Nursing an Hispanic Patient

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Learning Objectives

  • Early History

The Hispanic presence in what is now the United States actually began before the country existed. Spanish explorers established colonies in what would become the Southeast and Southwest regions of the United States.

In the Southeast

In 1513, the explorer Juan Ponce de Leon sailed from Puerto Rico to the east coast of Florida. He claimed the peninsula, which he thought was an island, for Spain, thus becoming one of the first explorers to stake a Spanish claim in North America.

In 1526, a colonizing force under the leadership of Lucas Vasquez de Ayllon, a Spanish nobleman, founded the first European settlement in the present-day United States. Historians believe that this settlement, named San Miguel de Gualdape, stood somewhere along the coast of what is now Georgia and South Carolina. Before the end of the year, malaria and other diseases killed about two-thirds of the original population of 600, including Ayllon. The remaining settlers returned to the West Indies in early 1527.

The Spaniards did not establish a permanent settlement in the Southeast until 1565. In that year, the Spanish explorer Pedro Menendez de Aviles founded St. Augustine in Florida.

This was the first permanent European settlement in what would become the United States. It predated Jamestown—the first permanent British settlement in North America—by more than 40 years. St. Augustine served as Spain’s military headquarters in North America during the 1500’s.

Florida remained under Spanish control until 1763, at which time Spain was forced to give the territory to Britain. Spain regained Florida in 1783, but problems soon broke out between the Spanish colony and the new United States. American settlers moved into Florida, and the U.S. government sought to purchase the territory from Spain. In 1821, Florida came under United States control, and thousands of Americans poured into the territory. Soon the Spanish presence in Florida was overwhelmed by the tide of English-speaking settlers.

In the Southwest

To the west, the desire for wealth and fame led the Spaniards to expand their claims in Mexico. In 1540, the explorer Francisco Vasquez de Coronado set out to conquer the legendary Seven Cities of Cibola, which were said to lie north of Mexico. Coronado and his men explored areas of present-day New Mexico, Arizona, Texas, Oklahoma, and Kansas in the hope of finding the great riches they had heard described. The expedition returned to Mexico in 1542. No gold had been found, but Coronado had claimed a vast area of the North American continent for Spain. The area was given the name New Mexico.

In 1598, the first Spanish settlers arrived in New Mexico to begin missionary work among the Pueblo Indians. The settlers established Santa Fe, the capital of New Mexico, in 1609 or 1610. The Spaniards treated the Indians harshly, and in 1680 the Pueblos revolted. The Indians killed about 400 Spaniards and captured Santa Fe. The Spaniards did not retake Santa Fe until 1692.

The Spanish settlement of Texas began in 1682, when two missions were built by Franciscan friars. By 1731, the Spaniards had established missions throughout central, east, and southwest Texas. But Spanish colonization of Texas proceeded slowly. By 1793, the territory had only about 7,000 white settlers.

California also was part of the Spanish Empire in the New World. First settled by the
Spaniards in 1769, California remained sparsely populated for many years. By the 1820’s, Franciscan friars had established 21 missions in California. The Spanish governors had also built a number of presidios (forts) in California.

During the early 1800’s, the westward expansion of the United States alarmed the Spanish colonial governors. These officials restricted trade between the United States and the northern colonial provinces of New Mexico, Texas, and California. By so doing, they hoped to avoid a heavy flow of American settlers into the sparsely populated colonies.

Mexican Independence and Free Trade

In 1821, Mexico gained its independence from Spain. The new nation included the northern provinces, as well as present-day Mexico. Soon, free trade with the United States was established in New Mexico. The government of the Republic of Mexico tried to regulate U.S. trade in New Mexico, which led to increasing resistance among the New Mexicans, many of whom did not feel especially loyal to Mexico.

Mexicans living in California, called Californios, also opened free trade with the United States and other countries. The Mexican government broke up the missions and gave or sold huge tracts of ranch lands to private individuals. As a result, a small group of several hundred Mexican landowners became very wealthy. But most Californios, like the majority of settlers throughout Mexico’s northern territories, remained poor.

The abundant resources of California attracted many American settlers in the 1830’s and 1840’s. The United States was already considering ways of acquiring California as a territory. The Californios enjoyed the benefits of their trade with the United States and saw advantages to becoming a U.S. territory. The Mexican government neglected its northern territories, and many Californios resented the interference of government officials from Mexico City.

Texas had by far the smallest population of any of the northern Mexican territories, and the Mexican government’s hold on Texas was weak. In January 1821, American merchant Moses Austin received permission from Spanish authorities in Mexico to settle 300 Americans in Texas. The project eventually passed into the hands of Austin’s son, Stephen Fuller Austin. Instead of being limited to 300 settlers, however, the American

settlement of Texas swelled to thousands of people. In 1836, Texas won its independence from Mexico and became a republic.

  • Conflict With the United States

In 1845, the United States annexed Texas. In response, the Mexican government broke off relations with the United States. Texas claimed territory as far south as the Rio Grande, but Mexico disputed the claim, saying that Texas’ southwest border was the Nueces River. These and other events led to the Mexican War (1846-1848) between the United States and Mexico. The United States won the war. The Treaty of Guadalupe Hidalgo, which ended the war, awarded the United States the territory that now makes up the states of California, Nevada, Utah, most of New Mexico and Arizona, and part of Colorado and Wyoming. This vast area was home to approximately 80,000 Mexicans, most of whom were granted U.S. citizenship.

The original draft of the Treaty of Guadalupe Hidalgo stated that the United States would honor any land grants that had been made by the government of Mexico. However, this provision was deleted in the U.S. government’s revision of the treaty. Mexican officials protested this change. At the signing of the treaty, the U.S. representatives also signed the Protocol of Queretaro, which stated that the U.S. government’s changes in the original treaty did not invalidate the civil, political, and religious guarantees that the treaty had extended to Mexican residents of the new U.S. territories. The U.S. government, however, did not ratify the Protocol of Queretaro, claiming that its representatives at the treaty signing did not have the authority to sign the protocol. Mexico’s government also failed to ratify the protocol.

Problems For Landowners

Many of the new Hispanic Americans were living on land that had been granted to them by the Mexican government. For many years after the war, Mexican-American landowners in the Southwest were able to maintain their claims. But as more and more Anglo settlers came in search of land on which to raise crops and livestock, the demand for land soared. Mexican-American landowners had to legally confirm their claims. The process was so lengthy and expensive that many were forced to take out large loans to pay court costs. They often sold large tracts of their land in order to pay off their loans.

Many Mexican Americans were unable to communicate with the English-speaking judges and did not understand the U.S. court system. As a result, they were often cheated out of their legitimate claims to the land.

By the late 1800’s, most Mexican Americans had become tenants or workers on land that belonged to Anglo-Americans. The two groups lived apart in towns and cities, and each had its own schools, stores, and places of entertainment. The Mexican Americans called their sections barrios, the Spanish word for neighborhoods.

During this period, the immigration of Mexicans to the United States was relatively small. Jobs on large cattle, sheep, cotton, and vegetable farms attracted some Mexicans to Texas. But the great period of Mexican- American immigration was yet to come.

  • Immigration in the Early 1900’s

In 1900, the total Mexican-American population was estimated to be between 380,000 and 560,000. The early 1900’s saw a sharp increase in the number of Mexican immigrants as economic conditions in Mexico worsened. In 1910, the Mexican Revolution broke out. This conflict plummeted Mexico into years of political and economic chaos. The revolution also sparked a tremendous wave of immigration that continued until the 1930’s.

Between 1910 and 1930, more than 680,000 Mexicans came to live in the United States. During the 1920’s, Mexicans accounted for more than 10 per cent of all immigration to the United States. Most Mexicans fleeing the Mexican Revolution settled in the Southwest, where they took jobs in factories and mines or on railroads, farms, and ranches.

In 1917, the United States entered World War I (1914-1918), and thousands of Mexican Americans volunteered for service in the U.S. armed forces. The wartime economy also provided new opportunities for Mexican Americans. Some were able to move into better-paying, skilled occupations in construction and in the war industries.

Despite these gains, Mexican Americans continued to suffer discrimination in jobs, wages, and housing. To fight these conditions, they organized labor unions and took part in strikes to obtain higher wages and better working conditions. Mexican Americans also formed civic groups to deal with their problems. In 1929, the major groups merged to form the League of United Latin American Citizens (LULAC).

Immigration Restrictions

In 1917, the United States passed a law requiring all adult immigrants to be able to read and write at least one language. In 1924, the U.S. Bureau of Immigration established the Border Patrol to control illegal immigration across the Mexican-U.S. border. Strict enforcement of the 1917 adult literacy law led to a decline in Mexican immigration in the late 1920’s. This decline continued through the Great Depression—the economic hard times of the 1930’s—when only about 33,000 Mexicans entered the United States.

The 1930’s brought heightened discrimination against Mexican Americans. Many people viewed them as a drain on the American economy because they held many low-paying jobs while other, “true” Americans went unemployed. In response to such angry views, the U.S. and Mexican governments cosponsored a repatriation program that returned thousands of Mexican immigrants to Mexico.

Growing Discrimination

The program was intended to encourage people to return voluntarily to Mexico, but thousands were deported against their wishes. Many of these immigrants had lived in the United States for more than 10 years. Their American-born children were U.S. citizens. In some cases, adults who were deported were U.S. citizens who were mistakenly or intentionally forced to leave their country. In California especially, many Mexican Americans were placed in detention camps, where they were mistreated by government officials. Of the approximately 3 million people of Mexican descent living in the United States in 1930, about 500,000 had been repatriated by 1939. The repatriation program created much anger and resentment among Mexican Americans. Family relationships were often strained because young people who had been born in the United States did not want to go to Mexico.

In addition to the humiliation of repatriation, Mexican Americans suffered other forms of discrimination. Many restaurants refused to serve Mexican Americans. Public swimming pools, rest rooms, drinking fountains, and theaters were often segregated. Mexican-American schoolchildren were often forbidden to speak Spanish in schools and were sometimes punished severely for doing so.

  • Effects of World War II

During World War II (1939-1945), more than 300,000 Mexican Americans served in the U.S. armed forces. Their courage and determination helped them earn proportionally more military honors than any other ethnic group. Many Mexican-American veterans returned from the war with new-found skills. Unwilling to go back to living with the pressures and barriers of discrimination, they formed a number of social, political, and service organizations, including the Mexican American Political Association (MAPA) and the American GI Forum of the United States. Such organizations have helped Mexican Americans fight poverty, lack of education, and discrimination.

World War II had renewed the demand for immigrant labor. In 1942, the U.S. and Mexican governments developed the bracero program. Under the program, Mexican braceros (day laborers) could enter the United States legally for seasonal agricultural work and for work on U.S. railroads. Bracero programs were in effect from 1942 to 1947 and from 1951 to 1964. The programs provided almost 5 million Mexicans with temporary work in the United States. The braceros often worked under harsh conditions for un

  • Immigration In the Mid-1900’s

The mid-1900’s saw a great influx of Hispanic people into the United States. These new arrivals included not only Mexicans, but large numbers of Puerto Ricans and Cubans, too.

Mexican immigration to the United States—both legal and illegal—climbed steeply during the 1950’s. The U.S. government developed a program to curb illegal immigration. The program was highly publicized in order to encourage undocumented immigrants to leave voluntarily. It resulted in the deportation of a total of 3,800,000 undocumented immigrants. It did little, however, to control illegal immigration, which continued to increase from the 1960’s through the 1980’s.

Puerto Rican Migration

The mid-1900’s also brought the first great wave of people from Puerto Rico. This island had been a U.S. possession since 1898, and its people had been U.S. citizens since 1917. As citizens, Puerto Ricans may enter the United States without restriction. Between 1940 and 1960, more than 545,000 Puerto Ricans came to the U.S. mainland to look for jobs. By 1960, almost 70 percent of Puerto Ricans living on the mainland had settled in East Harlem in New York City. New York City has continued to have the largest Puerto Rican population of any mainland U.S. city, with about a third of all Puerto Ricans on the mainland living in the city.

For many years, Puerto Ricans have remained one of the poorest groups in the United States. Unemployment among Puerto Ricans is about 50 percent higher than it is among the general population, and the poverty rate is almost four times higher.

Cuban Migration

Cuban immigration to the United States picked up sharply during the late 1950’s, as a result of increasing political turmoil in Cuba. Until the mid-1950’s, only a few thousand Cubans came to the United States each year. But during the late 1950’s and early 1960’s, the number of Cuban immigrants increased dramatically. In 1959, Cuban revolutionary Fidel Castro came to power. He announced the restructuring of Cuban society. Many middle- and upper-class Cubans found Castro’s plans threatening to their way of life. Between 1959 and late 1962, about 200,000 anti-Castro Cubans immigrated to the United States.

In October 1962, commercial air flights between Cuba and the United States were suspended. Nonetheless, about 50,000 Cubans entered the United States between late 1962 and 1965. Many of these people sailed secretly from Cuba in small boats, some of which were apprehended by the Cuban navy before they reached the United States. In 1965, the United States and Cuban governments agreed to set up an airlift between Cuba and Miami. The airlift brought about 250,000 Cubans into the United States between 1966 and 1973.

Until 1994, the United States welcomed Cuban immigrants as victims of an oppressive regime. Many of the first Cubans to flee Castro’s dictatorship in the early 1960’s were from wealthy families and were well educated. The U.S. government granted asylum to these people and offered federal help to qualified applicants in finding homes and in making job contacts. Most later Cuban immigrants were relatives of the first group or were poor people looking for work.

Problems With Cuban Migration

A major influx of Cuban immigrants was the arrival in 1980 of the Marielitos. Numbering about 125,000, the Marielitos were a group that the Cuban government wanted out of Cuba. They included many unskilled workers, criminals, and mentally ill people. These people were put aboard boats at the Cuban port of Mariel and sent to Miami. The U.S. government allowed the Marielitos to enter the United States, though U.S. officials had not expected such large numbers of people and were at first unaware of the presence of criminals on board the boats. Some of the criminals were placed in U.S. prisons. Many of them were rehabilitated and released. A few were returned to Cuba.

In 1994, thousands of Cubans set out for southern Florida on small boats and rafts to escape poverty in Cuba. But soon after the influx began, U.S. President Bill Clinton announced the United States would not accept any more of the refugees. This policy was designed to avoid the cost of settling large numbers of refugees in Florida. Many of the Cubans were stopped at sea by U.S. ships and taken to a U.S. naval base at Guantanamo Bay on Cuba’s coast.

Living Conditions for Cuban Americans

Nearly two-thirds of all Cuban Americans live in Florida. More Cuban Americans live in Miami than in any other U.S. city. Large numbers of Cubans also live in suburban towns outside Miami and in Tampa, on Florida’s west coast. Although the Little Havana section of Miami remains the center of the Cuban-American population, many Cubans have now moved into the city’s more affluent neighborhoods. Some of Miami’s most successful businesses are owned and operated by Cuban Americans. New York City, Los Angeles, and Chicago also have significant Cuban populations

Cuban Americans face many of the same problems that trouble other minority groups, though to a lesser degree. In the 1980’s, the level of educational achievement among Cuban Americans matched the national average. The unemployment and poverty rates of Cuban Americans are much lower than those of other Hispanic groups.

  • Immigration in the Late 1900’s

People from Latin America continue to immigrate in large numbers to the United States. In the 1980’s, Hispanics accounted for more than a third of all legal immigration to the United States. For many, the United States represents opportunities unavailable in their homelands. Most desire to work hard to improve the lives of their families.

From the 1970’s to the early 1990’s, large numbers of Hispanic immigrants came from war-torn countries in Central America, including El Salvador and Nicaragua. Many of these immigrants were children and teen-agers whose parents had been killed or had disappeared. Some U.S. citizens felt that Central Americans fleeing military conflict should be granted political asylum in the United States. However, the U.S. government maintained that most of these immigrants had been motivated by economic, not political, concerns. Therefore, they were not entitled to the special treatment given political refugees under U.S. immigration law. Many of the immigrants from Central America were placed in large detention camps until they could be relocated or returned to their homelands.

Hispanic Americans Today

People from Latin America continue to immigrate in large numbers to the United States. Hispanics historically have accounted for more than a third of all legal immigration to the United States. For many, the United States represents opportunities unavailable in their homelands. Most want to work hard and to improve the lives of their families. But for many Hispanic families, slow educational progress hinders efforts to achieve a better life.

A high rate of immigration and a high birth rate have combined to make Hispanic Americans one of the fastest-growing minority groups in the United States. From 1990 to 2000, the Hispanic population increased nearly 60 percent—more than four times faster than the nation’s total population. The 2000 census reported that Hispanics had become the nation’s largest minority group.

Some non-Hispanics in the United States fear that the country’s rapidly growing Hispanic population will not adopt the language, customs, and viewpoint of the dominant, English-speaking culture. Some of these people fear that their way of life will be replaced by the “foreign ways” of Hispanic Americans. Others worry that a large Spanish-speaking minority will become a permanent underclass, locked out of economic advancement by a lack of fluency in English. Many historians and sociologists discount such fears. They point to the many immigrant groups that have become part of American culture. They also note that except for recent immigrants, most Hispanic Americans can speak English.

Nevertheless, language has become an increasingly controversial issue in some states with large Spanish-speaking populations. About 25 states have passed laws making English their official language. Some people support the passage of an amendment to the U.S. Constitution that would make English the official language of the United States.

An increased demand among Hispanic Americans for Spanish-language media has led to the development of two national Spanish-language television networks. In addition, hundreds of U.S. radio stations broadcast in Spanish. Also, many Hispanic newspapers, magazines, andjournals are published in the United States.

Table of Contents

1. History of Hispanic American Immigration

  • Early History
    • In the Southeast
    • In the Southwest
    • Mexican Independence and Free Trade
  • Conflict With the United States
    • Problems For Landowners
  • Immigration in the Early 1900s
    • Immigration Restrictions
    • Growing Discrimination
  • Effects of World War II
  • Immigration In the Mid-1900s
    • Puerto Rican Migration
    • Cuban Migration
    • Problems With Cuban Migration
    • Living Conditions for Cuban Americans
  • Immigration in the Late 1900s
    • Hispanic Americans Today

2. Understanding the Hispanic Culture

  • Cultural Backgrounds of Hispanic Americans
    • Cultural Bonds
    • National and Ethnic Origins
    • Where Hispanics Live
    • Settlers in the West Indies
    • Spanish and African Influences in Puerto Rico and Cuba
    • Aztec Influence in Mexico
    • Spanish and Indian Cultures in Mexico
    • Holidays
  • The Day of the Dead–Mexico Honors Those Gone But
    • Not Forgotten
  • Hispanic Values
    • Family Values
    • Etiquette
    • Rituals and Religions
    • Celebrations and Holidays
    • Eating Habits
    • Teaching and Learning Implications
    • References

3. What It Means to Be Latino

  • On Terminology: Hispanic or Latino?
  • ‘Hispanic’ vs ‘Latino’

4. Getting to Know The Hispanic/Latino Culture

    • La Familia
    • Respeto
    • Personalismo
    • Confianza
    • Names
    • Family Structures
    • Communication and Social Interaction
    • Time Orientation
    • Concept of Health
    • References
  • Mexican-American
    • Food Habits and Their Relationship to Dietary Guidelines
    • Eating Practices, Food Preferences and Food Preparation Techniques
    • Teaching Implications
    • References
  • Puerto Rican
    • Food Habits and Their Relationship to Dietary Guidelines
    • Eating Practices, Food Preferences and Food Preparation Techniques
    • Teaching Implications
    • References
  • La Cocina—Southwestern Cuisine

5. Hispanic Health Status

    • Key Facts
  • Mortality and Morbidity
    • Smoking
    • Diet
    • Cholesterol
    • Weight and Exercise
    • Alcohol and Substance Abuse
    • Violence and Unintentional Injuries
    • Environment
  • Key Areas of Concern
    • AIDS and HIV
    • Cancer
    • Coronary Heart Disease, Stroke, and Hypertension
    • Diabetes
    • Environmental Health
    • Mental Health
    • Tuberculosis
  • Health Beliefs and Practices
    • Concept of Health
    • Potential Culture-Related Health Concerns Among Hispanic
    • Populations
    • Health Promotion, Prevention, and Treatment
    • Folk Beliefs of Some Hispanics About Health and Illness
    • That Can Affect Care and Treatment
    • Major Folk Illnesses Among Hispanic Populations
    • Major Systems of Folk Healing Among Hispanic Populations
    • Sources for Further Reading
  • Health Culture Sketch
    • Introduction
    • Geographic Distribution in U.S.
    • General Characteristics
    • Health Care Decision-Making

6. Cultural Diversity: Eating in America

  • Mexican-American
    • Food Habits and Their Relationship to Dietary Guidelines
    • Eating Practices, Food Preferences and Food Preparation Techniques
    • Teaching Implications
    • References
  • Puerto Rican
    • Food Habits and Their Relationship to Dietary Guidelines
    • Eating Practices, Food Preferences and Food Preparation Techniques
    • Teaching Implications
    • References
  • La Cocina—Southwestern Cuisine 88

7. Acculturation Erodes the Diet Quality of U.S. Hispanics

    • Status of Hispanics Varies by Origins
    • Table 1. U.S. Hispanic Populations Vary Widely in Age,
    • Earnings, Level of Schooling, and Household Size
    • Disease and Mortality Puzzle Policymakers
    • Hispanics Surpass Non-Hispanics in Diet Quality
    • . . . Especially Spanish-Speaking Hispanics
    • Table 2. Hispanic Spanish Speakers Score Highest on Healthy
    • Eating Index
    • Table 3. Hispanic Attitudes and Knowledge About Nutrition Diverge
    • References
  • Nutrition Counseling Tips For Hispanic-American Clients

8. Folk Medicine in Hispanics

    • Concept of Disease
    • Origins of Hispanic Folk Medicine
    • Utilization of Lay Healers Among Hispanics
    • Hypertension
    • Diabetes Mellitus
    • Folk Medicine-Treatments-Upper Respiratory Infection
    • Folk Medicine-Treatments-Osteoarthritis/Rheumatism
  • Treatment of Folk Illnesses
    • Conclusion
    • Folk Remedies Everyone Should Know
    • Illustrations: Plants and Herbs Commonly Used as Folk Remedies
    • Curandera Preparing for a Barrida

9. The Influence of Ethnicity on the Use of Herbal Remedies

  • Introduction
    • Discussion
    • Conclusion
    • Table 1. Herbal Users by Perceived Health Problems
    • Table 2. Botanical Nomenclature for Commonly Used Herbal Remedies
    • Table 3. Herb Users’ Sources of Information on Herbal Remedies
    • Table 4. Frequency of Use of the Top 10 Herbs Used by Herbal Users
    • Table 5. Most Frequently Used Herbal Remedies forTop Five Perceived Health Problems
    • References

10. Hispanics/Latinos: Health Disparities Overview

    • Terminology
  • Demographics
    • Size and Origin of Population
    • Location
    • Age
    • Family Size
    • Underlying Causes of Health Disparities: Income and Education
    • Education
    • Socioeconomic Status and Health Status
    • Income and Economic Status
    • Employment
  • Health Status
    • Leading Causes of Mortality
    • Specific Health Concerns
    • Traditional Health Beliefs and Practices
    • Traditional Illnesses
  • Risk Factors and Challenges
    • Racism
    • Environmental and Occupational Hazards
    • Health Insurance Coverage and Access to Quality Care
    • Language and Communication
    • Obesity
    • Smoking
    • Alcohol Use
    • Physical Activity
    • Practical Tips For Treating Hispanic Patients
    • Strengths and Protective Factors
    • Diet
  • Adherence Factors
    • Decision-making
    • Communication
  • Complementary and Alternative Medicine
    • References and Resources
  • Quality & Culture Quiz
  • Quality & Culture Quiz Answers

11. Cancer Health Disparities

  • Cancer Rates
    • Overall Incidence and Mortality Rates
    • African -Americans
    • Hispanics/Latinos
    • Asian Pacific Islanders
    • American Indian/Alaska Natives
  • What Are Cancer Health Disparities?
    • Financial Issues
    • Minorities Are More Likely Not to Have a Regular Doctor
    • Minorities Face Greater Difficulty in Communicating With Physicians
    • Transportation Can Limit Access
    • Accurate Information is Not Universally Available
    • Percentage of Adults Who Have Problems Communicating With Their Doctor
    • Percentage of U.S. Women Who Had Screening Tests
    • Available Information Does Not Reach All Populations
    • Potential Biases Can Affect Cancer Health
    • Not Everyone Receives the Screening Equally
    • Higher Percentage of Whites Receive Medicare Services in Managed Care Plans
    • Older African Americans Receive Lower Rate of Surgery And Have Lower Resulting Survival Rate

12. Disparities in Cardiovascular Disease (CVD)

  • Eliminate Disparities in Cardiovascular Disease (CVD)
    • What is the burden of cardiovascular disease in the United States?
    • Where are the disparities?
    • What is the goal?
    • What is the strategy?
    • What can healthcare providers do to help reduce the burden of CVD?
    • What can individuals do to decrease their risk of developing CVD?
    • For More Information About Cardiovascular Disease:

13. Unequal Treatment: What Healthcare Providers Need to Know

  • Do Racial and Ethnic Minorities Receive a Lower Quality of
    • Healthcare?
  • What Are the Sources of Healthcare Disparities?
    • Clinical Uncertainty
    • The Implicit Nature of Stereotypes
    • Healthcare Provider Prejudice or Bias
    • Medical Decisions Under Time Pressure with Limited Information
    • Patient Response: Mistrust and Refusal
  • What Can Healthcare Providers Do to Help Eliminate
    • Disparities in Care?
    • Guide to Information Sources
    • Did You Know…

14. Diabetes in Hispanic Americans

  • Major Studies of Diabetes in Hispanic Americans
  • How Many Hispanic Americans Have Diabetes?
    • Table 1. Hispanic American Populations in the United States and Percentage With Diabetes
  • What Factors Increase the Chance of Developing Type 2 Diabetes?
    • Genetic Risk Factors
    • Figure 1. Prevalence of Diagnosed and Undiagnosed Diabetes in Mexican Americans, U.S., 1988-94
    • Figure 2. Genetic Origins of the Major Hispanic Subgroups in the United States
    • Medical and Lifestyle Risk Factors
    • Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
    • Gestational Diabetes
    • Hyperinsulinemia and Insulin Resistance
    • Obesity
    • Figure 3. Prevalence of Overweight Individuals Among Whites, Blacks, and Mexican Americans in the Population, 1988‑91
    • Physical Activity
  • How Does Diabetes Affect Hispanic Young People?
  • How Does Diabetes Affect Hispanic Women During Pregnancy?
  • How Do Diabetes Complications Affect Hispanic Americans?
    • Eye Disease
    • Kidney Disease
    • Nerve Disease
    • Peripheral Vascular Disease
    • Heart Disease
    • Diabetes and Diet
  • How Is NIDDK Addressing the Problem of Diabetes in Hispanic Americans?
    • Diabetes Prevention Program
    • National Diabetes Education Program
  • Points to Remember
    • References

15. Minority Women’s Health Concerns

  • What Health Problems Affect a Lot of Hispanic Americans/Latina Women?
    • Obesity and Overweight
    • Heart Disease
    • Stroke
    • Cancers
    • Maternal and Infant Health
    • Smoking and Pregnancy: A Critical Risk Factor for Pregnant Females
    • HIV/AIDS
    • Cultural Attitudes
    • Gender Roles
    • Attitudes About Sex
    • Other Sexually Transmitted Diseases
    • Diabetes Mellitus
    • Tuberculosis
    • Psychiatric Disorders
  • Violence Against Women
    • Hispanic American/Latina Women
    • Leading Causes of Death for Women in the United States, 2000
  • Getting Health Care
    • What types of care coverage exist? How do I find out about them?
    • For More Information

16. Factors Affecting The Health of Women of Color

  • Adolescent Females of Color
    • Access to Services
    • Health
    • Health Risk Behaviors
    • Sexual Intercourse
    • Substance Abuse
    • Unsafe Moter Vehicle Operation
    • Healthful Behaviors
  • Elderly Women of Color
    • Demographics
    • Native Americans
    • Hispanics
    • Black Americans
    • Asians and Pacific Islanders
    • Access to Health Care
    • Health Assessment

17. Maternal Health of Hispanic Women

    • Folic Acid Knowledge and Use Among Hispanic Women
    • Preventing Alcohol-Exposed Pregnancies Among Hispanic Women
  • Maternal Health Risks of Immigrant Women From Latin America
  • Maternal & Reproductive Health Beliefs
  • Understanding the Health Culture of Recent Immigrants to the United States: A Cross-Cultural Maternal Health Information Catalog
    • Examples of Cultural Beliefs Held by Certain Immigrant Groups
    • Examples of Epidemiological Data Affecting the Health of Childbearing Women
    • Examples of Proposed Links Between Epidemiological Data and Cultural Beliefs/Practices; and Associated Health Risks to Pregnant Women and Infants
    • Lessons for Health Care Professionals From Knowledge of Cultural Beliefs or Immigrant Experiences

18. Violence and Minority Women

  • Screening for Abuse in Spanish-Speaking Women
    • Women Abuse Screening Tool

19. Hispanic American Elders

  • Introduction
  • The Older Hispanic Population: Past, Present, and Future
    • Residence
    • Educational Level
    • Living Arrangements
    • Poverty
    • Health
    • Self-Rated Health Status
    • Access to Medical Care
    • Diversity of Hispanic Elders
    • Health and Chronic Illnesses
    • Hispanic Americans and Family Caregiving
    • Older Hispanic Americans and Poverty
    • Education
  • Elderly Abuse in Hispanic Families

20. Alcohol and Minorities

  • Ethnic Differences in Drinking Patterns
  • Ethnicity and Alcohol Problems
    • Medical Consequences
    • Social Consequences
  • Contributors to Ethnic Differences
    • Social Factors
    • Biological Factors
  • Prevention
    • School-Based Prevention
    • Family-Based Prevention
    • Alcohol Availability
  • Treatment
  • NIAAA Analysis Reveals Increased Risk for Liver Cirrhosis Death Among Hispanic Americans
    • References

21. Hispanics and Tobacco

  • Health Effects
  • Cigarette Smoking Prevalence
    • Prevalence of Other Forms of Tobacco Use
    • Tobacco Industry Influence
    • References

22. Mental Health

  • Latinos/Hispanic Americans
    • Need For Mental Health Care
    • High-Need Populations
    • Availability of Mental Health Services
    • Access to Mental Health Services
    • Use of Mental Health Services
    • Appropriateness and Outcomes of Mental Health Services
    • Culturally Specific Mental Health Resources

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