# Presentation: 088279

## IMPLICATIONS OF MEASURES OF HISPANIC ETHNICITY FOR STD PREVENTION AND TRANSMISSION

- Mary B. Adam, MD
- and the
- Informatics and Decision Making Laboratory, University of Arizona College of Medicine

## How do you measure ethnicity?

**Skin color/race**
**Country of birth/continent of origin**
**Parents/Grandparents national origin**
**Surname/name analysis**
**Self perception**
**Shared language**

**Notes:**
Skin color/race is imprecise, subjective and unreliable

Country of birth/origin-Example India is culturally diverse with innumerable distinct ethnic groups, a complex caste system and at least eight major religions and 15 official languages.
Grandparents nation of origin is rigid, ignores current lifestyles or self perception and yielded a large heterogeneous “mixed” group (people who have grandparents from several different countries)

Surname-in our area will mix up many Native Americans who have Spanish surnames
In addition, in some cases surnames indicate  origin on a certain continent,  or a specific religion problems with south Asian Christians who share names with the white population

Self perception of ethnicity is changeable over short periods of time, and not subject to the control of the investigator

You can be from Mexico, Colombia, Spain, Cuba or the US and speak Spanish as your first language.

## Hispanic Origin Form US Census 2000“NO” Box if Not Spanish/Hispanic/Latino

**No, Not Spanish/Hispanic/Latino**
**Yes, Mexican, Mexican American, Chicano**
**Yes, Puerto Rican**
**Yes, Cuban**
**Yes, Other Spanish/ Hispanic/Latino______**
**_____________, Salvadoran, Dominican etc**

**Notes:**
The Term Latino appeared for the first time on the census form

## Heterogeneity in Hispanic Populations

- Recent immigrant-legal/illegal
- Family could have lived in this region for hundreds of years and under several different flags
- English speakers
- Spanish speakers
- Retain strong ties with country of origin or may had adopted attitudes values and beliefs of the dominant culture.

**Notes:**
Heterogeneity exists even in Hispanics who are from the same country of origin.
In Tucson we have about 93% of the Hispanics are of Mexican or Mexican American origin.
Hispanic is a term from Espainola meaning Spain and many consider it a term reflecting a narrow and excessive emphasis on the European influence influence of Spanish colonialism and does not accurately reflect the crucial roles of Indigenous and African peoples in Latin American history

## NIH Project Aims:

**(1) to evaluate measures of Hispanic Ethnicity (Phase I)**
**(2) to measure differences in sexual beliefs/values/attitudes in Hispanic versus Anglo teens and in high risk versus low risk teens (Phase I).  **
**(3) To measure differences in reasons for risky sexual decisions in Hispanic versus Anglo teens and in high risk and low risk teens (Phase I)**
** ****(4) to use the data from (1) and (2) in a new curriculum for reducing and avoiding sexual risk in teens (Phase II). **

## Measures of Hispanic Ethnicity

**Self-reported Ethnicity**
**Subjects birth country**
**Parent’s and Grandparent's birth country**
**Language Use Scales**
**Religion**

**Notes:**
We took over 30 items which have been used in the literature routinely to evaluate ethnicity and these items are described by these broader categories.

## Description of sample

- 255 Adolescents age 14-19
- Gender
- 45% male; 55% female
- Ethnicity
- 45% Mexican American/Hispanic
- 40% Anglo
- 14% Mixed ethnicity
- 1% Black
- <1% Central/South American
- <1%Native American
- <1% Asian

## Description of Sample

- Anglo
- 98% speak English
- 99% Born in the United States
- 27% Protestant
- 16% Catholic
- Hispanic
- 41%  speak English, 20% speak Spanish
- 78% born in the United States
- 18% Protestant
- 70% Catholic

**Notes:**
3% Hispanic claim no religion, 28% Anglo claim no religion, 39% of Hispanics speak both English and Spanish

## Factor Analysis

- Language Use		54% variance
- Country born			8% variance
- Spanish media		6% variance
- Religion importance	6% variance
- Self born			4% variance
- Catholic/nonCatholic	3% variance

**Notes:**
33 items that represented  different measures of Hispanic ethnicity were evaluated using Factor Analysis.  
6 unique dimensions all of which are separate issues influencing cultural identity. 
6 orthogonal factors accounted for 81% of the variance.  All may point to Hispanic but they cannot be lumped into one dimension which can be called Hispanic.

## Hierarchical Cluster Analysis

- Generation born
- English language use
- Spanish language use

**Notes:**
Cluster analysis is looking for how things group together. Three clusters.  Religion items were split between these.

## Rates of Sexual Activity by Gender and Ethnicity

**49% of males reported sexual activity**
**49% of females reported sexual activity**
**48% of Anglos reported sexual activity**
**44% of Hispanics reported sexual activity**

## Rates of Sexual Activity by Country of Birth

**38% of foreign born Hispanics reported being sexually active**
**48% of US born Hispanics reported being sexually active**
**48% of US born Anglos reported being sexually active.**

**Notes:**
If you go back a generation the effect is attenuated.

## Rates of Sexual Activity by Language Use: How often do you speak Spanish in general?

**34% of Hispanics who “almost always” spoke Spanish were active**
**45% of Hispanics who “often” or “sometimes” spoke Spanish were active**
**55% of the Hispanics who reported “almost never” were sexually active**

## Rates of Sexual Activity by Religious Affiliation 

- 40% of Catholics reported being sexually active
- 54% of non Catholics reported being sexually active

## Individuals within ethnic groups are not homogenous in their beliefs, values, experiences, or behavior.

## Culture vs Context

- Family structure
- Availability of family members
- Social economic status
- Educational attainment
- Discrimination
- Access to health care

- Language barriers
- Religiosity
- Perceptions about illness, treatment, physician-patient roles
- Value of maternal role
- Acculturation

**Notes:**
The specific causal factors may vary from one health outcome to another.  Obviously our interest is in risks related to pregnancy and STD
But this is why we need to be unpacking ethnicity, separating out those areas/outcomes/decisions which are related specific measurable factors and get a closer look at what contribution is really played by culture.

In addition, when we work in areas where several cultures are coming into first hand contact we need to be paying attention to acculturation, and see what changes result. We need to be cautious about interpreting acculturation results and separate issues of social class which may be confounding outcomes.  
Example many of the Mexican American/Hispanics coming to Arizona are poor and are coming for economic opportunity.  Cuban/Hispanics on the other hand were often political refugees and those who were able to come to America were often those of the upper classes who had resources to leave a politically hostile regime.
Conclusion: We need to examine our measures carefully in order to account for the complexity of ethnicity and culture, we need to distinguish between ethnicity as a risk factor or as a risk marker, and we need to avoid contributing to the racial/ethnic divisions of society while acknowledging health outcome disparities.