Reported Health Related Issues Among Rural Illinois Hispanic Adults: Results of Surveys in Five Communities

1. Reported Health Related Issues Among Rural Illinois Hispanic Adults: Results of Surveys in Five Communities APHA Annual Meeting Nov. 8, 2006, Boston, MA Martin Krebill-MacDowell, DrPH (corresponding author) Sergio Cristancho, PhD Marcela Garcés, MD, MSPH Ben Mueller, MS Karen Peters, DrPH Project Export and National Center for Rural Health Professions University of Illinois at Rockford E-mail mmacd@uic.edu Project support provided in part from the NCMHD funded Project EXPORT - Center of Excellence in Rural Health University of Illinois at Rockford

2. Purpose/Objectives • Identify priority health related issues reported by rural Hispanic residents in the five study communities • Describe major relationships observed between the family income and time in the US to health related indictors in the five rural communities • Identify communication methods most preferred for obtaining health information by rural Hispanic residents in the five communities

3. Introduction • The number of rural communities with in-migration of Hispanic residents in the Midwest has increased during the last ten years. The immigration, language, and socioeconomic characteristics of these new residents have major implications for public health and health services organizations.

4. Methods • An IRB approved purposive (convenience sample) written survey was conducted without recording of any personal identifiers. A Participatory Action Research (PAR) approach was used in cooperation with Hispanic community leaders and Hispanic Health Advisory Councils in 5 rural Illinois towns. Surveys having a Flesch-Kincaid grade level of 7.4 were provided in either Spanish or English based on respondent choice. • Surveys were completed (n=720) at Hispanic events in the five Illinois communities. Specifically Rochelle (n=58), DeKalb (n=239), Effingham (n=119), Danville (n=49), and Beardstown (n=255).

5. Overview of Respondents • 91.3% answered the Spanish version of the survey • 50.2% of the respondents were aged 30 or less • Those in US < 10 years were of younger ages p <.01 (parametric and non-parametric tests used) • Years in US 1O years or less mean age = 30.45 (n=403) versus More than 10 years in US mean age = 38.63 (n=120) • Gender was about equally balanced between male and female • About 70% of respondents gave their country of birth as Mexico (about 10%, 75 gave no answer) • Of those giving length of time in US, about 77% had lived in the US < 10 years (122 gave no answer) • About 62% were currently married (48 gave no answer) • About 80% had children (47 gave no answer)

6. Data Analyses • Frequencies were run for all variables related to health problems, health risk behaviors, health care access, and sources of health information • Cross tabulation of the study variables was done for income and length of residence categories • Family income was categorized as < $20,000 and $20,000 or more ($20,000 is poverty level for a family of four) 1 • Length of residence in US was categorized as 10 year in the US or less and more than 10 years in the US. • Chi-square statistics were used to compare differences in patterns of study variables between income and length of residence categories. Two-sided chi-square of .05 was considered a statistically significant difference when income and residence categories were compared.

7. Results – Reported priority health issues * * * * * * Notes: Other problems mentioned: Arthritis 8.5%, Health Disease 6.5%, Cancer or Tumors 3.5%, Infectious Diseases 2.6%, Brain Conditions (e.g. stroke; epilepsy)2.2%, Physical Disability 2.1%, and Misc. Other 10.1% * indicates p < .05 difference in pattern between residency subgroups

8. Summary – health problems • Dental problems were highest reported problem in both length of residence categories (39% if < 10 years, 47.1% if > 10 years and 40.6% overall • Reporting of diabetes and kidney problems did not show statistically significant differences between residence categories. • High blood pressure, high cholesterol, obesity, asthma, psychological problems, and arthritis were the next most commonly reported problems – all were significantly higher among those respondents residing in the US 10 years or more.

9. Logistic regression results:Prediction of health problems - effects of length of residence, age and years of education R2 is quite low for prediction of all problems and estimated relative risk due to predictors is consistently low. For all problems except dental problems, residing in US 10 or more years was a predictor of having the problem with the effects of age and years of education held constant.

10. Results – Reported behavioral issues influencing health No statistically significant differences occurred between residency subgroups

11. Results – Health Related Behaviors • Percentage reporting adverse health related behaviors was less than 10% ranging from 9.6% for lack of physical activity to 1.7% for domestic violence. • No statistically significant differences were observed between length of residence categories for health related behaviors.

12. Results - Reported positive responses about health care No statistically significant differences occurred between residency subgroups

13. Results - Reported problem issues regarding health care * * * Indicates p <.05 difference in pattern between residency subgroups

14. Results – Health care issues • Percentage reporting adverse health related behaviors was less than 10% ranging from 9.6% for lack of physical activity to 1.7% for domestic violence. • No statistically significant differences were observed between length of residence categories for health related behaviors

15. Results – Preferences for obtaining health related information * * indicates p <.05 difference in pattern between residency subgroups

16. Results-Health information Preferences • Preference for health information being conveyed in Spanish at schools, churches, and community centers was consistently over 60% in both residence categories with a slight decline if residence was > 10 years, p < .05. • Interest in other methods of communicating health information were about the same (about 25% to 32% overall would had interest in getting health information that way. No significant differences were observed between length of residence categories. • Interest in home visits was the lowest at 18% overall with no difference observed between length of residence categories.

17. Conclusions / Discussion • Dental care access, language impact on health care delivered, and ability to obtain health insurance are priority health issues among those surveyed • Those having longer residence in the country experiencing somewhat less concern about these issues than recent immigrants • A strong preference for health information to be presented in community oriented Hispanic health organizations instead of conventional health promotion methods (written or media) is indicated

18. Conclusions - continued • Many chronic health conditions or chronic disease risk factors are reported more commonly among those residing in the US > 10 years than those in the US < 10 years • Adjusting for age and education, length of time in the US of >10 years is a predictor of these health problems or risk factors. • Community health organizations should seek to reduce adoption of US lifestyle and nutrition practices that increase risk of chronic conditions and risks • Attention to language issues and reduction of barriers to health care associated with lack of a payment mechanism should be addressed.

19. Discussion • Variation between income groups was also examined but is not presented due to space limitations. Few differences were observed in study variables between the two income categories < $20,000 (76.6%) and > $20,000 (23.4%); however, only 427 of the 720 survey respondents reported family income which limits the usefulness of comparisons between income categories. • Results of the comparisons between income categories are available upon request from the corresponding author.

20. Discussion of Limitations • The survey is based on self reporting with no clinical verification of health conditions or risk factors • Social response bias may have influence reporting of health behaviors and reported percents of health risk behaviors may actually be higher • Samples in each community were not random samples of all Hispanics residing in the community and were thus “volunteers” who chose to come to community meetings/events and participate in the survey.