Que Sera Sera

1. Que Sera? Sera? Elizabeth Lee-Rey, MD Luz Towns-Miranda, PhD Hispanic Center of Excellence Albert Einstein College of Medicine

2. Que Sera? Sera? OBJECTIVES To obtain an overview of demographic representation of Latinos nationally and locally in NYC and the Bronx. To gain knowledge regarding key health issues facing Latinos/as.

3. Que Sera? Sera? OBJECTIVES To increase awareness regarding significant parameters that impact the health care of Latinos. To gain greater understanding of the differences that distinguish the predominant Latino groups in the Bronx.

4. Name all 11 countries in South America. Peru Ecuador Bolivia Chile Colombia Venezuela the Guyana Brazil Uruguay Paraguay Argentina

5. Name all 8 countries in Central America. Panama Costa Rica Guatemala Nicaragua Salvador Honduras Belize

6. What are the 3 countries of Hispanic origin found in the Caribbean? Cuba Dominican Republic Puerto Rico

7. What are some of the barriers to health care for Hispanics? Poverty Less education Unemployment rates Poor access to adequate health care Discrimination Socioeconomic status Lack of health insurance

8. $100

9. Tortillas are a staple food of which ethnic group? Puerto Ricans Mexicans Salvadorians Dominicans

10. $200

11. The largest ethnic parade held in NYC is celebrated by which Latino group? Mexicans Dominicans Cubans Puerto Ricans

12. $300

13. Mangu is a breakfast food for which Latino group? Mexicans Cubans Puerto Ricans Dominicans

14. $500

15. Which group is less likely to have a regular physician? Asian Seniors Hispanic Male Adolescents African American Newborns Middle-age Women

16. Minority Boys Are Less Likely to Have a Regular Physician

17. $1000

18. Who was the first female Puerto Rican Congresswoman? Iris Chacon Nydia Velazquez Marife Hernandez Celia Cruz

19. Who was the first NYC Dominican Councilman? Guillermo Linares Victor Marisete Adriano Espaillat Tito Puente

20. $2000

21. What percentage of Latino babies are born into poverty? 50% 66% 75% 40%

22. What percentage of Latino Babies are born into poverty? ¾ of Latino babies are born into poverty Almost 2/3 of all Latino children live below the poverty line 73% of Hispanic children are living in “distressed neighborhoods.”

23. $4,000

24. Hispanic women make up what percentage of the total NYC female population? 29% 33% 45% 50%

25. Hispanic women make up what percentage of the total NYC female population? Latinas represent 29% of the total female population in NYC Latinas comprise approx. 51% of the Hispanic pop in NYC Their median age is lower than for all other racial and ethnic groups

26. $6000

27. Latinas nationally are how likely to have diabetes as compared to the general population As likely Less likely Twice as likely Three times as likely

28. Latinas and Diabetes While NYC statistics are not available be ethnicity, data from neighborhoods where Hispanics comprise more than 60% of the population indicate that the incidence of DM hospitalizations far exceeds the average. Latinas nationally are twice as likely as the general population to have diabetes. The average incidence of DM hospitalizations in NYC is 7.4 per 1000. In Bushwich, where the Hispanic population is 67%, the rate is 20.8 per 1000. Presentation by the NYC Mayor’s Office of Health Services

29. $8,000

30. Latina’s biggest cancer risk is Colon Lung Breast Cervical

31. Cancer Facts Latinas are somewhat under-represented in the total cancer statistics. This may due to the relatively younger age of Latinas Latina’s biggest cancer risk is Breast Cancer. As a whole, the rate of Latina deaths due to Breast Ca is 1.7 per 100,000. This compares to less than .5 for all other forms of cancer to the reproductive health organs. Presented by the NYC Mayor’s Office of Health Services

32. $16,000

33. The leading cause of death for Hispanic females from birth to 49 is Cancer Heart Disease AIDS Diabetes

34. The leading cause of death for Hispanic Males age 1 to 59 is a) Homicide b) Heart Disease c) AIDS d) Cancer

35. The Leading Cause of Death for Hispanics in NYC In NYC, according to 1995 data, AIDS was the leading cause of death for Hispanic males from ages 1 yr old to 59 yrs old. It was the leading cause of death for Hispanic females from birth to 49 yrs old. Source: The seventh Annual Hispanic Federation Annual Survey Hispanic New Yorkers on Nueva York Report 4:Latinos and HIV/AIDS

36. $32,000

37. Who are the Uninsured? Live in families with incomes higher than the federal poverty level. Poor, unemployed and belong to a racial ethnic group. Seniors over the age of 65. Children.

38. Who Are The Uninsured? Many Americans stereotype the uninsured as poor, unemployed, and minorities. While these groups run a greater risk, they do not represent the majority of Americans without health coverage.

39. Who Are The Uninsured? In fact, most of the 44 million uninsured Americans: live in families with incomes higher than federal poverty level. Are from working families with at least one full time worker. Are adults under the age of 65. Work in medium size/large businesses with more than 25 employees. Are not from America’s racial and ethnic minority groups.

40. $64,000

41. What is the distribution of the Hispanic nonelderly uninsured when compared by race and ethnicity? 50% 25% 5% 17%

42. The Nonelderly Uninsured, by Race/Ethnicity, 1998

43. $125,000

44. Which group is at most risk of being uninsured? White (non-Hispanic) Black Native American Hispanic

45. Which group is at most risk of being uninsured? Source: Hall, Collins, and Glied, 1999 The Commonwealth Fund Collins, Hall, and Neuhaus, US Minority Health:A Chart Book, 1999 Trends in being uninsured have remained relatively unchanged for each group over the past 10 yearsSource: Hall, Collins, and Glied, 1999 The Commonwealth Fund Collins, Hall, and Neuhaus, US Minority Health:A Chart Book, 1999 Trends in being uninsured have remained relatively unchanged for each group over the past 10 years

46. $250,000

47. Which Hispanic group report the worst health status and the highest incidence of acute medical conditions? Colombians Ecuadorians Puerto Ricans Mexicans

48. Which Hispanic group report the worst health status and the highest incidence of acute medical conditions ?

49. $500,000

50. When was the category Hispanics first included in national data systems such as US census and birth/death certificates? 5 years ago In the last 2 decades Never an issue 100 years ago

51. What is the projected growth of the Hispanic population of the US population within the next 50 years? Nearly 25% Half No growth anticipated Not significant

52. Projected Resident Population by Race and Ethnicity of US 2001- 2050

53. $1,000,000

54. Which group has had the most emerging presence in US population? Central and South America Puerto Rican Mexican Cuban

55. Characteristics of the Hispanic Population in the US,2000

56. Emerging Latino Populations The Latino population is by all accounts growing dramatically and in the year 2000 became the country’s largest “minority” group. Immigration from the Caribbean and South America is making significant contributions to the growth of the Latino population. Relatively new Latino subgroups- Salvadorians, Dominicans, and Mexicans. Between 1980-2000 the size of the Central and South American pop doubled from 7% to 14.5%.

57. Latinos In The United States

58. National Origin of Latinos in New York City: Est 2000 Census

60. Vignette You are seeing for the first time a 56 yo Latina woman who comes in because she is “ feeling that her blood pressure is high”. She has a past medical history significant for Diabetes, Hypertension, Hyperlipidemia, and a family history of Breast Cancer. She volunteers to you that she had been listening to a doctor over the Spanish radio who was talking about herbal teas and concoctions (“preparaciones”) for her blood pressure which might be helpful to her symptoms. She is considering ordering a sampler package. She also wants her cholesterol checked because she also feels it is high.

61. Vignette Her 19 yo daughter who comes to the appointment her, reports that she is concerned about a breast lump that her mother found on herself about 3 months ago but had not sought medical attention for it. Patient had last mammogram 3 years ago. Results were not known.

62. PHYSICAL EXAM FINDINGS History offered by patient and daughter. Exam revealed an Overweight, Hispanic woman who appeared much older than her stated age. VSS- T98.7 BP 170/100, repeat 168/ 90 HR 70 HEENT- Fundi cotton wool spots noted and changes consistent with HTN retinopathy PERRLA- fair dentition with upper dentures Neck- Supple, No neck masses, No bruits noted Lungs- Mild upper airway rhonchi, no rales or wheezes noted. Adequate inspiratory effort noted Cor- Distant heart sounds, mild 2/6 systolic ejection murmur at apex.

63. PHYSICAL EXAM FINDINGS Breast Firm, discrete, irregular 2x4 cm, nontender mass palpated in LUQ Left breast. Left Axillary node palpated-mildly tender Abd Obese, nontender with no HSM or masses noted No abd bruits noted Ext Limited ROM with crepitus of knees noted when getting on and off exam table, 1+ edema with varicosities bilaterally. Without skin breakdown or fissue Of evidence of infection. UE arthritic changes noted bilaterally Neuro Cranial nerves intact. Monofilament testing revealed sensory deficits bilaterally

64. Vignette Medications: Allergies- NONE Atenolol 50 mg po qd Tobacco 30 yr/pack HCTZ 25 mg po qd Quit 10 years ago Zocor 100mg po qd Metformin 500mg po qd ASA 81mg po qd Premarin 4months/d/c’ed Una de gato Shark cartilage Hoja de Tilo Hoja de naranja Agria Flores de Coco Indio Anis de Estrella

65. Vignette Questions: What are are some challenges presented to the physician in this encounter? Given what what you have just learned about Latino health: What are some possible health needs to be addressed with this patient? What are some factors that can facilitate or hinder the doctor-patient relationship to be considered? What issues seem important to this patient?

66. Outcome Patient went for mammogram, which indeed revealed breast mass as palpated by patient and confirmed by MD. Subsequently, needed special views, ultrasound of the area and an excisional biopsy was ordered. Pathology revealed a fibroadenoma. No evidence of malignancy. Annual mammograms with monthly SBE were recommended. Pt with positive family history will require surveillance. Diabetes and Arthritis no active issues. Remain stable and are monitored on following visits.

67. Outcome After several visits patient revealed that she had believed that a mass found in her breast meant cancer and that meant death. It was in” la manos de dios” and so had not needed attention. Patient had met with the local cuidrandero and had been going for banos. Patient starts to come to her visits unaccompanied by daughter. Daughter schedules appointment with provider.

71. “To Feel Heard and Understood is Perhaps the Most Precious Gift of Life” Arthur Frank,

72. Thank You

75. Which Latino group has the highest rate of poverty? Salvadorians Mexicans Ecuadorians Puerto Ricans

77. Who was the first Puerto Rican Congressman? Ramon Velez Bobby Garcia Herman Badillo Luis Munoz Marin

88. Thanks to: Technical Support Carol Whitaker Maria Pasa Wilma Burgos Taneka Banks