Latina Women’s Health Frances Ashe – Goins, RN, MPH Deputy Director - Office on Women’s Health...

Latina Women’s Latina Women’s HealthHealth

Frances Ashe – Goins, RN, Frances Ashe – Goins, RN, MPHMPH

Deputy Director - Office on Women’s Deputy Director - Office on Women’s Health Health

U.S. Department of Health and Human U.S. Department of Health and Human Services (HHS)Services (HHS)

Racial/ethnic categoriesRacial/ethnic categories 2000 Census 2000 Census

RaceRace – African American/Black; Hispanic/Latino; – African American/Black; Hispanic/Latino; Asian American; American Indian & Alaskan Asian American; American Indian & Alaskan Native; and Native Hawaiian & Other Pacific Native; and Native Hawaiian & Other Pacific IslanderIslanderEthnicityEthnicity – Hispanic or Latino or Not Hispanic – Hispanic or Latino or Not Hispanic or Latinoor LatinoCaucasian/WhiteCaucasian/White – majority population – majority population

(Note – the data in this presentation is not reflected (Note – the data in this presentation is not reflected of the new racial categories) of the new racial categories)

U.S. Population U.S. Population

307 million people in the US, 2009 307 million people in the US, 2009 estimateestimate

15.8% are of persons of Hispanic or 15.8% are of persons of Hispanic or Latino originLatino origin

50.7% are Hispanic/Latina female50.7% are Hispanic/Latina female

Leading Causes of DeathLeading Causes of Death All women All women Hispanic Hispanic

American & American & Latina Latina WomenWomen

1.1. Heart DiseaseHeart Disease2.2. All cancersAll cancers3.3. StrokeStroke4.4. Chronic lower Chronic lower

respiratory diseasesrespiratory diseases5.5. DiabetesDiabetes6.6. Flu & pneumoniaFlu & pneumonia7.7. Alzheimer’s diseaseAlzheimer’s disease8.8. AccidentsAccidents9.9. Kidney DiseaseKidney Disease10.10. SepticemiaSepticemia

1.1. Heart DiseaseHeart Disease2.2. All cancersAll cancers3.3. StrokeStroke4.4. DiabetesDiabetes5.5. AccidentsAccidents6.6. Flu & pneumoniaFlu & pneumonia7.7. Chronic lower Chronic lower

respiratory diseasesrespiratory diseases8.8. Perinatal conditionsPerinatal conditions9.9. Chronic liver disease & Chronic liver disease &

cirrhosiscirrhosis10.10. Kidney diseaseKidney disease

Health Concerns for Health Concerns for Hispanic/Latina WomenHispanic/Latina Women

Heart diseaseHeart disease• 137.1 per 100,000; 34.4% of Mexican-137.1 per 100,000; 34.4% of Mexican-

American women have cardiovascular American women have cardiovascular disease. disease.

Stroke death ratesStroke death rates• 36.4 per 100,00036.4 per 100,000

Cancer Mortality Rates per 100,000Cancer Mortality Rates per 100,000• Lung – 13.1Lung – 13.1• Breast –15.8Breast –15.8

Health Concern: Heart Health Concern: Heart Disease, Cancer, and Disease, Cancer, and

StrokeStroke

232.3 228.2

300.2

160.2

127.6

173.2190.1 188.5

233.3

119.3 113.5126.6

53.5 51.4

74.3

34.645.2 40.5

0

25

50

75

100

125

150

175

200

225

250

275

300

325

All Races White AfricanAmerican

AmericanIndian/ Alaska

Native

Asian/ PacificIslander

Hispanic

Age-A

dju

sted D

eath

Rate

per

100,0

00 P

ers

ons

Heart Disease

Cancer

Stroke

Health Concerns cont.Health Concerns cont.

Maternal Mortality rates - 2000Maternal Mortality rates - 2000• 9.0 per 100,000 live births9.0 per 100,000 live births

Infant MortalityInfant Mortality• 5.6 per 1,000 live births5.6 per 1,000 live births

Low birth rate (<5.5 pounds)Low birth rate (<5.5 pounds)• 6.4% (Puerto Rican 9.3% and 6.4% (Puerto Rican 9.3% and

Mexican 6.1%) Mexican 6.1%)

Health Concern: Infant Mortality Health Concern: Infant Mortality

Rates per 1,000 Live BirthsRates per 1,000 Live Births

6.8

5.7 5.7

13.6 13.5

8.7

4.85.6 5.5

8.2

4.6 5.0

6.7

0

5

10

15

Infa

nt

Mo

rtal

ity

Rat

e p

er 1

,000

Liv

e B

irth

s

Health Concern: Sudden Infant Health Concern: Sudden Infant Death Syndrome (SIDS) Rates per Death Syndrome (SIDS) Rates per

1,000 1,000 Live BirthsLive Births

55.550.4

122.9 124.2

15.5

29.3

0

50

100

150

All Races Non-HispanicWhite

AfricanAmerican

AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic

Ag

e-A

dju

ste

d D

ea

th R

ate

pe

r 1

00

,00

0 P

ers

on

s

Source: National Vital Statistics Report Nov. 7, 2003, 52(9): 69-77

Health Concerns cont.Health Concerns cont.

HIV/AIDSHIV/AIDS – Hispanic/Latina women – Hispanic/Latina women accounts for 24% of new HIV accounts for 24% of new HIV infections among Hispanic/Latino in infections among Hispanic/Latino in 2006. 2006.

Diabetes Mellitus DeathsDiabetes Mellitus Deaths – 6% – 6%

Tuberculosis RatesTuberculosis Rates – 24% – 24%

Health Concern: Human Health Concern: Human Immunodeficiency Virus (HIV) Immunodeficiency Virus (HIV)

Disease: U.S., 2004Disease: U.S., 2004

4.5

2.3

20.4

2.9

0.7

5.3

0

5

10

15

20

25



Native


Hispanic

Age-A

dju

sted D

eath

Rate

per

100,0

00 P

ers

ons

Health Concern: Diabetes Health Concern: Diabetes MellitusMellitus

24.522.3

48.0

39.2

16.6

32.1

0

5

10

15

20

25

30

35

40

45

50



Native


Hispanic

Age-A

dju

sted D

eath

Rate

per

100,0

00 P

ers

ons

Health Concern: Tuberculosis Health Concern: Tuberculosis (TB): U.S., 2001(TB): U.S., 2001

5.6

1.6

13.8

11.0

32.7

11.9

0

5

10

15

20

25

30

35

All Races non-HispanicWhite

non-HispanicAfrican

American

AmericanIndain / AlaskaNative (AI/ AN)


Hispanic

Age-A

dju

sted C

ase

s per

100,0

00 P

ers

ons

Source: CDC Reported Tuberculosis in the U.S., 2001. Atlanta, GA, U.S. Dept. of Health & Human Services, CDC, September 2002. Table 13. http://www.cdc.gov/nchstp/tb/surv/surv2001/pdf/T12and13.pdf

Health Concerns Cont.Health Concerns Cont.

Mental HealthMental Health Depression – 11% Hispanic/Latina Depression – 11% Hispanic/Latina

reported being depressed.reported being depressed. Suicide – Hispanic/Latina 1.8/100,000 Suicide – Hispanic/Latina 1.8/100,000

Violence Against WomenViolence Against Women 53% Hispanic/Latina and least likely 53% Hispanic/Latina and least likely

to be rapedto be raped

Risk Factors – Hispanic Risk Factors – Hispanic American, Latina womenAmerican, Latina women

• High rate of obesityHigh rate of obesity• High rates of breast and cervical cancers due to High rates of breast and cervical cancers due to

delayed diagnoses, lack of preventive screeningsdelayed diagnoses, lack of preventive screenings• Tobacco use highTobacco use high• Alcohol dependence prevalentAlcohol dependence prevalent• 30% of Hispanic/Latina women uninsured though 30% of Hispanic/Latina women uninsured though

many employed or live with someone who is many employed or live with someone who is employedemployed

• Further barriers to health care: language Further barriers to health care: language barriers, lack of transportation, immigration barriers, lack of transportation, immigration statusstatus

Obesity EpidemicObesity Epidemic

Among Mexican American Among Mexican American women, 73 percent are women, 73 percent are overweight or obese, as overweight or obese, as compared to only 61.6 compared to only 61.6 percent of the general percent of the general female population.1 female population.1

In 2003- 2004 Mexican In 2003- 2004 Mexican American children, American children, between the ages 6-11, between the ages 6-11, were 1.3 times more likely were 1.3 times more likely to be overweight as Non- to be overweight as Non- Hispanic White Children. Hispanic White Children.

Source: OWH http://www.4women.gov/minority/hispanicamerican/obesity.cfm

What Is Obesity?What Is Obesity?

BMI (Body Mass Index) is a measure of body fat based on height and weight. People with a BMI of 25 to 29.9 are considered overweight. People with a BMI of 30 or more are considered obese.

What Are The Health Effects of What Are The Health Effects of Being Overweight or Obese?Being Overweight or Obese?

Heart disease Heart disease Stroke Stroke Type 2 diabetes Type 2 diabetes High blood pressure High blood pressure

Breathing problems Breathing problems Arthritis Arthritis Gallbladder disease Gallbladder disease Some kinds of cancerSome kinds of cancer

Being overweight or obese can increase your risk of:

Risk Factors for Disease Risk Factors for Disease 1999-20001999-2000

Physical Inactivity Physical Inactivity 57% immigrants over 18 years are 57% immigrants over 18 years are

sedentarysedentary

Tobacco UseTobacco Use 12.4 %12.4 %

Alcohol UseAlcohol Use 49% abstained from using alcohol49% abstained from using alcohol

Illicit Drug UseIllicit Drug Use 7.2% drug related deaths7.2% drug related deaths

Vaccinations and Vaccinations and ScreeningsScreenings

Pneumococcal and Influenza – Pneumococcal and Influenza – among adults 65 and older 30.5% among adults 65 and older 30.5% Hispanic/Latina reported no Hispanic/Latina reported no vaccination.vaccination.

Influenza – 55.6% Hispanic/Latina no Influenza – 55.6% Hispanic/Latina no vaccination in the past 12 monthsvaccination in the past 12 months

Cervical cancer – 37% Cervical cancer – 37% Hispanic/Latina not screened Hispanic/Latina not screened

Screenings cont.Screenings cont.

Breast cancer – women over 40 Breast cancer – women over 40 years 33% of Hispanic/Latina women years 33% of Hispanic/Latina women had not been screened in two years.had not been screened in two years.

Blood pressure –26% Blood pressure –26% Hispanic/Latina women had not Hispanic/Latina women had not been screened in the past 12 monthsbeen screened in the past 12 months

Definition of LupusDefinition of Lupus

Widespread chronic autoimmune Widespread chronic autoimmune diseasedisease

Immune system attacks tissue and Immune system attacks tissue and organs within the body organs within the body Joints, kidneys, heart, lungs, brain, Joints, kidneys, heart, lungs, brain,

blood, and/or skinblood, and/or skin Immune system loses ability to Immune system loses ability to

distinguish between itself and distinguish between itself and foreign tissueforeign tissue

Who has Lupus?Who has Lupus?

There are more than 325,000 Americans There are more than 325,000 Americans diagnosed with Lupus--90% womendiagnosed with Lupus--90% women

Limited awareness and knowledge of LupusLimited awareness and knowledge of Lupus Disproportionately affects young women of Disproportionately affects young women of

color (3 times more than whites); color (3 times more than whites); More prevalent during the years of 15 to 45 More prevalent during the years of 15 to 45

Symptoms Symptoms

Fatigue, fever, pain, stiffness, swelling, Fatigue, fever, pain, stiffness, swelling, rednessredness

Common symptoms – painful swollen Common symptoms – painful swollen joints, unexplained fever, extreme joints, unexplained fever, extreme fatigue, red rash or color on the face, fatigue, red rash or color on the face, chest pain with deep breathing, pale or chest pain with deep breathing, pale or purple fingers or toespurple fingers or toes

Additional – mouth sores, headache, Additional – mouth sores, headache, depression, cognitive dysfunction, scalp depression, cognitive dysfunction, scalp hair loss, anemia, kidney diseasehair loss, anemia, kidney disease

TreatmentsTreatments

There is no cureThere is no cure Current therapies Current therapies

Suppress the entire immune systemSuppress the entire immune system Reduction of inflammationReduction of inflammation

Medicines can treat symptoms Medicines can treat symptoms according to organ involvement and according to organ involvement and severity of diseaseseverity of disease

Treatments are based on the Treatments are based on the individual patientindividual patient

Barriers to EngagementBarriers to Engagement

“I don’t have Lupus!” If I don’t acknowledge it then I

won’t get it.

Lupus hits minority women harder and more often?

I don’t believe it!

I’m tired, I ache, I have a migraine…it’s just stress.

I’d rather feed my family than pay for a doctor’s visit.

Additional Information: Additional Information:

Lupus Foundation of America. Lupus Foundation of America. Website: Website: http://www.lupus.org

American College of Rheumatology. American College of Rheumatology. Website: Website: http:///www.rheumatology.org

DHHS/Office on Women’s HealthDHHS/Office on Women’s Health Website: Website: http://www.womenshealth.gov

U.S. National Library of MedicineU.S. National Library of Medicine Website:Website:

http://www.nlm.nih.gov/medlineplus/lupus.html

Strategies for the Task Strategies for the Task AheadAhead

Initially connect to women on an an Initially connect to women on an an emotional levelemotional level

Set up information so that the Set up information so that the women can consume and digest women can consume and digest information at the individuals paceinformation at the individuals pace

Give information through many Give information through many platforms and touch pointsplatforms and touch points

Key Components of Successful Key Components of Successful Programs for Minority WomenPrograms for Minority Women

Internalization of Cultural SensitivityInternalization of Cultural Sensitivity• Integrate cultural influences & language Integrate cultural influences & language

preferences of target communitypreferences of target community• Where is minority group located and Where is minority group located and

concentrated?concentrated?• Address issues of stigmaAddress issues of stigma• Hold events in accessible facilityHold events in accessible facility• Address racial/ethnic variations associated with Address racial/ethnic variations associated with

the incidence, prevalence, morbidity and the incidence, prevalence, morbidity and mortality of health condition/diseasemortality of health condition/disease


Recognition that Disease is not an Isolated Recognition that Disease is not an Isolated PhenomenonPhenomenon

• Address the societal issues (poverty, Address the societal issues (poverty, welfare, violence, crime) which affect welfare, violence, crime) which affect community healthcommunity health

• Identify and target behaviors that Identify and target behaviors that contribute to increased incidence and contribute to increased incidence and prevalence of health conditionsprevalence of health conditions


Identification of Disparities between groups Identification of Disparities between groups in obtaining health carein obtaining health care

• What gaps in services exist?What gaps in services exist?• What services are needed?What services are needed?• Do different groups need different Do different groups need different

prevention efforts?prevention efforts?• Are resources reaching all in the Are resources reaching all in the

community?community?


Honest and Frequent EvaluationsHonest and Frequent Evaluations• Conduct both impact and process evaluationsConduct both impact and process evaluations• Outline clear and timely objectives to show Outline clear and timely objectives to show

achievement and improvement over timeachievement and improvement over time• Produce detailed work plans, quarterly reports, Produce detailed work plans, quarterly reports,

and final reportsand final reports• Obtain input from program participants to Obtain input from program participants to

determine participant benefitdetermine participant benefit


Building of partnerships Building of partnerships • Partner with community organizations, local Partner with community organizations, local

government agencies, faith-based organizations, government agencies, faith-based organizations, social organizations, educational institutions, social organizations, educational institutions, non-profits, sororities, etc.non-profits, sororities, etc.

• Try to partner with groups that can attract as Try to partner with groups that can attract as many women as possible from the target many women as possible from the target populationpopulation


Staff who Relate to the Target CommunityStaff who Relate to the Target Community• This includes staff who have grown up in the This includes staff who have grown up in the

community, look like members of the target community, look like members of the target community, or speak the same language as the community, or speak the same language as the target communitytarget community

• Staff must be knowledgeable about health Staff must be knowledgeable about health condition of the program’s focuscondition of the program’s focus

• Staff must have ability to communicate in Staff must have ability to communicate in culturally and individually sensitive mannerculturally and individually sensitive manner

Contact Contact informationinformation

DHHS-OWHDHHS-OWH200 Independence Avenue, SW200 Independence Avenue, SW

Washington, DC 20021Washington, DC 20021202-690-7650; fax 202-401-4005202-690-7650; fax 202-401-4005

www.womenshealth.gov 1-800-994-9662 1-800-994-9662

Latina Women’s Health Frances Ashe – Goins, RN, MPH Deputy Director - Office on Women’s Health...

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