CHS Roundtable Presentation

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CHS Roundtable Presentation

• Gloria Giraldo
• gpgiraldo_at_earthlink.net

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Goals

• To present some ideas (what I have learned in my
  DrPH so far)
• To elicit candid feedback (What do you guys
  think)
• To help me narrow down lines of interest/inquiry
  (Help me, what can I do)

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Options of Titles for Presentation

• Acculturation A critical insiders view
• Latinos/Hispanics a case of semantic fallacy?

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Outline

• Brief overview Sociodemographic characteristics
  of Latinos in the U.S.
• Critical ideas of acculturation
• Health behavior and acculturation
• The case of cancer screening

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Hispanics, Latinos, Latins? What is a in a name?

• The term Hispanic did not come into wide usage
  until the 1970s and 80s.
• In the 50s and 60s, national identities as
  Mexicans, Mexican-Americans, Puerto Ricans were
  used
• Hispanic term created by the Census Bureau to
  identify all Spanish speaking groups

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Socioeconomics and history

• First Spanish settlement of North America 1565
  Florida
• 1568 New Mexico
• 1821 Treaty of Guadalupe Hidalgo, Mexico lost
  half of its Northern Territory to the U.S.
• More recently
• Economic pull and push factors
• Wars

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History continued

• 1897 Puerto Rico annexed to the U.S.
• 1917 Puerto Ricans became U.S. citizens
• Cubans 1959 exodus and 1980 wave
• Central Americans 1980s national civil wars
• Dominicans 1965, U.S. invasion
• South Americans political instability and
  economic pull

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Heterogeneity of Latino Groups
Source Current Population Survey, March 2000
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Age Differences (median)

• Mexican American 24.4
• Puerto Rican 28.0
• Cuban 41.4
• Central and South American 29.9
• Other Latino 29.1
• Non-Latino white 37.9

Source US Bureau of the Census, CPS March, 2000
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Nativity Status Latinos (in percent)
Source US Bureau of the Census, Current
Population Reports, 1998 Figures for All
Latino exclude Puerto Ricans
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Median Income(in thousands, 1999)
Source US Bureau of the Census, CPS March, 2000
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Percent of Families LivingBelow Poverty Level
Source US Bureau of the Census, CPS March, 2000
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Education High School or More (Percent of
persons age gt 25 years)
Source US Bureau of the Census, CPS March, 2000
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Occupations (Civilians age gt 16 years)
Source US Bureau of the Census, CPS March, 2000
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Reasons for differences

• Political factors
• Immigration
• Reasons for immigrating
• Patterns
• History
• Economic factors
• Social factors

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Fundamental Cause Concept

• Resources like knowledge, money, power, prestige,
  and social connectedness are transportable from
  one situation
• As health related situations change social groups
  who command the most resources are best able to
  avoid risks, diseases, and the consequences of
  disease
• (Link and Phelan, 1995)

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A critical view of acculturation

• MEASURES OF ACCULTURATION
• Language (use, comfort with) speak, read, think
• Length (proportion) of time in the U.S.
• Generation status, parents place of birth
• Ethnicity of past, current friends
• Ethnic composition of past, current neighborhood
• Behaviors, preferences
• Music, radio, television, movies,
  books/newspapers, celebrating occasions,
  diet/food
• Unidimensional vs. multi-components measures
• (Abraido-Lanza, 2005)

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Commonly used acculturation scale (Marin)

• In general, what language(s) do you
• Read and speak
• Speak at home
• Think
• Speak with friends
• 1 Only Spanish
• 2 Spanish better than English
• 3 Both equally
• 4 English better than Spanish
• 5 Only English

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Cuellars acculturation scale

• Language
• Self-identification
• Parents identification
• Ethnic origin of childhood and teen friends
• Current friends
• Music, TV, movie, food preferences
• Generation status
• Country in which raised
• Contact with Mexico
• Ethnic pride

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According to Abraido-Lanza

• Is acculturation a proxy for other variables?
• Exposure to adverse circumstances, stressful
  events
• Adjustment for confounding variables (e.g., SES)
• Age differences
• Different indicators of acculturation
• Acculturation as a risk or protective factor?
• Health-related and other beliefs, values, and
  behaviors
• Effect may vary depending on outcome variable

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Main questions

• What is the role of socioeconomic status in
  acculturation?
• What is the impact (if any) of historical and
  political factors on acculturation processes?

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Cancer Screening

• Some studies on cancer screening and
  acculturation have had conflicting results.
• Some found no statistical significance of
  acculturation on screening utilization, while
  others did find an effect (O'Malley et al. 1999).
  
• One of the major problems is the inconsistency of
  acculturation measures across studies.

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Acculturating to whom? To what?

• Acculturation is inherently a comparative
  construct by its nature, it assumes a homogenous
  other that can be compared to another
  homogenous referential group.
• (From Hunts Critique)

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The Ecosystem Model
Source Valdés,I., 1991 Bronfenbrener, U
Falicov, C.J., 1977
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Behavior

• Behavior is affected by and affects multiple
  levels of influence
• 1) Intrapersonal
• 2) Interpersonal
• 3) Institutional or organizational
• 4) Community factors
• 5) Public policy factors (McLeroy, Bibeau,
  Steckler and Glanz)

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Behaviors ? Lifestyles

• Behavior is seen increasingly not as isolated
  acts under the autonomous control of the
  individual, but rather socially conditioned,
  culturally embedded, economically constrained
  patterns of living LIFESTYLES

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Reciprocal causation

• Individuals and environments
• Behavior both influences and is influenced by
  social environments

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Well

• Failing to address important factors, such as SES
  risks inadvertently viewing culture as the
  explanation for what are fundamentally social
  issues.

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So

• Research in acculturation
• Humility
• Willingness to evaluate ones own sense of
  culture (identity)
• Asking deeper questions