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9 The Health Status and Health Behaviors of Hispanics--José J. Escarce, Leo S. Morales, and Rubén G. Rumbaut
Pages 362-409

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From page 362...
... The health status and health behaviors of today's Hispanic youth will play a central role in shaping the long-term health and health care needs not only of Hispanics in the United States but also of all Americans. Efforts to provide a detailed and comprehensive description of the health and health behaviors of Hispanics are complicated by a variety of factors.
From page 363...
... The three sections that follow cover, in order, the health status and health behaviors of Hispanic adults, the health status and health behaviors of Hispanic children and adolescents, and birth outcomes. The sixth section discusses the so-called epidemiological paradox, one of the most fascinating findings regarding the health of Hispanics and a source of controversy since it was first described.
From page 364...
... The age-adjusted death rate for Hispanic women was 544.2 per 100,000, compared with 713.5 for white women and 925.5 for black women. The mortality advantage of Hispanics in comparison with whites is present
From page 365...
... THE HEALTH AND HEALTH BEHAVIORS OF HISPANIC ADULTS We begin with a discussion of the health status and health behaviors of Hispanic adults. We review data on common chronic conditions, including diabetes, hypertension, cardiovascular disease, and cancer; on activity limitations caused by chronic conditions; and on biological risk factors for chronic disease, including lipid levels and obesity.
From page 366...
... 366 HISPANICS AND THE FUTURE OF AMERICA TABLE 9-2 Leading Causes of Death for Non-Hispanic Whites, NonHispanic Blacks, and Hispanics, by Sex, 2000 Racial or Ethnic Groups/Sex/Cause of Death Number of Deaths Non-Hispanic whites Men All causes 1,007,191 Diseases of heart 301,551 Malignant neoplasms 247,403 Cerebrovascular diseases 54,938 Chronic lower respiratory diseases 54,816 Unintentional injuries 53,329 Diabetes mellitus 26,009 Influenza and pneumonia 25,002 Suicide 21,293 Chronic liver disease and cirrhosis 15,002 Nephritis, nephrotic syndrome and nephrosis 14,385 Women All causes 1,064,096 Diseases of heart 320,168 Malignant neoplasms 232,608 Cerebrovascular diseases 89,642 Chronic lower respiratory diseases 58,024 Alzheimer's disease 32,936 Influenza and pneumonia 32,912 Diabetes mellitus 29,552 Unintentional injuries 29,263 Nephritis, nephrotic syndrome and nephrosis 15,213 Septicemia 14,088 Non-Hispanic blacks Men All causes 145,184 Diseases of heart 36,740 Malignant neoplasms 32,817 Unintentional injuries 8,531 Cerebrovascular diseases 8,026 Homicide 6,482 Human immunodeficiency virus (HIV) disease 5,400 Diabetes mellitus 4,771 Chronic lower respiratory diseases 4,238 Nephritis, nephrotic syndrome and nephrosis 3,074 Influenza and pneumonia 2,915 Women All causes 140,642 Diseases of heart 40,783 Malignant neoplasms 29,128 Cerebrovascular diseases 11,195 Diabetes mellitus 7,250
From page 367...
... Our focus on chronic conditions and biological and behavioral risk factors for chronic disease stems from our goal of assessing the dimensions of health status and health behaviors that have the greatest implications for the long-term health of Hispanics in the United States. For comparative purposes, the available data on Hispanics is contrasted principally with non-Hispanic whites and whenever possible among the major Hispanic national-origin groups and between foreignborn and U.S.-born Hispanics.
From page 368...
... (1991) found that 3.8 percent of Hispanics of Mexican origin who were 20 to 44 years old and 23.9 percent of Hispanics of Mexican origin who were 45 to 74 years old had diabetes, compared with 2.4 percent and 15.8 percent of Hispanics of Cuban origin and 4.1 percent and 26.1 percent of Puerto Ricans, respectively.
From page 369...
... found lower age-adjusted rates of hypertension among Hispanic adults who were younger than 75 years old than among non-Hispanic whites. Specifically, age-adjusted rates of hypertension were 22.9 percent, 19.7 percent, and 20.5 percent for men of Mexican, Puerto Rican, and Cuban origin, respectively, compared with 32.6 percent for non-Hispanic white men.
From page 370...
... . For example, vital statistics data for 2000 indicate that the age-adjusted death rate from heart disease among Hispanics was 196.0 per 100,000 people, compared with 255.5 per 100,000 people among non-Hispanic whites, while the age-adjusted death rate from ischemic heart disease among Hispanics was 153.2 per 100,000 people, compared with 186.6 per 100,000 people among nonHispanic whites (National Center for Health Statistics, 2003)
From page 371...
... . (In this study, most of the Hispanics were presumably Puerto Ricans and Dominicans.)
From page 372...
... These studies found that total cholesterol levels were similar for men and women of Mexican, Puerto Rican, and Cuban origin, and that the levels for Hispanics compared favorably with those for nonHispanic whites. More recent data from NHANES III and NHANES IV show similar or more favorable total cholesterol levels for men and women of Mexican origin compared with non-Hispanic whites.
From page 373...
... . Earlier data from HHANES found that Puerto Ricans were more likely than Mexicans or Cubans to have high-LDL and lowHDL cholesterol (Pérez-Stable et al., 2001)
From page 374...
... Hispanics, rates of obesity are higher for the U.S.-born than for the foreignborn. However, the findings for Hispanics of Cuban and Puerto Rican origin do not follow this pattern.
From page 375...
... . Abdominal obesity is also a component of the "metabolic syndrome," which is a strong risk factor for cardiovascular disease and includes impaired glucose tolerance, elevated blood pressure, elevated triglyceride levels, elevated levels of LDL cholesterol, and low levels of HDL cholesterol in addition to abdominal obesity.
From page 376...
... have interpreted the data to suggest that some Hispanics, such as Mexicans, Puerto Ricans, and Cubans, generally migrate to the United States with better mental health status than the U.S.
From page 377...
... In one study using HHANES data, Hispanics of Mexican origin had higher total fat and saturated fat intake than did Puerto Ricans or Cubans (Loria et al., 1995)
From page 378...
... of Cuban origin also have lower smoking rates than whites, whereas Puerto Ricans of all ages smoke at rates similar to those of whites. Consistent with these findings, Guendelman and TABLE 9-5 Current Smoking by National Origin and Age National Origin and Age (years)
From page 379...
... Other Health Behaviors Hispanic men and women are less likely to drink alcohol than their non-Hispanic white counterparts. For example, in 2001, 61 percent of adult Hispanic men and 39 percent of Hispanic women reported being
From page 380...
... . For example, in HHANES, marijuana use was five to eight times higher among highly acculturated Hispanics of Mexican origin and Puerto Ricans than among those who were not acculturated, controlling for other demographic factors.
From page 381...
... In this section, we review the data on the health status and health behaviors of Hispanic children and adolescents. We begin by summarizing the available information on two important chronic conditions -- asthma and diabetes -- and several other disorders that affect the well-being of Hispanic youth.
From page 382...
... Nearly two-thirds of the half million Hispanic children with asthma are Puerto Rican, and Puerto Rican children have the highest prevalence of asthma (11 percent) of any racial or ethnic group in the United States (Carter-Pokras and Gergen, 1993)
From page 383...
... . Risk Factors for Chronic Disease Risk of Overweight and Overweight Risk of overweight and overweight have become major health problems for Hispanic youth in the United States.
From page 384...
... confirmed the rapid rise in overweight among Hispanic youth using data from the National Longitudinal Survey of Youth. Using data from NHANES IV, Ogden, Flegal, Carroll, and Johnson (2002)
From page 385...
... Thus adolescents of Mexican and Puerto Rican origin were the most likely to be at risk of overweight, while Cuban girls and boys and girls of Central American or South American origin had lower rates (Figure 9-2)
From page 386...
... Risk Factors for Atherosclerosis A number of recent studies have documented high levels of risk factors for atherosclerosis and cardiovascular disease among Hispanic youth, and especially among youth of Mexican origin. The risk factors that have been studied include blood pressure, fasting insulin levels, insulin resistance, and lipid levels.
From page 387...
... The available evidence suggests that the differences between Hispanic and white youth in the prevalence of these risk factors for atherosclerosis are at least partly explained by differences in BMI. Health Behaviors Physical Activity Lower levels of physical activity combined with unhealthy diets have been identified as important underlying causes for rising rates of obesity and diabetes in Hispanic children and adolescents (Gordon-Larsen et al., 2002, 2003)
From page 388...
... . In analyses of data for a nationally representative sample of high school seniors, youth of Cuban origin and whites were found to have the highest levels of tobacco, alcohol, and illicit drug use, followed by youth of Mexican origin and youth of Puerto Rican origin.
From page 389...
... 389 Past 2002. Cigarette in Days 30 Use Hispanics Daily ethnicity, Past in Days Cigarette and 30 Blacks Any Use race by Whites graders, twelfth Past Days Alcohol- Related in 30 Drunkenness among use Past Alcohol in Days 30 Any Use tobacco and in Drug Days consumption, Except 30 Illicit Use Marijuana Any Past alcohol (2003)
From page 390...
... And 57 percent of Cuban-origin youth reported smoking in the past 30 days, compared with 51 percent of Mexican-origin youth, 45 percent of Puerto Ricans, and 48 percent of other Hispanics. And 30 percent of Cubanorigin youth reported having a drink in the past 30 days, compared with 26 percent of Mexican-origin youth, 30 percent of Puerto Ricans, and 25 percent of other Hispanics.
From page 391...
... Hispanics of Cuban origin have among the lowest infant mortality rates in the United States, and Hispanics of Mexican and Central American or South American origin have low rates as well. By contrast, infants of Puerto Rican mothers have
From page 392...
... . The low infant mortality rates for Mexican and Central American women, and especially for immigrant women from these countries, have attracted a great deal of attention because they are unexpected in the context of these women's low socioeconomic status.
From page 393...
... linked data file to examine mortality differences between non-Hispanic whites, on one hand, and Hispanics of Mexican, Puerto Rican, Cuban, Central American or South American, and other Hispanic origin, on the other. They found a sizable mortality advantage for Hispanics of Mexican, Central American or South American, and other Hispanic origin in analyses that controlled for age, sex, and socioeconomic status, but not for Puerto Ricans or Cubans.
From page 394...
... Vital statistics data, in particular, may understate mortality for Hispanics. Mortality rates based on vital statistics data are drawn from two distinct sources.
From page 395...
... interpreted data on health status and life expectancy from a variety of sources as offering strong evidence of a healthy-migrant effect among Hispanic immigrants to the United States. Birth Outcomes The epidemiological paradox is also manifested in birth outcomes, including rates of low birthweight and infant mortality.
From page 396...
... Hispanics of Puerto Rican origin tend to have worse health status indicators than other national-origin groups, including higher mortality and less
From page 397...
... And with the exception of Puerto Ricans, Hispanic children have low rates of asthma, the major chronic disease of childhood. Our review has also uncovered a number of worrisome findings regarding the health and health behaviors of Hispanics.
From page 398...
... The health consequences of current trends in BMI for Hispanic youth are already evident. The rising prevalence of Type 2 diabetes among Hispanic children is unprecedented, and portends the future development of diabetic complications in Hispanic adults in much larger numbers and at much younger ages than historical norms.
From page 399...
... Poor oral health is associated with a variety of adverse outcomes among youth, including lower quality of life and worse educational outcomes. Hispanic children also have higher blood lead levels than white children and, consequently, are at much higher risk for the adverse effects of lead poisoning on cognitive development.
From page 400...
... Interventions designed to preserve and build on salutary elements of Hispanic culture may be helpful in dealing with smoking, drug use, and teenage childbearing among Hispanic youth and in promoting favorable birth outcomes among Hispanic women. More research is needed on how acculturation to American culture affects the health and health behaviors of Hispanics and on how interventions that exploit the beneficial elements of Hispanic culture can be designed.
From page 401...
... . Asthma among Puerto Rican Hispanics: A multiethnic comparison study of risk factors.
From page 402...
... . Prevalence of diabetes in Mexican Americans, Cu bans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982­1984.
From page 403...
... . Cardio vascular risk factors in confirmed prediabetic individuals: Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?
From page 404...
... . Mortal ity from coronary heart disease and cardiovascular disease among adult U.S.
From page 405...
... . The Hispanic health and nutri tion examination survey: Depression among Mexican-Americans, Cuban-Americans, and Puerto Ricans.
From page 406...
... . Commu nity-wide coronary heart disease mortality in Mexican Americans equals or exceeds that
From page 407...
... population from the Third National Health and Nutrition Examination Survey, 1988­1994. Archives of Internal Medicine, 163(4)
From page 408...
... . Cardiovascular disease risk factors among older black, Mexican-American, and white women and men: An analysis of NHANES III, 1988­1994.
From page 409...
... . Cardiovascular risk factors in Mexican-American and non-Hispanic white children.


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