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EMERGING ISSUES IN HISPANIC HEALTH

SUMMARY OF A WORKSHOP

Committee on Population

Center for Social and Economic Studies

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES

Joah G. Iannotta, Editor

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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Emerging Issues in Hispanic Health: Summary of a Workshop EMERGING ISSUES IN HISPANIC HEALTH SUMMARY OF A WORKSHOP Committee on Population Center for Social and Economic Studies Division of Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES Joah G. Iannotta, Editor THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Emerging Issues in Hispanic Health: Summary of a Workshop THE NATIONAL ACADEMIES PRESS 500 Fifth Street. N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. N01-OD-4-2139, TO #96, between the National Academy of Sciences and the Office of Behavioral and Social Sciences Research of the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 0-309-08524-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America Copyright 2002 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council. (2002). Emerging Issues in Hispanic Health: Summary of a Workshop. Joah G. Iannotta (Ed.). Committee on Population. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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Emerging Issues in Hispanic Health: Summary of a Workshop THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Emerging Issues in Hispanic Health: Summary of a Workshop COMMITTEE ON POPULATION JANE MENKEN (Chair), Institute of Behavioral Sciences, University of Colorado, Boulder ELLEN BRENNAN-GALVIN, Woodrow Wilson International Center for Scholars, Washington, DC JANET CURRIE, Department of Economics, University of California, Los Angeles JOHN N. HOBCRAFT, Population Investigation Committee, London School of Economics F. THOMAS JUSTER, Institute for Social Research, University of Michigan, Ann Arbor CHARLES B. KEELY, Walsh School of Foreign Service, Georgetown University DAVID I. KERTZER, Department of Anthropology, Brown University DAVID A. LAM, Population Studies Center, University of Michigan, Ann Arbor CYNTHIA LLOYD, Social Science Research Division, The Population Council, New York W. HENRY MOSLEY, Department of Population and Family Health Sciences, Johns Hopkins University ALBERTO PALLONI, Center for Demography and Ecology, University of Wisconsin, Madison JAMES W. VAUPEL, Max Planck Institute for Demographic Research, Rostok, Germany KENNETH W. WACHTER, Department of Demography, University of California, Berkeley LINDA J. WAITE, Population Research Center, University of Chicago Barney Cohen, Director Joah G. Iannotta, Research Associate Ana-Maria Ignat, Senior Project Assistant

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Emerging Issues in Hispanic Health: Summary of a Workshop Preface The National Academy of Sciences has a long-standing tradition and continuing responsibility to promote a national dialogue on race based on the best behavioral and social science research. For example, America Becoming: Racial Trends and Their Consequences (National Research Council, 2001) confronted contentious race-related issues by evaluating research in highly controversial areas such as welfare, racial stratification and disparities, and criminal justice, making important recommendations for the future. As a part of its continuing commitment to produce scholarly work to inform a national dialogue and improved policies on race, the Center for Social and Economic Studies convened a planning meeting on Hispanics in the United States on July 30, 2001. This meeting confirmed that the time is ripe for a scientific review of the recent past experience of Hispanic Americans. The consensus of the attendees at this planning meeting was that an in-depth study of the status of Hispanic Americans was much needed, that it should be comprehensive, and that it should cover a broad array of arenas, including health, education, labor, poverty, immigration, political participation, crime, language, and social and cultural change. Participants also felt that this study should go beyond extrapolating from current trends to drawing potential implications of current knowledge. In order to develop this broad-scale study on issues facing the Hispanic population in the United States, the National Research Council (NRC)

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Emerging Issues in Hispanic Health: Summary of a Workshop convened a meeting, Emerging Issues in Hispanic Health, on April 10, 2002, to identify the set of health-related issues that should help frame the larger proposed study. The meeting brought together experts from a wide range of disciplines and provided time for discussion concerning key issues in creating opportunities and reducing barriers to Hispanic health and well-being. This meeting was supported by the Office of Behavioral and Social Sciences Research of the National Institutes of Health, whose interest in the meeting stems from its commitment to eliminating racial and ethnic health disparities. This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Frank D. Bean, Center for Research on Immigration, Population, and Public Policy, University of California at Irvine; L. Beth Dixon, Department of Nutrition and Food Studies, New York University; and Donald J. Hernandez, Department of Sociology, University at Albany, State University of New York. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Charles B. Keely of the Walsh School of Foreign Service at Georgetown University. Appointed by the NRC, he was responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution. Many individuals deserve recognition for their contributions to the meeting and this report. E. Richard Brown, Donald J. Hernandez, Raynard Kington, Alberto Palloni, Jane Ross, and Marta Tienda gave considerably of their time to plan the meeting. Brown and Ross also provided feedback on the first draft of the meeting summary and offered many insightful comments that significantly improved the manuscript.

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Emerging Issues in Hispanic Health: Summary of a Workshop Several staff members also made significant contributions to the meeting and the report. Ana-Maria Ignat deserves special recognition for her assistance in ensuring that the meeting ran smoothly and successfully and that the report met its production deadlines. Joah Iannotta served as research associate for the project, assisting with development of the agenda and drafting of the report. Barbara Bodling O’Hare’s editing skills provided the polish to complete the report, and Kirsten Sampson Snyder ensured that the report traversed all the right steps toward publication. The project took place under the general direction of Jane L. Ross and Barney Cohen. We thank them for their efforts. Jane Menken Chair, Committee on Population

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Emerging Issues in Hispanic Health: Summary of a Workshop Contents     Emerging Issues in Hispanic Health   1     Introduction,   1     What’s in a Name: Defining the Term “Hispanics,”   3     Population Statistics of Hispanics in the United States,   6     Determinants of Health,   15     Health Care Coverage,   21     Emerging Issues,   26     Summary Thoughts,   32     References   36     Appendix: Workshop Materials   39 BOX, TABLES, AND FIGURES Box 1   Data Quality,   4

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Emerging Issues in Hispanic Health: Summary of a Workshop Tables 1   Age Distribution in U.S. Population of Hispanics, Non-Hispanic Whites, and African Americans, 2000,   7 2   Percentage of U.S. Population Living in Poverty in 2000,   7 3   Ten Leading Causes of Death in U.S. Population for Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics, 1999,   9 4   Ten Leading Causes of Death for U.S. Hispanic Population by National Origin, 1999,   10 5   Birth Outcomes of Mexican-Born, U.S.-Born Mexican American, and White Non-Latina Women in California,   16 6   Lifetime Prevalence of Psychiatric Disorders Among Migrant Workers and Residents in the Mexican American Prevalence and Services Survey, Among Residents of Mexico City, and Among Respondents to the National Comorbidity Survey,   29 Figures 1   Total age-adjusted mortality rates for U.S. population by major ethnic group, 1999,   9 2   Total fertility rate for U.S. population by major ethnic group, 2000,   12 3   U.S. births to mothers with 12 or more years of education by major ethnic group, 2000,   14 4   Percentage of low-birthweight babies for U.S. population by mothers’ major ethnic group, 2000,   14 5   Relative odds of infant mortality for Puerto Rican migrants by length of time on U.S. mainland,   20 6   Uninsured rates among nonelderly (ages 0 to 64) non-Hispanic whites, Hispanics, African Americans, and Asian Americans and Pacific Islanders,   22 7   Health insurance coverage among nonelderly persons (ages 0 to 64) by major Hispanic ethnic group,   23 8   Examples of GIS population and epidemiological mapping: San Antonio domestic violence cases and Hispanic population by census tract,   33 9   Examples of GIS population and epidemiological mapping: Hospital visits for asthma for all ages and minors in the San Antonio area by census tract,   33