Provide info on CHIPs
• Develop local/regional/national telephone
  hotlines in Spanish to respond to medical
  questions
• Be familiar with community resources

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Breaking Down The Barriers

• Utilize focus groups to zero in on issues
  important to the Hispanic/Latino community
• Establish bilingual liaisons with the Latino
  community to build relationships and earn trust
• Establish health care facilities in Latino
  communities or send mobile units
• Approach transportation authority to have buses
  routed to Latino communities
• Print bus schedules in Spanish

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Breaking Down The Barriers

• Expand outreach for public assistance programs
• Government incentives to encourage small
  businesses to offer coverage
• Oppose federal health mandates that increase
  costs of providing health care
• Change tax law to allow individuals to deduct
  entire cost of purchasing health insurance (Fair
  Care Act)
• Lobby for health insurance for all

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Motor Vehicle Safety - The Stats

• Motor vehicle crashes are 1 cause of death in
  Hispanics 1-24 years
• Hispanic children lt 4 years have 2nd highest
  death rate from motor vehicle crashes (2nd only
  to African-American children)
• Hispanic children 5-12 years have 72 higher
  death rate from motor vehicle crashes than
  Caucasians
• Minority children are at about 3x greater risk of
  air-bag related injuries due to riding more
  frequently in the front seat of vehicles with
  passenger-side airbags

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Motor Vehicle Safety - The Stats

• Per vehicle mile traveled, Hispanic children are
  3x more likely to die
• 3x less likely to use child safety restraints and
  3x less likely to ride in the backseat
• Much less likely to wear seatbelts
• Despite fewer miles traveled, teenage Hispanics
  are twice as likely to die

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Motor Vehicle Safety Hispanics vs Whites

• ? seat belt use (22 vs 38)
• ? EtOH use (31 vs 24)
• ? EtOH levels
• ? fatality
• ? insurance (24 vs 50)
• ? hospital costs
• Motor Vehicle Safety in Illinois Hispanic
  Communities - Findings from Focus Groups

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Barriers to Hispanic Injury Prevention

• Poverty
• Unable to afford child safety restraints, helmets
• Older cars without seatbelts, airbags
• Overcrowding of cars
• Riding in back of pickup trucks
• Language barriers
• Cultural barriers
• Lack of insurance
• ? access to medical care
• Not familiar with US child restraint and safety
  belt laws

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The Problem
Skyrocketing Hispanic Population Barriers to
Injury Prevention ? Marked Increase in Injuries
and Deaths ? Emerging Public Health Crisis
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Hispanic Youth Injury Prevention Initiative

• Modeled after the faith-based African-American
  Youth Injury Prevention Initiative
• Similar to African-Americans, Hispanics also have
  strong ties to family and the church
• We hypothesized that a faith-based initiative
  similar to that developed for African-American
  youth would be successful in the rising Hispanic
  population as well
• The model is in place, but must be culturally
  adapted for the Hispanic population and their
  specific injury prevention needs and concerns

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Hispanic Youth Injury Prevention Initiative

• Supported by Toyota Manufacturing of North America

A Committed Partner to Safety
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Development of the Initiative

• Establish relationships with key Hispanic faith
  and community leaders
• Conduct surveys and focus groups to identify
  population characteristics and unique areas of
  concern among Hispanics about injury and injury
  prevention
• Conduct pre-intervention observations of vehicle
  restraint use among Hispanics
• Develop culturally relevant injury prevention
  curriculum based on outcomes of surveys and focus
  groups
• Implement curriculum into faith-based Hispanic
  community

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Occupant Protection Survey Results (n 250)

• 84 reported wearing their seat belt always
  11 reported wearing their seat belt most of the
  time
• Parents reported that 68 of children under 5
  years of age were always restrained and rode in
  the back seat 96 of the time
• Only 37 of parents were aware that Ohio law
  requires children to ride in a car seat until
  they are both 4 years old and 40 lbs
• Barriers to use of proper restraints included
  distance travel gt50 miles or an ill or fussy
  child

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Occupant Protection Observations

• Observation of restraint use was significantly
  lower than self-reported use
• Only 34 of children were properly restrained and
  42 of children rode in the back seat (reported
  68 and 96)
• Only 34 of drivers and 55 of adult passengers
  were observed wearing seat belts (reported 95
  always to most of time)

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Hispanic Parent Focus Groups

• 42 eligible Hispanic parents (19 males and 23
  females)
• Median age of both male and female participants
  was 25-34 years
• Median income 10,000 24,000
• 68 were high school graduates or less
• Majority were from Mexico (66.7), Central
  America, South America, Puerto Rico, and
  Dominican Republic
• Mean length of time in USA was 7.4 years (range 1
  month - 22 years)
• Total number of children among participants was
  88 (mean 2.1 range 1-4) with a mean age of 6
  years (range 1-20 years)
• Majority of children (71.6) were 8 years of
  age and 94 were 12 years of age

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Key Factors Leading to Misuse/Non-Use of Child
Restraints

• Inability to afford them
• No tradition of using them in their native
  country
• Lack of knowledge about how to properly install
  and use the seats
• Lack of understanding of child safety laws
• Very short or very long trips
• In a hurry
• Overcrowding in vehicles
• Riding in someone elses car
• Ill, fussy, or misbehaving children

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Barriers to Seat Belt Usage

• Females were more likely to wear seatbelts than
  males (96 vs 79)
• Discomfort, especially during pregnancy
• Lack of awareness of the consequences of not
  using seat belts
• Didnt feel that there was a need to buckle up
  while riding in the back seat
• More people in car than seatbelts

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Focus Group Findings

• Parenting styles, unfamiliarity with laws, child
  behavior, and situational factors (trip length,
  vehicle overcrowding, alcohol use) emerged as
  important issues
• Language is a significant barrier
• Many felt that literature is often erroneously
  translated into Spanish without regards to the
  diversity of Hispanic cultural origins
• Most participants reported either driving under
  the influence of alcohol or allowing their
  children to ride with someone under the influence
  of alcohol on at least one occasion
• Only 50 of participants had drivers licenses
  (39 of females 63 of males), while 86 stated
  that they drive either their own car or borrow
  one from a relative or friend
• Many were unfamiliar with the rules of the road
  and safety precautions

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Focus Group Findings

• Most sought safety advice from family and trusted
  friends.
• Most reported that faith was an important
  component of injury prevention, but that we must
  take actions to protect ourselves.
• All participants attended church, and nearly all
  (98) were receptive to obtaining occupant
  protection information from a faith-based source.
• Other suggested avenues of delivering safety
  information included child care centers, clinics,
  community centers, grocery stores, and
  restaurants.

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Motor Vehicle Restraint Use in the Hispanic
Community
250 pre-intervention observations at churches
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Where we are now

• We have identified 6 faith-based centers
  committed to participate in the Hispanic YIP
  program
• We have developed and translated into Spanish
  safety curricula to address the following
• Recognizing what happens in a crash why are
  safety restraints important?
• Car seat safety
• Use of the booster seat
• Importance of buckling up for children, teens,
  parents, and grandparents
• Importance of children lt 12 yrs sitting in the
  back seat
• Correct travel behavior
• Teen driving
• Laws of the road
• Dangers of drinking and driving
• Bicycle safety
• We have conducted of 6 preliminary occupant
  protection observations at 6 different sites (3
  in KY 3 in OH). Will conduct unannounced
  observations at conclusion of program and 6
  months later to determine effectiveness of
  program.
• Delivery of safety message
• Sunday school lessons
• Sermons focused on safety
• Safety messages in church newsletter
• Teen safety groups/role models
• Parent/grandparent groups

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Where we are going

• Partner with the Hispanic business community to
  identify best ways to spread safety message to
  community
• Spanish safety newsletters
• Community safety events
• TV/radio/billboard safety messages
• Spread the good newspropagate to other
  faith-based and business organizations
• Package the program for distribution and
  implementation regionally, nationally, and
  globally

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Growth, Opportunity, and Change
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MissionTo advocate for and empower members of
the Hispanic community and to bridge the gap
between communities by inspiring and supporting
healthy attitudes and behavior through substance
abuse prevention and intervention
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Abriendo Puertas Abriendo Brazos Abriendo
Corazones
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