National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance use and mental health issues. A child's failure to thrive may be attributed to mal de ojo (evil eye), a hex conveyed by an envious glance. In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. Obesity and genetic factors increase risk. Our Future. Delayed immigration protocols and anti-immigration legislation may contribute to stress. Journals. You recommend a compromise treatment plan for her diabetes and grief. Treatment referral and information, 24/7, Visit the SAMHSA Facebook page For Latino/Hispanic adults suffering from any type of mental health disorder, roughly 67 percent did not receive treatment. This consortium study defined distinct somatic cancer gene mutation patterns by race/ethnicity and sex among patients with early-onset colorectal cancer (CRC), yielding novel biological clues into early-onset CRC disparities. These instructions can be studied by the patient or translated when time permits. Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs. 1 (Sept. 2007). For at least the past century, a relative lack of jobs in Mexico has been driving many Mexicans north in search of work. US Hispanics, currently the largest minority group in the country, face disparities in the recognition and treatment of major depression. This content is owned by the AAFP. Free and confidential support for people in distress, 24/7, Behavioral Health Treatment Services Locator The same is also applies to the substance abuse treatment. They also must beware of the tendency toward "othering"; that is, the penchant to understand non-dominant groups as inferior, exotic, or deviant.17 Some efforts at cultural competence may incline toward these unhelpful postures. In today's United States, these terms are often thought . This reliance does not necessarily replace modern biomedicine; rather, herbal remedies and other non-allopathic treatments often are utilized in conjunction with Western medical care. The Hispanic culture differs from that of America despite the ever-growing integration of both populations. These factors have not been studied in Hispanics/Latinos with chronic kidney disease (CKD). Interferon gammarelease screening tests are preferable to tuberculin skin testing in immigrants who have received the bacille Calmette-Gurin vaccine. About 23 percent of Latinos in the United States live in poverty.2. Find treatment facilities confidentially and anonymously, 24/7, National Helpline1-800-662-HELP (4357) Spanish language handouts are available from several Internet sources.33 Recruiting Latino physicians and staff, and recognizing Latino holidays at the office (e.g., Cinco de Mayo), will open many doors to the Latino community.34 Office staff, as well as physicians, should be instructed in basic cultural sensitivity (Table 5).34,35 Hospitals can include culturally appropriate foods in their menus. Azarcon and greta (lead salts) and azogue (mercury) compounds, which are sometimes given for teething or empacho, are contraindicated.22 Some injuries have occurred with curandero treatment of caida de la mollera (fallen fontanel). From the upstairs hallway of our home, I watched my great-aunt prepare for the cleansing. Approximately 43 percent of Mexican Americans older than 20 years are obese, compared with 33 percent of non-Latino whites. Developing cultural sensitivity to Latino patients entails recognizing and appreciating their diversity. al., "Racial and Ethnic Disparities," Chart 4-1. The toolkit includes tips and techniques to overcome challenges and increase effectiveness when working with Latino populations. Among U.S. states, New Mexico has the highest percentage of Hispanic ancestry, at 47 percent (as of July 1, 2012). The final commentary, drawing on the others, seeks to join the issues from an explicitly bioethical perspective. 8Holly Mead et. Additionally, when a woman gets married, her husband's name may be appended to her father's name. While Hispanic refers to language and those whose ancestry comes from a country where Spanish is spoken, Latino refers to geography. Maria needs to eat fruit; she should also consume more fiber to counteract her high-carbohydrate diet. It is the primary method used in hospitals. 6Kaiser Permanente National Diversity Council, "A Provider's Handbook on Culturally Competent Care: Latino Population," 2nd ed. SAMHSA Blog. 2U.S. For Authors For Reviewers For Editors For Librarians For Publishers For Societies For Conference Organizers. One way of describing the distinction is that modern Western doctors are primarily trained to diagnose and treat diseases (in a purely biomedical sense), while traditional healers approach the patient as one suffering from an illness-that is, a culturally located experience of sickness.12 Among some Latino subcultures, folk illnesses such as empacho (a digestive ailment), mal de ojo (the "evil eye"), mollera caida (fallen fontanelle), susto (fright illness), and nervios (vulnerability to stressful experiences) are commonly described; and traditional healers range from curanderos (Mexican healers) and sobadores (traditional masseuses and bone setters) to yerberos (herbalists) and espiritistas (spiritual healers).13 Reliance on folk medicine certainly is not to be found in every, or even most, Latino communities; but it does exist as part of the health care landscape and is found among many patients from Mexico, as well as from various other regions within Latin America. These terms are often used interchangeably, including by the U.S. Census Bureau, although "Hispanic" is more often utilized in governmental and market research and statistical record keeping, while "Latino" perhaps enjoys more popular usage today. Latino culture has several normative values that must be recognized in clinical settings. dissertation, University of Southern Cali-fornia, 1973. Hayes-Bautista relayed that one important theme presented in the collaborative workshops is how . by Marcia Carteret, M. Ed. 5600 Fishers Lane, Rockville, MD 20857 Some cultural barriers may be overcome by using the teach back technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. Mozote (Bidens pilosa) to refresh and clean the stomach. The largest and fastest growing minority population in the United States today is commonly referred to as "Hispanic" or "Latino." Fluegelman, Andrew, ed. al., "Important Health Care Issues for California Latinos: Health Insurance and Health Status," UCLA Center for Health Policy Research, January 2003. Vari Hall, Santa Clara University500 El Camino RealSanta Clara, CA 95053408-554-5319, Ethical Considerations for COVID-19 Vaccination, Hackworth Fellowships Project Showcase 2021, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process, https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf, Culturally Competent Care for Latino Patients. Using don or doa with the given or full name indicates even greater respect for older patients. The teach back technique should be incorporated into the cross-cultural patient encounter to ensure patient understanding of discharge instructions. Recent immigrants often feel lonely and can have culture shock, fears of deportation, and financial problems; depressed mood may manifest as headaches and somatic symptoms. In terms of health, on some measures Latinos are better off than other ethnic groups. Although patients of all cultural backgrounds warrant kindness, a personal connection, and respect, the consequences of omitting these traditional values may be more problematic with Latinos. Herbal therapies play a major role in Latino folk medicine, so knowing the Spanish names of common herbs can be helpful (eTable A). Her husband died in an industrial accident four years ago, and she is still grieving. However, the most useful technique is teach back or show me: having patients repeat their care instructions until they do it correctly. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. These materials focus on the challenges that can confront Hispanics in American health care settings. 3 Essentially, a curandero or curandera removes mental, emotional, physical and spiritual illnesses or imbalances. The cultural value of familism has important implications for the successful treatment of a child with AD/HD. A consequence of these problems is a marked disparity in the quality of care that Latino patients receive. Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. Yet Latinos are at particular risk for diabetes mellitus, tuberculosis, hypertension, HIV/AIDS, alcoholism, cirrhosis, and death from violence.4 There is also a disproportionately high prevalence of acute care in the treatment of Latinos; that is, too often patients delay medical care until their conditions worsen and necessitate immediate attention. She might also stop giving her infant vitamins, because they are a hot therapy.24 It is often possible to safely accommodate conventional and alternative treatments (in reasonable doses) if potential conflicts or interactions are identified in advance. Most Latino immigrants have received the BCG vaccine; although past practice has been to interpret skin test results without regard to BCG status, false-positive tests in this population are common. Manybut not allfolk and herbal treatments can be safely accommodated with conventional therapy. Personalismo, a personal connection, can be achieved by asking about the patient and his or her family. Switch to Chrome, Edge, Firefox or Safari. They are also far more likely than whites to feel that they are treated unfairly by providers or by the medical system.8, These gaps and dissatisfactions become even more troubling in the context of significant disparities in access to health insurance and to the health care system in general. For those who have a serious mental health disorder, around 44 percent did not receive treatment. A chaperone is often appreciated if a same-sex physician is not available. America is rapidly changing as a cultural collision between Latino and white culture transforms lives on both sides of the border. Some trials examined overall CAM use, whereas others looked at. Hence, the individual's good cannot be neatly separated from his or her community. Significantly, some patients appear to experience greater improvement after meeting with folk practitioners than with Western doctors.14. The ethnic terms Latino or Hispanic refer to a diverse population of Latin American descent that includes many nationalities and races. Garlic and onion are used extensively, as is aloe vera. Treatment of Various Ocular Manifestation of Systemic Lupus Erythematosus with Therapeutic Plasma Exchange. Additionally, within this family-centric decision making structure, there may be particular gender-based roles. Case 1: Delinquency or a Mental Health Problem: The Case of Pablo Sanchez, Case 3: From Chronic to Critical: End-of-Life Decisions. They are written by health care providers and others who work with the relevant Latino sub-community. Our Health. Abdominal pain may be attributed to empacho, or food stuck in the intestine. These numbers include Mexican-Americans, Puerto Ricans, Central and South Americans, Cubans, and many other communities although, throughout California, the vast majority of Latinos identify themselves as of Mexican background. First among these, of course, is a language barrier. Her visits to your clinic have been challenging because of her limited English proficiency, late arrivals, and nonadherence to several medications. Become an expert on our coaching methods, internal systems, processes, and technology. using as treatment, if they remained open-minded, and if doctors had an understanding of folk medicine.37 Another common barrier within healthcare delivery is that the alternative or traditional medicine within the Latino culture is deeply rooted in spirituality and religion.38 While in the United States, After immigration, some Latios adopt American naming conventions, but others do not. Approximately 11.8 percent of Latinos older than 20 years and 13.3 percent of Mexican Americans have diabetes. Latinos are far more likely than the overall population to live in poverty; the poverty rate in 2006 was 20.8 percent, compared to 12.3 percent for the overall U.S. population. Patient activation will help motivate the patient to become involved in his or her own care. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Because many health beliefs and behaviors are culturally-based, it follows that when two different cultures come together in a health care setting, a collision of expectations often occurs. These may include antioxidants, probiotics, or a combination of medications to target any of the contributing factors. Results: Teas were most commonly used for colic, upper respiratory tract symptoms, and abdominal pain. Conveying medical instructions to patients with limited English skills can be frustrating. Spanish language handouts are a better option. Specifically, to Latin America, to people from the Caribbean, South America, and Central America. Media Contact . Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties.4 Another barrier is inability to afford health insurance; nearly one-third of Latinos (30.7 percent) lack coverage.5 Yet another barrier stems from cultural mistrust coupled with a predisposition to seek alternative care first, thus delaying conventional treatment. Religion can be a protective factor for mental health in Latinx/Hispanic communities (faith, prayer) but can also contribute to the stigma against mental illness and treatment (demons, lack of faith, sinful behavior), so targeting religious institutions to help encourage good mental health and treatment-seeking is important. For example . Hispanics' experience with discrimination or being treated unfairly varies greatly by age. Chartbook for Hispanic Health Care (Agency for Healthcare Research and Quality) This Hispanic Health Care chartbook is part of a family of documents and tools that support the 2014 National Healthcare Quality and Disparities Report (QDR). Lower rates of hypertension awareness, treatment, and control have been observed in Hispanics/Latinos compared with non-Hispanic whites. Census Bureau News, "U.S. Hispanic Population Surpasses 45 Million," Press Release, Thursday, May 1, 2008; U.S. Census Bureau, "Hispanic Americans By the Numbers," accessed at www.infoplease.com/spot/hhmcensus1.html; and U.S. Census Bureau, "State and County QuickFacts: Santa Clara County, California," 2006, accessed at http://quickfacts.census.gov. The APA additionally reported that both language barriers and values created barriers to treatment for Hispanics experiencing mental health issues. This article provides an evidence-based review of the prevalence, presentation, and management of major depression in primary care in this heterogeneous ethnic group. If successful, the intervention could be adapted to other racial or ethnic minorities, such as Hispanic Americans. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. You explain why these interventions are necessary, but acknowledge her frustration and agree to revise her diet. Trauma-Focused CBT is one of the most effective types of treatment for a trauma-based disorder, particularly in adolescents and children. This inequality puts these communities at a higher risk for more severe and persistent forms of mental health conditions, because without treatment, mental health conditions often worsen. Chagas Disease Is a Consideration in Latino Patients, http://www.stanford.edu/group/ethnoger/hispaniclatino.html, http://www.rice.edu/projects/HispanicHealth, http://www.hogarhispano.homestead.com/HispanicHealth.html, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3, http://www.ohsu.edu/xd/education/library/research-assistance/patient-education-handouts.cfm/, https://www.aamc.org/download/54328/data/tacctresourceguide.pdf.pdf, http://depts.washington.edu/pfes/CultureClues.htm. Neurocysticercosis is the most common cause of seizures in Latino immigrants. This free webinar will discuss a guide for service providers, which includes aspects such as how culture change affects Hispanics and Latinos. There are likely many possible reasons for this, including poverty and lack of health insurance, and thus at best irregular access to health care; cultural factors that might cause patients to delay seeing a doctor, for example, the expectation that one should tolerate pain without complaint; and a belief that certain conditions (such as pregnancy) are natural and do not require medical attention. National Prevention Week 2020 is about Our Lives. Objective Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. For instance, a doctor could perceive as evasive a patient who declines to make direct eye contact, when in fact,that patient may be demonstrating respect for the doctor's position and authority. The material in this section is part of a larger project by the Markkula Center for Applied Ethics on culturally competent care; that is, health care that is sensitive to the differing values and needs of cultural subgroups within our pluralistic society. Animal-based medicines are also used, including snake oil, which is obtained from the fat of snake skins, and bufo toad medicine, which contains a powerful psychedelic. To sign up for updates or to access your subscriber preferences, please enter your contact information. A mother might use cooling herbs to treat diaper rash, a hot condition. | Mar 1, 2011. 17Delese Wear, "Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education," Academic Medicine 78/6 (June 2003): 549-554. Thematic analysis was used to identify common patterns and form recommendations for future research and programs. An intention-to-treat approach using a last-observation-carried-forward method was used to analyze outcome data whereby the last available measurement for all participants was then used for all time points through the 12-month final follow-up. 15 supp. She says that she does not feel better when taking the medicine, and says the diet you prescribed does not include tortillas or any of the foods she likes. [4] needs and experience of less acculturated Latino clients who are mostly from Mexico and Central America, and represent a large segment of the Latino community in Southern California. Courtney Parker, CC BY. Copyright 2023 American Academy of Family Physicians. Low levels of hypertension awareness are a major problem in the Latino community. In fact, the number of Latino physicians dramatically lags behind Latino population growth; and, according to cross-cultural health care expert Larry Purnell, Latinos are the most underrepresented major minority group in the entire U.S. health care workforce.5 This discrepancy contributes to many different linguistic and cultural hurdles for Latino patients, as well as for their health care providers. This traditional food is high in fiber and pectin and lowers lipid levels by binding bile acids; when eaten with other foods, it reduces the glycemic index of the meal by 50 percent. Lack of third party reimbursement for professional interpreter services exacerbates this problem. High level of belly fat or metabolic syndrome. Cysticercosis is caused by consumption of contaminated with pork tapeworm. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Davis Company, 1998): 397-421. Emotional distress often presents with headaches (dolor de cabeza) or other physical symptoms instead of depressed mood.9 Consequently, a high index of suspicion is needed to recognize adjustment reactions or depression. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. Compared with non-Latino whites, Mexican Americans have up to a three times higher incidence of diabetes mellitus and a three times higher prevalence of obesity, but hypertension-related mortality is only 4 percent higher (not a significant difference). 50 percent of those with no usual health care provider are at least high school graduates. By the year 2050 that figure is expected to rise to 24 percent of the total U.S. population. This is lower than the average of 43 percent for adults in the U.S. overall. Addiction can affect a person's impulse control, ability to stop using a substance, using despite risks, and physical and mental changes. Plants are used on their own, or mixed together to form herbal remedies. Maria is a 54-year-old Mexican immigrant with type 2 diabetes mellitus, hypertension, and obesity. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. First-generation immigrants are likely to seek out curanderos, whereas their children may scoff at the idea. 13 Kaiser, "A Provider's Handbook," 6-7. For instance, Latino mothers may determine when medical care is warranted for a family member, though a male head of household may formally make the decision to send the family member to a medical center.16. Neurocysticercosis, a leading cause of seizures in Mexico, and pulmonary tuberculosis are more common in Latino immigrants.10 Interferon gammarelease assay blood testing for tuberculosis is now preferred over tuberculin skin testing in immigrants with a history of bacille Calmette-Gurin vaccination because of a high rate of false-positive results with skin testing (although skin testing is still recommended for children younger than five years).13 Publicized fears of contagion from illegal immigration may be overblown. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. Barriers to care have resulted in striking disparities in quality of health care for these patients. Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties. Mexican Americans are much less likely to be treated for hypertension than non-Latino whites (35 versus 49 percent).11 Targeted public health campaigns are needed for hypertension, diabetes prevention, and weight control. A little more than 45 percent of all births in Mexico are Cesarean sections, which makes it one of the world's leaders in the practice. Table 3 lists some common Latino folk illnesses, their symptoms, and treatment.19 Therapies for these conditions may seem odd, but most are harmless, with a few exceptions. Under-recognition of depression in adult Hispanic Americans may be related to language . Interferon gammarelease assays are preferred to tuberculin skin testing in immigrants with a history of BCG vaccination. Data Synthesis: Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. Call or text 988 or chat 988lifeline.org. Again, it is imperative to stress that these values represent broad generalizations that may or may not apply to any individual patient or in any given situation. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. By comparison, only 35% of Hispanics 50 and older say the same - a 30-percentage-point gap. 1 The term does not refer only to Spanish speakers, however; many people usually thought of as "Hispanic"-the people of Brazil, for instance, or those from indigenous Mexican communities-often do not speak Spanish at all, or at least not as their primary language. placed on religious beliefs in the maintenance of health and the treatment of illness. Cold water with lemon for high blood pressure. She says that since her husband died, she has lost interest in what might happen to her in the future. One suggestion she readily agrees to is to include nopales (prickly pear cactus pads), a favorite from her childhood in Mexico. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Latino healing traditions include curanderismo in Mexico and much of Latin America, Santeria in Brazil and Cuba, and espiritismo in Puerto Rico.19 Curanderos, traditional healers, distinguish between hot and cold illnesses (Table 220 ) and occasionally between natural and unnatural (sorcery-related) diseases.19,20 Patients may seek out the care of brujos or brujas (wizards or witches) for the latter conditions. Increasing Cultural Sensitivity in Existing Treatment Approaches For Latinos, interpersonal warmth is very important, and when a therapist is experienced as "cold" or Because of less access to health care, Latinos with diabetes are often diagnosed later and have a greater risk of complications.15,16 Despite these unfavorable health and socioeconomic statistics, overall mortality is lower than would be expectedan anomaly termed the Hispanic paradox.17 Latinos live an average of 2.5 years longer than non-Latino whites (to 80 years, seven months of age) and 7.7 years longer than non-Latino blacks.1 It is not known what protective factors exist, but immigrant hardiness, social integration, and diet may have a role.1 Raising awareness about the consequences of obesity is necessary in Latino communities, especially because being somewhat overweight (gordito) can be considered healthy.