SUMA/ORCHARD SOCIAL MARKETING, INC.

2. Cathy Schechter & Susan Poag Co-Principals SUMA/ORCHARD SOCIAL MARKETING, INC.

3. Research with Latinas • 6 Focus Groups with Hispanic women • Ages 18-27 • Born in U.S. and/or immigrated at <5 years old • 4 Preconception/2 Interconception • Woodburn/Salem, Eugene, Medford and surrounding areas • All groups conducted in English

4. Research with Providers • 3 “Provider” groups (staff from clinics, agencies serving Latinas) • Salem, Eugene, Medford • 15 Provider In-Depth Interviews • All five target counties represented

5. A Note about Eugene • Findings among women in Medford and Woodburn very resonant and consistent • University students in Eugene were significantly more educated, web-savvy and knowledgeable about their bodies and health care/birth control options • Providers in Eugene did not describe serving the women who came to the Eugene focus groups, indicating that university students are more acculturated and assimilated.

6. TOPLINE FINDINGS YOUNG WOMEN

7. Lines of Inquiry • Top-of-Mind thoughts about “health” • Definition of “good health” and “bad health” habits • Differences between them and their mothers vis-à-vis health and healthy habits • Health concerns and how they face them • Response to information in mock-up health magazines • Values • Media preferences • Recommendations for communications strategies

8. Generation 1.5: Straddling Two Worlds • Women place highest value on maintaining family connections, but also value the freedom to make their own decisions based on what is best for them • Most are bilingual & bicultural (media preferences, music choices) • They straddle two worlds, and this can be a source of stress & confusion

9. I chose this family picture because they’re all different ages. My family’s bigger, but we’re always together, and not so cheesy like, “Thumbs up happy.” But when everybody’s together, we’re happy. Then I chose this for myself because it just kind of reminds me of goals that I have and things I want to do for myself. So it kind of keeps me motivated to do that.

10. Like, our family comes from Mexico. When I go to Mexico everybody’s happy and they have nothing close compared to what we have. And we’re like, “I gotta get this, I gotta get that,” and a lot of people are like, “I got to go to college because I’ve got to make money.”It’s like the material things make the person. In Mexico everybody’s with joy and happiness. I want to live over here, but I don’t know about the lifestyle.

11. Key Influencers • Mom • Sisters and other female relatives • Friends • Boyfriends and husbands • Health care providers

12. BUT MOM RULES! • Number one source of health information: Mom • Number one source of home remedies: Mom • Who do you respect most: Two thirds of all participants said MOM or MY PARENTS

13. My mom. I call her up first, and if she can’t figure it out, then I go to the doctor.

14. Parents Often Lack Knowledge & Skills to Educate them about their Bodies • Many women did not learn about reproductive health in school • Parents are not educated about anatomy and reproduction • Many cultural taboos surround family discussions about menstruation and sexual relationships

15. I think that issue of changes and bringing up pregnancy, or even just talking about that is just like, forbidden. It’s just like we don’t talk about that. And especially sex. [Agreement] That’s a no.My mom was like, “… you can’t go swimming and you can’t have sex because you’ll get pregnant! And even if they touch your boobs!” If I talked to her about tampons, she’d be mad because she thought I was having sex.

16. They want to be able to use a tampon and not feel guilty about it…if a girl, another Latina, sees them and tells their mom, “You know Julie uses a tampon,” you’re worried the word’s going to get out. “Oh her daughter’s not a virgin, I heard she uses tampons.” That’s a huge issue for these young women.

17. Young Women Need Information about Women’s Health Care • Most women lack access to health insurance • Without Medicaid, young women may not know what their health care options are or when to use them unless they become pregnant

18. As a minor we always had OHP through my mom. Whenever I needed to go to the clinic, that was always taken care of. But now I’m kind of on my own. I don’t have no insurance, nothing, so I don’t really go unless it’s crucial, something really important.I need to get insurance soon. I turn 26 in two weeks and so I’m getting kicked off my parents’ insurance and my current job doesn’t provide it for me, so I’m looking for work that will give me that.

19. Without family role models or explanation, appropriate health education at school or a health care provider, many young women do not understand the reproductive process, birth control options and the components/reason behind well-woman check-ups (e.g., PAP smears)

20. Like you hear all this stuff on TV, this is new. Or get your yearly exam. Or like the HPV. You just hear different things. Then you go to the doctor, it’s like, “Oh you’re fine. Do you want me to check you for Chlamydia.” I was in my head thinking, “That’s what they were going to check for, they already checked for that stuff, like that’s what they gave me a PAP for.” But they asked me do you want to get checked for this, but I’m thinking what the heck is the test for? I thought I was getting checked for everything that’s out there…I don’t know what’s out there.

21. Access to Health Care Limited • Many lack health insurance • Many discuss their lack of health care options • Use of emergency room • Use of public health and/or indigent care clinics • Go only when they are really ill • Women in all groups describe mixed treatment in clinics by staff or doctors • Prevalence of feeling “dismissed,” or rushed • Long waits, lack of trust

22. If you don’t have insurance they won’t see you.They talk medical language, like what is that? I don’t even know. Can you please just talk to me in English? But that’s what they do sometimes.

23. Cultural Challenges with Healthcare • Some doctors try by learning Spanish etc. • Questions and concerns about US healthcare system vs care in Mexico • Some stories about lack of cultural sensitivity

24. I think it’s just that they don’t know the culture. They can’t relate to it….It’s like if you don’t have friends or family or whatever, someone that’s close to them to understand exactly what kind of people we are, what kind of customs we carry and the kinds of diets we carry and all those remedies our grandmas talk about. So to me it’s like there’s no way you can relate even if you were to take a Spanish class, sorry.

25. Respondent 1: There are a couple of friends and family members I know that went to the doctor. Something was wrong with them, and she said they couldn’t find a solution. They go to Mexico and get treated over there. They come back and they’re perfect.Respondent 2: Yeah, that’s what my mom said. She’s like, “They just want to use your insurance money here.

26. Yesterday I went to take an ultrasound, right here at maternal natal clinic, and they were giving me the paperwork in Spanish, and I’m like, “Can you give it to me in English please?” And the girl just looked at me and said “Aren’t you Hispanic?”

27. Perceived Generational Differences • Education • Openness • Traditional Ways • Cuarantina • Healthy foods • “Mom is there for me.”

28. Top of Mind: Preconception & Interconception Define “Health” Differently • Interconception, women often think of their children’s health first • Interconception, women more motivated to stay healthy for their children • Preconception women tend more to associate health with diet, exercise, mental health, sleep, skin care, • STDs, health insurance access and family history mentioned across groups

29. Staying Healthy • High awareness of what they need to do (eat well, exercise, avoid drugs and tobacco, etc.) • Barriers to taking steps to good health include time, money, motivation, skills

30. Many Use Home Remedies • Cinnamon sticks boiled in water with red onion for cough • Tobacco in the baby’s belly button for colic • Wear a red shirt with a safety pin during an eclipse during pregnancy to prevent sick babies • Put breast milk in eyes for pink eye • Put breast milk in ears for ear infections

31. More Home Remedies • If baby has diarrhea and soft spot has dropped, turn baby upside down and slap his feet • Rub raw egg over baby with a fever • Rubbing alcohol, marijuana and garlic for sore bones • Candle in the belly button to take the devil out

32. And More… • Alfalfa tea to improve eyesight • Smoke in the ear for an earache

33. The Curanderos • In all groups, almost half of the women had been to a curandero in Mexico, and some have seen one in Oregon

34. Respondent 1: My mom, when I was younger, she thought the devil was inside of me because I wouldn’t listen to her, so in December we went to Mexico for our vacation and she decided to take me. So they laid me down on a bed and this guy started shaking leaves. (Laughter)Respondent 2: Time out! I opened the garage door once and I thought my grandma was beating my brother with rosemary. I thought he was busted (overlapping laughter), I was like six.Respondent 1: And then they put a candle on my belly button and I guess the devil came out of me. (Laughter)

35. They Laugh Through Uncertainty Respondent 1: My boyfriend is like, “Are you wearing red?” I’m like, “Yes I am!” (laughter) But I don’t freak out about it. Respondent 2: But I wonder if it’s true! Respondent 1: No, I actually don’t think it’s true. Respondent 3: I think it’s true. Because when my boyfriend’s mom was pregnant she actually did wear something red, and a lady that was also pregnant didn’t, and her baby came out with defects.

36. Quarentena = 40 Days of Rest The forty days after they have the baby, you can’t do anything. You have to have someone cook for you, do all the chores for you. You can’t go outside. Every time my mom sees somebody that already they’re in their quarentena, “Oh my god, I can’t believe she’s out! What is she doing?” Like seriously, you know. And I’m like, “She looks fine to me. But okay.”

37. Well, there is this thing called quarentena, which is like 40 days. After I delivered even my mom was wrapping me up in all these clothes, “In Mexico, you can’t even take a shower for 40 days.”…then she’s like going upstairs she made me walk backwards…you have to wear a sweater when you go out…cover your head.

38. Perceptions of Latina Paradox • Believable • Number 1 Difference: Stress levels • Number 2: Nutrition • Number 3: Family support

39. I think a lot of the stress is cultural here versus there, because there people are more accepting. People want to be more nurturing and caring for mothers, whereas here a mom has all these stresses. She has to worry about people accepting her. Maybe she’s younger, so it’s like oh my god, all these people are looking at me like this, and that’s because I’m young and I gotta get a job, and what’s going to happen with my family, if your family is here. You have more of those stresses as opposed to in Mexico where it’s a little more accepting and people want to take care of you.

40. I think it’s probably worse because here you’re pregnant, you’re like, “Oh, I have to work and work and work, because buying this for the baby and buying a house and we’re paying the car and in Mexico, you’re pregnant, you’re like, you stay home and clean.

41. I think nutrition has a lot to do with it, too. Because I know that if you’re over there with your family, the way that you’re raised and stuff, the mom that is about to give birth needs to be taken care of. She needs to be eating right. And you have people around you. Your abuelas, your tÌas, whatever you want. People that raised you that are making sure you’re eating right.Down there the foods are a lot more natural. What you eat and drink is more natural. They don’t put chemicals down there like they do here.

42. Consequences of Unplanned Pregnancies • Interconception groups have lived it and express it • Preconception groups express consequences • Drop out of school • Depression • Financial instability • “Not succeeding” • Disowned by family • Boyfriend leaves you

43. Prospect of Birth Defects Mentioned in a Few Groups I think birth defects also, because people are either drinking or drugs, and they’re not thinking they’re going to get pregnant, and it passes on to their babies.

44. Not being physically ready. Or even mentally. Like say you are 19 and it was about partying. You smoke weed now and then. You weren’t thinking about being a mom yet. You were just doing your own thing. Then you find out you’re pregnant. It’s like, ‘Okay, now I have to step it up. I need to find a good job. I need to find a place to live.’ You need to get mentally quick.

45. “We hardly ever see things like this.”Very Positive Response to “Reproductive Life Plan” • Information seen as new and valuable • Many appreciate the questions and answers • Many like having resources for more information • Many expressed motivation to act on new information (vitamin chart, STDs, etc.)

47. I think it’s good that it has phone numbers and web sites on here that you can actually go and look up information if you want more.I like how it says, “The better you feel, the better you look.”It gives you the solutions, too, if you want to take it. I love this, “Life is full of ups and downs, but good news, when you’re down there’s no place to go but up.”

49. Anytime I do read something about health, it always makes me feel better when it says there’s “no normal.” Because mine are always three days late, but if you ask me that’s my normal, and it just always makes me feel not weird when I read this. I’m a chart person, so I love the vitamin chart, like what it is, the benefits, the source.It makes it simple and easy to understand, and it’s comfortable to read.