10/17/2014
LATINO HEALTH & WELL-BEING IN THE
UNITED STATES:
Making the Case for Adolescents
Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN
Professor, NYU School of Social Work and
Global Institute for Public Health
Co-Director, Center for Latino Adolescent and Family Health (CLAFH)
October 17, 2014
LSWO National Social Workers Conference 2014
OVERVIEW
I.
Provide a demographic overview of Latinos in the United States
II. Examine the importance of adolescents for the health and wellbeing of the Latino community
III. Identify a case example of Latino health and well-being through a
focus on adolescent sexual behavior
IV. Highlight the NYU Latino Initiative and the work of the Center for
Latino and Adolescent Family Health
The U.S. Latino Population:
Large, diverse, and growing.
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THE LARGE AND GROWING LATINO
POPULATION IN THE U.S.
• There are approximately 54 million*
Latinos living in the U.S.1
• Latinos comprise approximately
17% of the nation’s population.
•
A six fold increase since 1970.1
• The percentage of Latinos in the
U.S. increased five fold between
1960-2011 and is projected to
increase 70% by 2050.3
Source: [1] U.S. Census Bureau. (2014). Hispanic Americans by the Numbers. [2] Pew Research Center. (2014). Hispanic Trends Project. Retriev ed f rom http://www.pewhispanic.org/.
[3] Tay lor, P., Cohn, V. (2012). Pew Research Center U.S. Population Projections: 2005-2050. Retriev ed f rom http://www.pewhispanic.org/2008/02/11/us-pop ulation- projectio ns-200 5-20 50/.
f actf inder2.census.gov /faces/tableserv ices/jsf/pages/productv iew.xhtml?pid=ACS_12_1Y R_B01001I&prodTy pe=table.
DRIVERS OF LATINO POPULATION
GROWTH IN THE U.S.
+575,277
Migration
+2.3
Million
Births
334,517
Deaths
• From 2010-2012, Latinos
accounted for approximately 50%
of the population change in the
United States.
• Between 2010 and 2012, the Latino
population grew 5.8% while the
overall population grew by 1.7%.
Increase of approximately
2.5 million Latinos
Source: U.S. Census Bureau, National Characteristics: Population by Sex, Race, and Hispanic Origin. 2012.
DRIVERS OF LATINO POPULATION
GROWTH IN THE U.S.:
MIGRATION AND BIRTHS
• Births have surpassed
immigration as the main
driver of growth among
Latinos.2
Source: [1] Krogstad, J.M., Lopez, M.H. (2014). Hisapanic Nativ ity Shif t: U.S. births driv e population growth as
immigration stalls. Retriev ed f rom http://www.pewhispanic.org/2014/04/29/hispanic-nativ ity -shif t/. [2] Motel, S.
Patten, E. (2013). Statistical Portrait of Hispanics in the United States, 2011. Retriev ed f rom
http://www.pewhispanic.org/2013/02/15/statistical-portrait-of -hispanics-in-the-u nited-states-201 1/.
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In 2013, 65% of all Latinos in the U.S. were
U.S. born.
Source: [1] U.S. Census Bureau, 2013 American Community Survey.
LATINO ORIGIN GROUPS IN THE U.S.
17% (Includes 3.9 million residents of Puerto Rico)
(64%)
(4%)
(4%)
(3%)
(2%)
Mexicans and Puerto Ricans
comprise approximately 81% of
the U.S. Latino population.
Total Latino Population in U.S.: Approximately 54 million
Source: U.S. Census Bureau. 2012. Hispanic or Latino Origin by Specific origin: Universe: Total
Population.: 2012 American Community Survey 1-Year Estimates. Source: U.S. Census Bureau,
American Community Survey 2012.
GEOGRAPHIC DISTRIBUTION OF LATINOS IN THE U.S.,
The Latino population is primarily concentrated in 5 U.S. states.
2013
State
# of Latinos
(in millions)
% of State’s Total Population
California
Texas
Florida
New York
Illinois
14.7
10.2
4.6
3.6
2.1
38.4%
38.4%
23.6%
18.4%
16.5%
Over half of the Latino population in the U.S. resides in California, Texas and Florida:
traditional migration destinations.
Source: U.S. Census Bureau. (2014). http://quickfacts.census.gov/qfd/states/06000.html
Sources: Pew Research Hispanic Center 2011 American Community Survey.; U.S. Census Bureau, 2013 American Community Survey.
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INTERNAL MOVEMENT OF THE LATINO
POPULATION
•
•
Latinos are moving to new geographic
areas.
The five states with the greatest Latino
population growth from 2000-2010:
1.
2.
3.
4.
5.
Alabama
South Carolina
Tennessee
Kentucky
South Dakota
Fast Growth (= >75%)
Slow Growth (<75%)
< 1,000 Latinos in 2010
Sources: Brown, A., Lopez, M.H. (2013). Ranking Latino Populations in the States. Retrieved from
http://www.pewhispanic.org/2013/08/29/ii-ranking-latino-populations-in-the-states/.
LATINOS IN THE U.S.: A YOUNG POPULATION
Latino
White
Median age of…
Latinos
Latinos represent the youngest
ethnic minority group in the United States.
Sources: Pew Research Hispanic Center 2011 American Community Survey.; U.S. Census Bureau, 2013 American Community Survey.
Retrieved from: http://www.pewhispanic.org/2013/02/15/hispanic-population-trends/ph_13-01-23_ss_hispanics9/.
AGE DISTRIBUTIONS FOR
LATINOS VS. WHITES, 2011
Latino
Latino
White
White
Sources: Pew Research Hispanic Center 2011 American Community Survey.; U.S. Census Bureau, 2013 American Community Survey. Retrieved from
http://www.pewhispanic.org/2012/02/21/statistical-portrait-of-hispanics-in-the-united-states-2010/#11.
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Latinos represent the youngest ethnic
minority group in the U.S., attributed
primarily to new births.
Making a Case for Health & Well-Being:
The Importance of Adolescents
LATINO ADOLESCENTS:
A GROWING POPULATION
•
In the U.S., more than 1 out of 5 adolescents (ages 10-19) is Latino.
1 in 4
adolescents
•
1 in 3
adolescents
Every 30 seconds, a Latino in the U.S. turns 18 years old.3
Source: [1]Child Trends analy sis of US. Census Bureau. (2012). Population Projections: 2012 National Population Projections.[2] U.S. Department of Health and Human Serv ices. (2013). Health Snapshot-Hispanic
Adolescents in the United States. Retriev ed f rom http://www.hhs.gov /ash/oah/news/e-updates/eupdate-mar2013.html. [3] The Association of Hispanic Adv ertising Agencies.. (2013). Hispanic Fast Facts. Retriev ed
f rom https://ahaa.org/def ault.asp?contentID=161.
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DEFINING ADOLESCENCE
Young
Adulthood
•
Adolescence is perceived as a time of good health when disease burden is low.
As a result, adolescents have been largely neglected in global public health.
Early Adolescence
• Ages 10 to 14 years
Late Adolescence
• Ages 15 to 19 years
Young Adulthood
• Ages 20 to 24 years
Young
People
Adolescence
•
•
However, behaviors young people adopt in adolescence affect current health, have
substantial effect later in life, and potentially affect future generations 1.
 Time when opportunities for prevention of disease are great.
Source: Sawyer et al., Lancet 2012, 379, 1630-1640.
ADOLESCENCE: A KEY PERIOD FOR PREVENTION
Adolescence: A period of dynamic change, with potential for long-lasting effects.
Adolescence represents an
opportunity to:
1.
2.
3.
Correct early life
disadvantage.
Shape long term
trajectory.
Impact the country’s
economic well-being.
Figure From: Sawyer et al., Lancet 2012, 379, 1630-1640.
EMERGENCE OF RISK BEHAVIORS IN ADOLESCENCE
Nearly 70% of premature deaths and 1/3 of the total disease burden in adults is
associated with processes that begin in adolescence.1
Global DALYS (%) Attributable to
Leading Risk Factors Across Age Groups2
•
•
Disease burden among early
adolescents is generally low, but
rates sharply increase in later
adolescence & early adulthood.
Increase corresponds with the
emergence of risk factors in
adolescence that contribute to
disease outcomes apparent in
mid-late adulthood .2
10-14
years
15-24
years
25-59
years
60 years +
Alcohol use
2%
8%
8%
3%
Unsafe sex
2%
5%
8%
1%
Lack of contraception
0
2%
1%
0
Illicit drug use
0
2%
2%
0
High blood pressure,
cholesterol, glucose
0
0
11%
29%
Physical inactivity
0
0
3%
7%
Tobacco use
0
0
6%
10%
Overweight & obesity
0
0
4%
7%
*Risk factors below dashed line start contributing to DALYs from age 25 and older.
Sources: (1) World Bank. World Development Report, 2007. (2) Figure from: Gore et al., Lancet, 2011 .
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A COMPELLING CASE FOR LATINO
ADOLESCENT HEALTH & SOCIAL WELFARE
• Contribution of adolescence to overall population health been underestimated.
The Case for Investing in Latino Youth:
Second Critical Period
in Development
• Opportunity to correct early life disadvantage or modify
childhood trajectories towards health1.
•A significant and increasing proportion of the overall Latino population
are young people able to work2.
Demographic
Dividend & Future
Economic Growth
• The youth labor force (ages 16-24) is growing in the U.S., and 56.2% of
Hispanic youth (ages 16-24) were employed in July 2014, shaping
country level socioeconomic development.
• Economic potential is dependent on investment in the health &
education of future Latino working population, youth.3
Latino prevention programs should adopt life-course approach with emphasis on adolescent years.
Sources: (1), Viner et al., Lancet 2011, 379, 1641-1663; (2) UNFPA. 2010. The Case for Investing in Young People. (3) Bureau of Labor
Statistics, 2014. http://www.bls.gov/news.release/youth.htm.
ECONOMIC WELL-BEING
AMONG LATINO YOUTH
•
Demographic dividend and economic growth: When youth are in school or are
participating in the labor market, they contribute to the nation’s economic opportunity.
Currently, 6.7 million young adults
(ages 16-24) are not in school or
are not working.
• Approximately 20% of young
Latinos (ages 16-24) are
unemployed or not in school.
Disconnected youth* (ages 16-24) contribute to an estimated fiscal
burden** of $93.7 billion annually.
* Refers to youth ages 16-24 who are not in school or participating in the labor market.
** Refers to lost taxes and higher government spending.
Source: Belfield et al, 2012. The Economic Value of Opportunity Youth. Corporation for National and Community Service and The White House Council for
Community Solutions.
The future health and economic well-being of
the U.S. population will be largely shaped by
young people- particularly, Latinos.
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LATINO ADOLESCENTS IN A
BROADER CONTEXT
To fully understand Latino social welfare and health disparities, Latino youth must be placed
within a broader context .
• Risk & resiliency among Latino
youth occurs in a context in which
multiple influences shape behavior
and outcomes.
Adolescents are heavily shaped
by context, one of the most
important is the family.
Source: Bronfenbrenner, U. (1994). Ecological models of human development. In.
International Encyclopedia of Education, Vol. 3, 2nd. Ed. Oxford: Elsevier.
WHY FOCUS ON THE LATINO FAMILY?
Families play a critical role in shaping overall
adolescent health, well-being and economic trajectory.
As adolescents’ fundamental support system
(economic, emotional, physical, psychosocial), families can
act as a buffer against disadvantage and adversity.
Sources: Viner et al., Lancet, 2012; Patton et al., JAH, 2010.
PARENTAL INFLUENCES ON ADOLESCENT BEHAVIORS
Family Structure
Family Processes
• Marital status
• Parent-adolescent communication
• Parental education
• Parental monitoring and supervision
• Socioeconomic level
• Overall relationship quality and
satisfaction
Traditionally, there has been emphasis on family
structure with less attention to family processes
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Latino youth sexual and reproductive
health and behavior
DISPARITIES IN TEEN PREGNANCY
• The U.S. teen pregnancy rate declined 51% since it peak year in 1990.
Teen Pregnancy Rate* by Race/Ethnicity, 1990-2010
250
200
150
100
Latino teens
remain
disproportionately
impacted by teen
pregnancy.
223
162.2
116.9
98.8
152.9
83.4
137.1
99.5
71.3
57.4 49.8
50
83.5
0
1990
* per 1,000 women ages 15-19 years
2000
Overall
White
Black
2010
Latino
Source: Guttmacher Institute, 2014
LATINO TEEN SEXUAL AND
REPRODUCTIVE HEALTH
Teen Pregnancy
Teen Births
Repeat Teen Births
•Roughly 1 in 3
Latina teens get
pregnant at least
once before age
20.
•The Latina teen
birth rate is 41.9
births per 1,000
Latina teens ages
15-19.
•21% of teen births
among Latinas
were repeat
births.
Sources: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2014. Centers for Disease
Control and Prevention, 2013.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a4.htm?s_cid=mm6213a4_w#fig
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DISPARITIES IN SEXUAL AND
REPRODUCTIVE HEALTH OUTCOMES
• Disparities in STDs* and HIV infection persist among Latino teens.
Race/Ethnicity
STD Rates** Among Teens Ages 15-19 by Race/Ethnicity, 2011 & 2012***
Chlamydia
Gonorrhea
HIV
White
830.1
85.3
0.4
Latino
1191.0
139.7
2.3
4977.7
1513.5
10.6
Black
* Chlamydia and gonorrhea rates are presented because they are the two most
commonly reported infectious diseases in the U.S.
**per 100,000 population (ages 15-19)
*** Gonorrhea and Chlamydia estimates are from 2012; HIV rates are from 2011
Source: CDC (2011); CDC (2012)
TEEN PREGNANCY PREVENTION PROGRAMS
Dominant Approaches
Clinic-Based Prevention Programs
School-Based Curricula
Community Based Programs
Social Media Campaigns/PSAs
Focus on Teens Directly
Environment/Structural Policies
• Taken together,
these approaches
focus on
adolescents directly
(i.e. individual teen
behavior).
• Less attention is
placed on the teen’s
context, one of the
most important
being the family
FAMILY BASED APPROACHES
Advantages
• Adolescents want their parents
to be involved.
• Parents are the experts of their
children.
• Interventions can be
implemented in the context of
the family’s values.
• Timing is flexible & ongoing
• Information can be tailored for
the parent and child
• Parents are motivated to keep
their child safe & healthy
Challenges
• Interventions may be too time
intensive.
• Family organization and
contexts can change rapidly.
• There are competing priorities
for parent attention & resources.
• Participation rate vary due to
difficulties in recruitment &
retention.
• Interventions must appeal to
both parents & adolescents.
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FAMILIES TALKING TOGETHER
• A Brief Parent-Based
Intervention to Prevent/Reduce
Sexual Risk Behavior Among
Latino and African American
Adolescents*
Family-Based
Latino-specific
High quality rating*
Source: Guilamo-Ramos, Jaccard, Dittus et al., 2011
* This intervention is categorized as an effective
program by the US Department of Health and
Human Services
ESSENTIAL
COMPONENTS OF
FAMILIES TALKING
TOGETHER
I. Adolescent Level
II. Parent Level
Determinants of
sexual risk
behav ior
Communication
• There are three essential
components for
developing effective
family based interventions
integrated in Families
Talking Together.
III. Linkage of
Parent &
Adolescent Levels
Mechanisms that
link both lev els to
shape adolescent
decision making
Monitoring &
Superv ision
Quality of
relationship
INTERVENTION STRATEGIES
• Families Talking Together (FTT) essential strategies
Parent-Adolescent
Communication
Monitoring &
Supervision
• Motivate parents to talk
• Support parentadolescent
communication with
specific content and
delivery strategies
• Provide specific
guidance to parents on
monitoring and
supervision practices
Relationship
Satisfaction
• Overall relationship quality is
likely to encourage
behavioral expectations set
for the teen—emphasize key
parental characteristics for
higher relationship quality
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FAMILIES TALKING TOGETHER (FTT):
AN EFFECTIVE INTERVENTION
• FTT demonstrated efficacy in both clinic settings & school-settings
• Relative to the control group, adolescents whose mother received FTT:
Adolescent Outcomes
Parent Outcomes
 Experienced delayed sexual debut
 Lower frequency of sexual intercourse in past 30 days
 Less likely to have ever engaged in oral sex
 Higher levels of communication with mother about
not having sex
 Higher perceived maternal expertise & trustworthiness
 Higher reported relationship satisfaction with mother
VIDEO
THE CENTER FOR LATINO ADOLESCENT AND
FAMILY HEALTH
CLAFH investigates the role of
families in shaping
the development and wellbeing of adolescents
The mission of CLAFH is to address the needs of adolescents
and their families, specifically the prevention of problem
behaviors among Latin American youth and promotion of
health and economic well-being of Latin American families.
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CLAFH AROUND THE GLOBE
The United States
Shanghai, China
The U.S.-Mexico Border
Puebla, Mexico
The Caribbean Region
India
Across settings, parents play a role in their teens’ health and well-being
The Latino Initiative
THE NYU LATINO CONSORTIUM
To respond to the need for multi-national perspectives & approaches for supporting Latin
American health and social welfare needs:
1. Establish U.S.-Latin American Consortium
2. Conduct Research Relevant to both
United States and Latin American Region
Three step
strategy
3. Encourage Academic Exchanges Between
NYU and Latin American Institutions
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CLAFH RESOURCES
www.clafh.org
THANK YOU
Vincent Guilamo-Ramos, Ph.D., MPH, LCSW, RN
E-mail: [email protected]
Telephone: 212-998-4306
http://www.clafh.org
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