Latino Health Exam 2 Part 1

Future Considerations

- "We must extend our scope in public health and research beyond studies of risk behaviors to explore factors that encourage positive health outcomes" - Existing and future national health and healthcare data on the Latino ethnic group must be disaggregated by gender and place of residence with a concerted effort to oversample small cities. - Research has an important role to play in highlighting structural improvements in health care provision that can address several challenges (i.e. extending clinic hours beyond the nine-to-five workday; helping women meet the cost of transportation to clinics; Promotoras de Salud as a cultural mediator between Latinas and HCPs).

Cancer mortality

- 22,300 men and 20,400 women are expected to die from cancer - lung cancer, liver, and colorectal cancers account for cancer deaths in men - breast cancer, lung cancer and colorectum amount for cancer deaths in women * among US women overall, lung cancer is the leading cause of cancer death

Cancer is

- 2nd leading cause of death in US - 1st leading cause of death in NC - over half of all cancer deaths are due to: lung, colorectal, female breast, prostate

Cancer sites with higher rates for hispanics

- 3,900 hispanics in US will be diagnosed with stomach caner - hispanics have a higher risk of early onset stomach cancer than other cancers - 6,500 hispanics will be diagnosed with liver and intrahepatic bile duct (liver) cancer, with more than two-thirds of cases occurring in men - hispanics have liver cancer incidence rates that are nearly double to non-hispanic whites - more than 2/3 cases of liver cancer are men due to higher rates of alcohol consumption - A recent geographic analysis found that Hispanic women experience the highest cervical cancer incidence rates of any racial/ethnic group in every region of the US. - gallbladder cancer occurs more often in women than men

Rates of STI/STD

- Chlamydia has the highest rates and gonorrhea has the second highest - chlamydia and gonorrhea are most common among young people ages 15-24 - Highest rates for African Americans, then hispanics and lowest rates for whites

Cancer incidence

- 67,400 cancer cases in hispanic men and 81,700 cases in hispanic women - cancers of the prostate, colorectum, and lung are the most commonly diagnosed cancers in hispanic men - cancers of the breast, thyroid, and uterine corpus are most common in women

What is a cause of cervical cancer?

HPV - HPV is most common STI so it is important to get the HPV vaccine - HPV causes: cervical, ora pharyngeal, anal, penile, vular

Acculturation

the adoption of attitudes, values, customs, beliefs, and behaviors of the host country.

Sociocultural factors of cancer outcomes among hispanics

- Hispanic culture may shape various aspects of the cancer experience, from engagement in preventive health behaviors to treatment decision-making, illness perceptions, and coping with a cancer diagnosis and concomitant side effects. - cultural factors for hispanics (allocentrisim and familism, simpatico, gender roles, religiosity/spirituality, fatalism) - cultural factors neither fully protective nor deleterious: need more studies - family or patient may not understand treatment - caregivers face a lot of stress: they become worn out

Cervical cancer rates

- Incidence rates in Hispanic and non-Hispanic white women have declined for decades, but appear to have stabilized in recent years.

Help Seeking Behavior of Latinas for IPV

- Latinas reported seeking access to shelters less than women from other ethnic/racial groups; this is especially true for immigrant Latina survivors. - 1/2 never report the abuse (due to fear/lack of confidence in police, shame, guilt, loyalty and/or fear of partners, fear of deportation, and previous experience with childhood victimization) - Latinas prefer to tell family members, female friends or neighbors about IPV - Low-acculturated Latinas (both abused and non-abused) are less likely to seek and use formal social services than their more acculturated counterparts. - Non-immigrant Latina survivors contact formal services for IPV resources more often than immigrant Latinas.

Sociodemographic Profile of Latinas

- Mexican (59%) Puerto Rican (10%) - 38% born outside of US - young (57% younger than 30; median age of 26.6) - 56% married, 59% have children younger than 18, 83% of married have spouse in household - socioeconomic profile reflects multiple social inequalities that place them at high risk for certain health conditions and limit their access to quality healthcare - 43% have 12th grade education or less - more likely to be employed in low-paying, part-time, or seasonal jobs, experience twice rate of unemployment - full time income of $10,862 - tend to be head of household - more likely to live below poverty line - economically disadvantages and vulnerable to poverty-related health conditions and lack health insurance or financial means to access and pay for needed health care

Recent studies have suggested that acculturation plays a complex role in the disproportionate burden of liver cancer among Hispanic men.

- While US-born Hispanic men have higher liver cancer incidence rates than their foreign-born counterparts, rates are similar among Hispanic women, regardless of nativity.

Primary prevention for HBV/HCV

- achievable through vaccination only for HBV, treatment of chronic HBV and/or HCV infection may reduce the risk of developing liver cancer.

Why are stomach cancer rates so high in hispanics?

- alcohol consumption is high is hispanics - agriculture can increase the incidence of stomach cancer - incidence higher among hispanic men - women= incidence rate has doubled

Latinas: Prevalence and Occurrence of Intimate Partner Violence (IPV)

- approx 1/3 Latina women have experienced physical violence by an intimate partner - 1/22 hispanic/latina women experience violence in previous 12 months - rates of IPV lower for Mexican immigrants than for persons of mexican descent born in the US - immigrant women (latinas) who are married are more likely to experience IPV than unmarried women - non-immigrant latina survivors contact formal services for IPV resources more often than immigrant latinas - 63.1% of Latina women who identified being victimized in their lifetime (i.e., interpersonal victimization such as, stalking, physical assaults, weapon assaults, physical assaults in childhood, threats, sexual assault, attempted sexual assault, etc.). - IPV during pregnancy was reported at 10% for physical abuse and 19% for emotional abuse

Cancer among hispanics

- cancer has surpassed cardiovascular disease as the leading cause of death - 30% of hispanic men and women will be diagnosed with cancer - hispanics are more likely to be diagnosed with advanced stages of disease, have longer times to definitive diagnosis and treatment initiation, and experience poorer quality of life relative to non-hispanic whites

Socioeconomic factors of cancer outcomes among hispanics

- cancer is expensive - Poverty, limited access to care, lack of health insurance, limited work flexibility or medical leave, and lower educational status can severely limit access to preventive care and cancer screening, increase daily stress, reduce cancer treatment options and adherence to treatments, all of which can negatively affect cancer morbidity, mortality, and quality of life outcome. - Lack of health insurance and limited financial resources to pay for treatments indirectly affects cancer outcomes by limiting both standard treatment approaches to cancer and access to cancer clinical trials that can provide life extending or life saving treatments.

Mortality and health conditions

- cancer is leading cause of death in women ages 25-54 - breast cancer is number one cause of cancer death in Latina women - Latinas are also less likely to receive regular mammograms and Pap tests which is a contributing factor to the disproportionate mortality rates from breast and cervical cancers

Psychosocial factors of cancer outcomes among hispanics

- coping and social support - familism has been identified as an important cultural process that facilitates a strong social support network in the context of coping with cancer. - Lower acculturation associated with greater life satisfaction - more likely to endorse coping through religion or spiritual beliefs in cancer context (lower levels of distress and better overall quality of life)

Medical factors of cancer outcomes among hispanics

- higher rates of cancers associated with infectious diseases that place hispanics at a high risk for developing certain cancers - obesity has been associated with cancer morbidity and mortality : higher cost of health food and in food deserts and fewer recreational resources

Acculturation and Cancer

- immigrants may have improved access to health care and preventive services, but may also adopt unhealthy behaviors such as smoking, excessive alcohol consumption, and decreases dietary quality - leads to striking differences in cancer outcomes - cancer deaths of US hispanics higher than foreign-born counterparts - 1st gen hispanics show evidence of acculturation with higher rates of cancer than those in countries of origin

Prevention strategies for reducing stomach cancers

- include not smoking; reducing consumption of alcohol, foods preserved with salt, and processed meat; and reducing Helicobacter pylori (H. pylori) prevalence through improved hygiene practices - fruits and non-starchy vegetables, particularly allium vegetables protect against stomach cancer

How does smoking affect cervical cancer rates?

- increases the risk of both persistent HPV infection and cervical cancer and accounts for 1 in 5 new cervical cancer cases and deaths in the US among all races/ethnicities combined.

Chronic infection with hepatitis C virus (HCV) and/or hepatitis B virus (HBV)

- increases the risk of developing liver cancer - Hispanics who have chronic HCV infection may be particularly vulnerable to developing cirrhosis (scarring of the liver that can promote liver cancer development). - Although chronic HBV/HCV infection is the strongest risk factor for liver cancer, a larger proportion of cases in the US among all races/ethnicities combined are due to more prevalent risk factors such as excess body weight, heavy alcohol use, smoking, and metabolic disorders.

Reproductive Health

- key area for Latinas because their median age is 26.6 - latinas have highest birth percentages among women in the US - among expecting mothers, Latinas experience lower rates of pregnancy related hypertension, alcohol consumption and smoking - rate of maternal morbidity for Latinas is 1.7 times higher than for whites - more than 25% of latinas do not receive prenatal care

Access to Healthcare

- latinas have high rate of being uninsured - less likely to have a regular care provider or receive care in a doctors office - Latinas report difficulty receiving care due unavailability of physicians or clinics, unwillingness of their physicians to take time to answer questions, and concern with the quality of services - delaying health care due to lack of transportation, affordability, and lack of childcare - only 52% of latinas reported feeling comfortable at a family planning clinic - Even if Latinas can access sexual and reproductive health services, they must contend with a lack of culturally and linguistically competent services. - may not have latina providers or providers who can speak Spanish or interpreters - latinas delay preventative care

Who is at risk for cancer?

- lifetime cancer risk: 1 in 2 for men, 1 in 3 for women - 87% of cancer diagnosis are in adults over the age of 50 - cancer rates are dropping faster for whites than people of color (blacks, latinos, natives, asians)

what cancers can type 2 diabetes cause?

- liver, endometrium, pancreas, colorectum, kidney, bladder, breast, and perhaps ovary. - hispanics more likely to be diagnosed with type 2 diabetes and die from it - The biology underlying the association between type 2 diabetes and cancer risk is not completely understood, but may involve abnormal glucose control and related factors, including inflammation.

Why are hispanics more likely to be diagnosed with advanced stages of cancer?

- longer times from diagnosis to treatment - rural, low income, minority - this leads to poor life outcomes

Why might rates for gallbladder cancer be higher in women?

- not well-understood, but may include inherited and/or other factors associated with gallbladder disease development, such as gallstone formation - Potentially modifiable factors that increase risk of gallbladder cancer include excess body weight and use of hormone replacement therapy.

Health care factors of cancer outcomes among hispanics

- patient-physician communication, knowledge and cancer treatment factors play pivotal roles in determining cancer outcomes and disparities - more unmet cancer treatment information needs and psychosocial needs - chemotherapy treatment delays - less likely to be aware of available cancer clinical trials - disadvantaged with regards to receiving potentially lifesaving treatments - simpatía (i.e., non-confrontational interactions) can reduce conflict and facilitate pleasant interactions among Hispanics and their health care providers. BUT may also prevent from engaging with health care providers and limit effectiveness of communication - cultural misunderstandings and language barriers hinder communication and decision making about treatment - biased care, discrimination causes medical mistrust towards health care providers and institutions

What is cervical cancer caused by?

- persistent infection with certain types of human papillomavirus (HPV). Primary prevention is available through vaccination, which protects against the most common types of cancer-causing HPV. Among adolescents ages 13-17, HPV vaccination is higher in Hispanics than in non-Hispanic whites.

prevention for cervical cancer

- prevented through the removal of precancerous lesions detected via screening. - get vaccinated - stop smoking

Reproductive Health: Teen Pregnancy

- the national teen pregnancy rate has declined - births to teens (15-19) account for 5.3% of births in 2016- 9/10 of these births occur outside of marriage - teen birth rate is higher in US than in other developed countries

Behavioral factors of cancer outcomes among hispanics

- tobacco use is one of the most preventative causes of death - cigarette smoking increases the risk of 12 cancers - maintaining a healthy weight and engaging in regular physical activity are the most important approaches for reducing the risk of cancer - excess body weight increases risk of developing cancers - excess body weight associated with decreased survival for several cancers - type 2 diabetes increases risk for cancer - alcohol consumption increases the risk for cancers - engagement in cancer screening facilitates early detection of cancers and hispanics are less likely to adhere to cancer screening recommendations - Cultural factors such as language barriers, health literacy and values and beliefs about screening and cancer may play a role in Hispanic screening rates. - Lack of knowledge and awareness of cancer and screening methods have also been identified by Hispanics as additional psychosocial barriers to screening for cancer. * lung and bone cancer screening is expensive

Contextual Factors that Affect Latinas

1. Cultural values: must be identified and understood to develop effective IPV interventions. - familismo - gender role expectations: their role as mothers are the most important aspect of their lives, and that makes most of their decisions 2. Religion: plays a strong role in Latinas decisions on how or if they address IPV - divorce against religion - negative reactions of religious leaders- latina women feel responsible for making marriage work 3. Economic factors: employment issues related to immigration status 4. Immigration: most salient element of their lives - decisions about IPV deeply affected by immigration status and climate of their communities (the contextual factor is a prime barrier to their ability to access resources- knowing where resources are and can access) 5. Anti-immigration environments: increased rates of deportation and strict laws - latina women experiencing increased rates of harassment - increased climate of fear due to the immigration enforcement environment

What percentage of breast cancers are genetic?

5%

Cancer Health Disparities

Adverse differences in cancer incidence, prevalence, cancer death, cancer survivorship, and burden of cancer that exist among specific population groups in the United States

Pitt County Breast Wellness Initiative

Aim: reduce health disparities in cancer mortality •Provides culturally-tailored breast cancer education and navigation to age-appropriate screening •Uninsured Black and Latina women •25+ years, Pitt/Edgecombe Counties

What ethnic group has the highest rate for teenage pregnancies?

Hispanics - low education rates - parents don't talk about sex - no access to birth control or condoms - lack of planned parenthood- no abortion option

Future Recommendations

Latinas are more likely than other women to delay health care appointments because of transportation or child care difficulties or an inability to pay for health care services. - Future research needs to examine in greater depth the specific barriers to healthcare encountered by Latinas, with specific focus on small cities. 1. Latinas in small cities may be embedded in environments with fewer economic resources where they constitute a small number of the local population, are less visible, and hold less political leverage. 2. These differences may translate into fewer health programs, limited or no public transportation, greater alienation and marginalization, and fewer social supports from culturally prescribed sources. 3. In small communities, family and social networks derived from the Latino community are often limited. - Studies could focus on the dynamics of patient-physician interactions where patients' literacy and physicians' communication styles and sensitivity to linguistic and cultural nuances play crucial roles. Evidence-based, culturally responsive interventions that could effectively offset some of these healthcare barriers for this population of Latinas need to be identified. - Perhaps strategies shown to be successful in augmenting screening practices could be expanded to ensure follow-up and regular care.

Results: College Students

Mean age: 20.7 years (range 18-26 years); 62% female; 54% Caucasian Primary Outcome (HPV vaccine uptake): •Although 77% reported that the intervention helped them remember to get the vaccine, no significant differences were found by intervention vs. control group (HPV-2 (53% vs. 52%); HPV-3 (34% vs. 32%) •Subgroup analyses found no significant differences in completion between groups based on demographics or method of delivery of intervention (text vs. email) Secondary Outcomes (Knowledge): •Intervention Group: Mean knowledge score at follow-up (mean knowledge score = 93%, SD = 0.08) was significantly higher (p<0.01) than the score at baseline (mean knowledge score = 87%, SD = 0.11) •Control: No significant changes in knowledge were found

Results: Parents/Adolescents

Mean parental age: 38 years (range 19-69 years); 88% female; 60% Black or Hispanic 28% Mean child age: 12 years (range 9-17); 54% male Primary Outcome (HPV vaccine uptake): •No significant differences were found by intervention vs. control group (HPV-2 (65% vs. 65%); HPV-3 (35% vs. 30%) •Subgroup analyses found no significant differences in completion by group based on demographics or method of delivery of intervention (text vs. email) Secondary Outcomes (Knowledge): •Although the mean knowledge change between baseline and follow-up was higher for those in the intervention group (0.36) as compared to the control (0.21), this difference in knowledge change was not statistically significant.

Research on IPV

Research is beginning to document work related IPV among Latinas. One study reported abusive strategies such as, on the job surveillance, on the job harassment, and work disruption tactics. However, they also found strategies that were unique in a Latino sample, such as denying access to driver's license, lying about childcare arrangements, and sending the partner to their country of origin temporarily

Cancers of the stomach, liver, and uterine cervix

all of which are related to infectious agents, are more common in developing countries, especially in Central and South American countries and parts of Asia. In the US, the incidence and mortality rates of these cancers are higher among Hispanics than non-Hispanic whites, especially among first-generation immigrants to the US.

What is a basic principle of public health?

all people have the right to health

Why does chlamydia have the highest rates?

asymptomatic for women

Cancer incidence and mortality have ___________ over the past 20 years

decreased - new medications, new surgeries, oral radiation pills

What is a reason why latina women are more likely to experience IPV?

due to their religion- divorce is not an option

health disparities

health inequities when they are the result of the systematic and unjust distribution of these critical conditions

Top three health related causes of death for Latinas

heart conditions, cancer, and cerebrovascular diseases

specific population groups

include groups by gender, age, race or ethnicity, education, income, social class, disability, geographic location or sexual orientation - Blacks, Asians, Hispanics, American Indians, Alaska Natives, and underserved Whites are more likely than the general population to have higher incidence and death statistics for certain types of cancer -People in such groups not only experience worse health but also tend to have less access to the social determinants or conditions (e.g., healthy food, good housing, good education, safe neighborhoods, freedom from racism and other forms of discrimination) that support health.

cigarette smoking and cancer

increases risk for oral cavity and pharynx, larynx, lung, esophagus, pancreas, uterine cervix, kidney, bladder, stomach, colorectum, liver, and acute myeloid leukemia), and rare type of ovarian cancer - increases risk of fatal prostate cancer - cigarette smoking affects how body heals

machismo

man is head of household

coping strategies

negative: avoidance drugs/alcohol positive: religion/spirituality church support groups caregiver system

Gallbladder cancer

relatively rare, has nonspecific symptoms that typically result in a late stage at diagnosis, and has very poor survival - only about 10% of patients survive 5 years. It is one of the few cancers that occurs more often in women than in men.

burden of cancer

stress, access, side effects, economic, health outcomes

Familismo

the central place that the family has in most Latinas' lives. Strong family roles point to the father as the primary breadwinner (although this role is rapidly changing due to economic realities) and to the mother as the person responsible for the well-being and cohesiveness of the family.

what cancers does increased body weight cause?

uterine corpus, esophagus (adenocarcinoma), liver, stomach (gastric cardia), kidney (renal cell), brain (meningioma), multiple myeloma, pancreas, colorectum, gallbladder, ovary, female breast (postmenopausal), and thyroid. - non-Hodgkin lymphoma (diffuse large B-cell lymphoma), male breast cancer, and fatal prostate cancer.

How does alcohol consumption affect cancer rates?

• risk factor for cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and female breast. •Heavy drinking (3 to 4 drinks per day) may also increase the risk of stomach and pancreatic cancer. •Cancer risk increases with alcohol volume, and even a few drinks per week may be associated with a slightly increased risk of female breast cancer. •Combined with tobacco use, alcohol consumption increases the risk of cancers of the mouth, larynx, pharynx, and esophagus far more than the independent effect of either drinking or smoking alone.

HPV Health Education and Promotion Study

•To evaluate an intervention (electronic reminders & health education messaging) aimed at increasing HPV vaccine completion and knowledge among two different populations. •Study 1: Catch-up college population (18-26 year old). •Study 2: Adolescents (9-17 year old) via engaging parents who were uninsured or Medicaid insured.