Status of Hispanics Varies by Origins

In 1997, Hispanics accounted for 11 percent of the U.S. population. (The Census Bureau defines Hispanics as those who indicate their origins as Mexican-American, Chicano, Mexican, Puerto Rican, Cuban, Central or South American, or other Hispanic when shown a "flash card" listing ethnic origins.) In general, the Hispanic population is younger, poorer, less educated, and in larger households than the non-Hispanic population (Table 1). Median earnings for Hispanic males working full time in 1996 were $21,055, compared with $34,163 for non-Hispanics. Economic disadvantages reflect education disadvantages. Only 61 percent of Hispanics age 25-34 were high school graduates, compared with 91 percent of non-Hispanics.

Despite lower incomes and educational attainments, the Hispanic population enjoys a health and mortality record that in many respects is more favorable than that of the general population. Cutberto Garza, a physician and professor at Cornell University, comments that despite higher poverty and teenage fertility rates and less awareness of major risk factors for cancer and cardiovascular disease:

Hispanics in the Southwest have 99 percent of the life expectancy at birth of non-Hispanic whites. Even more remarkable, however, is that the lower than expected deaths due to heart disease, stroke, and cancer and lower than expected infant mortality are sufficient to compensate almost completely for the extraordinarily high mortality due to homicide and unintentional injury. The major exception… is excess deaths due to diabetes among Hispanic women. …

...The most striking challenge is the identification and preservation of factors that promote health before they are lost in the assimilation of Hispanic- Americans.

The higher death rates of Hispanic women from diabetes, compared with the general population, may be due to genetic factors. Garza also reports that Native Americans of the Southwest experience high incidences of diabetes that are hypothesized to result from a genetic ability to store excess energy, an advantage for populations at risk of severe food shortages. When food is plentiful, diabetes and obesity may result.

The Council on Scientific Affairs reviewed Hispanic use of health services and disease incidence, noting that Hispanics, particularly Mexican Americans, have lower rates of premature births and lower rates of low-birth-weight babies, major risk factors for infant mortality, than the general population. This outcome contradicts expectations that would be formed from the lower income and education levels of Hispanics. The authors also note that with acculturation, the risk of low-weight births increases, which might be due to increased smoking by pregnant women.

Diet could contribute to the lower than expected incidence of cancer and cardiovascular disease incidence in the U.S. Hispanic population. Sylvia Guendelman and Barbara Abrams with the University of California at Berkeley compared dietary quality of immigrants and following generation of Mexican Americans with non-Hispanic whites. The researchers used the Hispanic Health and Nutrition Evaluation Survey of 1982-1984 and the National Health and Nutrition Evaluation survey of 1976-1980. They concluded that as Mexican-origin women move from the first to the second generation, the quality of their diet deteriorates and approximates that of white non-Hispanic women. The researchers found that lower incomes were associated with less healthful diets among non-Hispanics, but with more healthful diets among first-generation Mexican Americans. Among second-generation Mexican Americans, they found no relationship between income and diet quality.

An earlier study by USDA’s Economic Research Service examined the interaction of Hispanic ethnicity, income, and education levels on intake of fat, saturated fat, and cholesterol, separating the direct effect of Hispanic ethnicity from the indirect effect of less nutrition knowledge as a result of lower education and income. The direct effect of Hispanic ethnicity was to reduce fat, saturated fat, and cholesterol intake. However, the indirect effect, through less knowledge as a consequence of lower income and education levels, offset these direct effects.

In this study, we examined whether the quality of Hispanic diets differed based on acculturation. The 1994-96 Continuing Survey of Intake by Individuals (CSFII) provides detailed information on intake of individuals as well as other information about them. The information includes whether the person was interviewed in Spanish. Thus, using interviews in Spanish as a proxy for acculturation, it is possible to compare the diets of nonacculturated Hispanics (Spanish speakers) with acculturated Hispanics (English speakers) and non-Hispanic whites, the largest population category.

Dividing the Hispanic survey respondents into Spanish speakers and English speakers highlights the economic disadvantages of Spanish speakers. Adult Spanish speakers lived in households that attained a median household income of 110 percent of the poverty level, compared with 201 percent for English speakers and 300 percent for non-Hispanic whites. Households with youth were more likely to be in poverty, which is based on the number of people in the household as well as income. Spanish-speaking youth (17 and under) lived in households with a median household below the poverty level, at 82 percent, compared with 131 percent of the poverty level for English-speaking youth and 291 percent for non-Hispanic white youth. (The median income divides households exactly in half–50 percent have higher incomes and 50 percent have lower; it is not necessarily the average.)

We used scores on the U.S. Department of Agriculture’s (USDA) Healthy Eating Index (HEI) to determine whether acculturation erodes diet quality. The HEI, developed by USDA’s Center for Nutrition Policy and Promotion, measures how well a diet conforms to 10 dietary recommendations in the Dietary Guidelines for Americans and the Food Guide Pyramid. All six populations (adult and youth Hispanic English speakers, adult and youth Hispanic Spanish speakers, and adult and youth non-Hispanic whites) fall below the 80-100 range that indicates a healthful diet. Properly designed and successful nutrition education programs would benefit all six populations.

Differences in fat, cholesterol, and fiber intake contribute to the Spanish speakers’ HEI scores. Adult Spanish speakers average approximately 4.6 grams per day less total fat and 1.9 grams per day less saturated fat than non-Hispanic whites. However, Spanish speakers’ consumption of cholesterol exceeds recommended levels, while cholesterol consumption of the other groups stays below recommended levels. Spanish speakers consume approximately 3.4 more grams of fiber per day than non-Hispanic whites, but the Spanish speakers still fall short of the standard of 25 grams per day, averaging only 19.4. Hispanic English speakers lag Spanish speakers by 2.9 grams of fiber per day.

We measured people’s attitude toward the importance of a healthful diet from the Diet and Health Knowledge Survey. This survey contacts a subsample of the respondents to the CSFII and asks questions on the importance of avoiding too much of nutrients such as fat, saturated fat, and cholesterol in their diets. We measured diet disease awareness by yes or no answers to another question on whether the respondent had heard about health problems related to several nutrients. Nutrient content knowledge was measured by correct choices between pairs of foods on the basis of higher or lower fat and nutrient contents. Spanish speakers’ higher HEI scores are not the result of better nutritional knowledge.

REFERENCES

v Nutrition Counseling Tips For Hispanic-American Clients

Ø Enter the session with an open mind.  Try not to be judgmental, but instead
    understand and accept differences.

# Latin Americans generally have a smaller personal space.
   Friendly physical contact such as touching the shoulder is
   appreciated after initial rapport is established.

# Maintaining eye contact is valued.

# Many Latinos have strong notions of social hierarchy, clear
   authoritarian/dependency social roles and a high regard for
   expert knowledge; thus they may expect the care provider to 
   be very directive and may exhibit dependency behavior.  They
   want clear evidence that the provider is concerned about them
   personally and they want 
   to be treated with respect.

Ø Use surnames and title (e.g., Mr./ Mrs.) for the first meeting, and at all times
   for the elderly, rather than given names.  This simple sign of respect will
   facilitate trust, a key factor in gaining acceptance for new dietary and lifestyle
   behaviors.

Ø Hispanics are not a homogeneous group so it’s important to identify the
   cultural background of the client.  Customize recommendations and
   interventions for each Hispanic audience.

Ø Assess the level of acculturation to mainstream American dietary practices. 
   The daily meal pattern in a typical Latino home varies according to the
   availability of traditional foods and the degree of assimilation into American
   society.  More acculturated individuals may need more help in selecting a
   variety of healthful foods, while the less acculturated, Spanish-speaking
   individuals may need  more assistance with modifying traditional dishes for
   healthier alternatives.

Ø Determine the client’s primary language spoken in the home as well as the
   reading and writing language and proficiency.  Latinos may be bilingual,
   speak Spanish only, or speak English only. Be aware that although
   Spanish-speaking, some may not read or write Spanish.

# If Spanish-speaking only, utilize Spanish educational materials to
   facilitate your instruction. Develop your own or use existing
   publications from other health and professional organizations,
   Hispanic groups or food manufacturers.

Ø Adapt the U.S. Food Guide Pyramid to include culturally-relevant foods and
   customs.

Ø Ask clients if they prefer to use an interpreter even if their English seems
   adequate.  Work with trained interpreters when possible, as a family member
   who is emotionally involved may not communicate everything or may add his
   or her own interpretation.  Also, a family member may be too proud to admit
   that he or she did not understand something.

Ø Involve and gain support of family members in the nutrition care plan,
   especially those that cook regular meals.  The family unit (including extended
   members) is the single most important social unit in the life of Hispanics, thus
   strong family support systems can be enlisted in their care.

Ø Consider gender differences and male dominance when working with Latino
   families.  If both the husband and wife are present during consultation there
   may be a tendency for the male to speak and make decisions for the woman.

Ø Support and stimulate the preservation of positive food practices related to
   traditional  health beliefs and dietary customs; the traditional Latin American 
   diet is high in fiber, relies mainly on vegetable proteins rather than animal
   fats, and increased consumption of vegetables and fruits high in vitamins A
   and C is common.

Ø Encourage the consumption of familiar and culturally acceptable healthy
   foods.

Ø Understand and appreciate different flavor systems — there is no one Latino
   cuisine.  Become familiar with the traditional foods, herbs and spices of the
   subcultural group you are working with and learn specific terminology in
   order to recommend healthier versions.  Clients may not divulge secret family
   recipes, but you can explore and shop at bodegas (neighborhood ethnic
   stores) to identify the "Latin pantry," or buy and cook dishes from authentic
   cookbooks, or dine out at authentic restaurants.

Ø Use food models, pictures and actual food labels during the instruction. 
   Remember to include typical mixed dishes – guisados (stews) are common.

Ø Emphasize portion control by asking the client to measure the amount of food
   typically consumed and then demonstrating the recommended amount of that
   food as a comparison.  Encourage the concept of grains/tubers (root
   vegetables), vegetables and fruits along with lean meats, such as pork loin.

Ø Encourage variety by raising awareness of the full range of food choices
   available.  Increase the client’s knowledge of healthy food selections from the
   typical American fare, especially whole grains.

Ø Conduct cooking and tasting demos of modified tasty and healthy traditional
   recipes in the Latino community at churches, recreation centers or after
   English-as-a-Second Language classes. 

Ø Dispel food and diet myths and misconceptions.  For example, some
   Hispanics may avoid dairy products because of perceived or real lactose
   intolerance limiting their calcium intake, when in  reality gradually increasing
   the intake of lactose-containing foods may improve tolerance to lactose.

Ø Exercising is not customary.  The "full-figured" woman is considered
   attractive and healthy.  Help clients, especially Latinas, understand the
   benefits of physical activity in terms of overall healthy body, mind and spirit. 

Ø Some Latinos see illness divided into "hot" or "cold" and food selections and
   treatments vary accordingly.  This is particularly important in pregnancy, a
   "hot" condition where "hot" foods are believed to upset the stomach.  Obtain
   detailed information about the client’s hot  and cold food practices as
   customs vary widely.

Ø Be aware of folk remedies.  The use of folk or traditional healers,
   Curanderos/Yerberos, is typical primarily of immigrant segments 
   of the Latino population.  Question the use of teas, powders, herbs, 
   as well as vitamins and minerals and assess potential nutrient and drug 
   interactions.  Explore neighborhood boticas, folk pharmacies, that carry
   curative herbs and ask how they are used.

Prepared for the National Pork Board by Maria AlamCameron, MPH, RD, LD
Salud Consulting, Inc.
Reprinted with permission.