# Presentation: 570662

## North Carolina: A Comprehensive 

- _[lderosset@marchofdimes.com](mailto:lderosset@marchofdimes.com)_
**(919) 781 -2481, ext 39**
**NC Folic Acid Campaign/March of Dimes, NC **
- _[www.getfolic.com](http://www.getfolic.com/)_

**North Carolina: A Comprehensive **
**Approach to Educating Latinos**

## North Carolina

-  In North Carolina, overall 15% of  the population   lives below the poverty level.
-  29% of Immigrant children & 20% of  non-  immigrant children are living below the poverty   level.
-  9.2% of North Carolinians speak a language other   than English at home.
-  19% of births in North Carolina in 2004 were to   foreign born mothers.

## Latinos in North Carolina

-  Estimated number of Hispanics/Latinos in NC = 517, 617
-  Median age of Latinos/Hispanic is 29 compared to 39 for   white non-Hispanics.
-  2/3 of NC’s Latino population is foreign born.
-  Over 73% of the Latinos in NC from Mexico

**Notes:**
In the 2000 US Census, there were around 450,000 Latinos living in NC –remember these are only the ones they count and locate. There are many Latinos living in HH with other family and friends that are not counted. Most experts estimate the numbers to be higher. 

First generation Latinos living in NC – young, healthy, working in blue collar jobs, both men and women working, fertile population, high birth rate numbers. 

## Latinos in North Carolina

-  Latino immigration new to NC (only past 20 years).
-  85% of Latinos in North Carolina report speaking English   less than very well, poorly, or not at all.
-  2006 survey of NC Latinas
-  54% had been in the state less than 5 years
-  32% had been in the state 5 - 10 years.

**Notes:**
North Carolina is a newer state fro immigration. Before the 1990’s mostly we saw men, here for agriculture, farming and migrant work. In the early 1990’s and late 90’s they started staying, bringing their families. But still most who came did not speak English and/or had low education and came from rural areas in their countries. 

## NTD Rates in NC

| State (1999 – 2003) | 7.2 per 10,000 live births |
| --- | --- |
| By perinatal region |  |
| West  | 5.9 |
| Triad Northwest  | 7.8 |
| Piedmont Southwest  | 5.4 |
| Triangle Northeast | 7.0 |
| Cape Fear Southeast | 9.3 |
| East  | 7.5 |
| By race/ethnicity |  |
| White, non-Hispanic | 6.27 |
| Black, non-Hispanic | 6.71 |
| Hispanic | 14.19 |
| Other  | 4.82 |

**Notes:**
Looking specifically at the birth defect rate for NC – you can see that the Latinos have 2x the rate of African Americans and Whites. You can also see the areas of the state that experience the highest rates of NTD are the Cape Fear area (New Hanover, Cumberland, Robeson, Pender, Brunswick counties) and also the Triad which is Forsyth, Guilford, Stanly, Alamance, Mecklenberg counties. The West had the highest rates for years but since the intervention campaign began in the mid 1990’s – rates have dropped and are almost the lowest in the state.  

## NC Folic Acid Campaign/March of Dimes

**Program goal:  **
- Increase multivitamin consumption among young women of childbearing age in order to reduce the number of neural tube defect-affected pregnancies in the state
**Program components:**
- Research and evaluation
- Community Ambassador (lay health educator) program
- Office Champion program (health care provider education)
- Media – television, radio and newspaper
***FREE*** materials, videos/DVDs
***FREE*** Folic Acid 101 course
***FREE ***cultural awareness workshops

## NCFAC: Research

**Focus groups** **conducted with:**
- Latina women in North Carolina
- Outreach workers and health educators
**Results:**
- Refined target audience
- Information about the following in regards to multivitamins, folic acid and birth defects (neural tube defects)
- Barriers
- Myths
- Beliefs
- Current knowledge
- Evaluate current educational                                           materials

**Notes:**
2006 baseline survey to measure impact of intervention (2006 – 2008).

12 counties selected: 6 urban and 6 rural.

Urban and rural counties were paired together based on similarities in population size of Latina women. 

Random selection of pairs with probability proportional to the combined size of the pair.

Within each pair, one county was randomly assigned as the “intervention” or “comparison.”

Eligible respondents included: 
Women, age 18 – 35
Born outside of the U.S. (including Puerto Rico)
Spoke Spanish as their first language & the majority             of the time
Lived/resided in one of the 12 intervention counties.

More than 1,100 surveys completed; 896 eligible for analysis.

Utilized SPSS and STATA to analyze data. 

## NCFAC: Research

**Health care provider surveys:**
- Quantitative, anonymous
- N = 163
- Provided NCFAC with information about                                providers’ perceptions of Latinas’:
- Barriers
- Myths
- Beliefs
- Knowledge

**Notes:**
2006 baseline survey to measure impact of intervention (2006 – 2008).

12 counties selected: 6 urban and 6 rural.

Urban and rural counties were paired together based on similarities in population size of Latina women. 

Random selection of pairs with probability proportional to the combined size of the pair.

Within each pair, one county was randomly assigned as the “intervention” or “comparison.”

Eligible respondents included: 
Women, age 18 – 35
Born outside of the U.S. (including Puerto Rico)
Spoke Spanish as their first language & the majority             of the time
Lived/resided in one of the 12 intervention counties.

More than 1,100 surveys completed; 896 eligible for analysis.

Utilized SPSS and STATA to analyze data. 

## NCFAC: Research

**Community Survey:**
- Quantitative, anonymous
- 1,100 face-to-face completed (N = 896)
- Pre-test/baseline survey
- Provided NCFAC with information about Latinas’:
- Knowledge
- Attitudes
- Beliefs
- Behaviors
- Helped to provide direction for program development and implementation
- Post-test will be conducted in 2008 to measure changes

**Notes:**
2006 baseline survey to measure impact of intervention (2006 – 2008).

12 counties selected: 6 urban and 6 rural.

Urban and rural counties were paired together based on similarities in population size of Latina women. 

Random selection of pairs with probability proportional to the combined size of the pair.

Within each pair, one county was randomly assigned as the “intervention” or “comparison.”

Eligible respondents included: 
Women, age 18 – 35
Born outside of the U.S. (including Puerto Rico)
Spoke Spanish as their first language & the majority             of the time
Lived/resided in one of the 12 intervention counties.

More than 1,100 surveys completed; 896 eligible for analysis.

Utilized SPSS and STATA to analyze data. 

## NCFAC: Materials Review 

-  Focus groups (consumers and providers) reviewed educational  brochures and/or radio and television public service  announcements (PSA’s) from:
-     CDC
-     Florida
-     March of Dimes
-     North Carolina Healthy Start Foundation
-     North Carolina Folic Acid Campaign/March of Dimes

**Notes:**
NCHS data

## NCFAC: Materials Development 

-     **New **
-  Radio PSA’s
-  Television PSA’s
-  Newspaper advertisements
-  Print advertisements
**    ****Revision**
-  North Carolina Healthy Start Foundation “Ana Maria” brochure
-     **Provided feedback & recommendations to:**
-  CDC
-  March of Dimes
-  Florida

**Notes:**
NCHS data

## NCFAC: Community Ambassador Program 

**Education *****for***** Latina women provided *****by***** Latina women**
- Grassroots, community-level education
- Modeled after Lay Health Educator programs (LHE)
- Receive a stipend after completion
**Requirements for becoming a Community Ambassador**
- Living in North Carolina
- At least 16 years of age
- Spanish speaking
- Complete an interactive training

**Notes:**
NCHS data

## NCFAC: Community Ambassador Program

** ****Elements of the Community Ambassador program**
- Participate in a 5 hour comprehensive and interactive training      about:
-  Multivitamins, folic acid and birth defects
-  How to give workshops and education to the community
-  How to do outreach in their social networks
- Educate 50 women of childbearing age
- Document women educated (age, country of origin, address)
- Provide five (5) written evaluations/comments about the      workshops (filled out by the participants)

**Notes:**
NCHS data

## NCFAC: Community Ambassador Program 

**NCFAC: ****Community Ambassador Program**** **

** ***** ******More than 6,000 Latinas have received                                one-on-one education in 13 counties***

**150 Community Ambassadors trained since May ’06**

**Notes:**
NCHS data

## NCFAC: Health Care Provider Education  

**Collaborate with the regional coordinators**
-  Provide education to public and private providers
-  Provide cultural awareness information and trainings to   providers (Latino/Hispanic culture)
**Participate in:**
-  Workshops
-  Conferences
-  Health fairs
-  Etc.

**Notes:**
NCHS data

## NCFAC: Health Care Provider Education

**Materials and incentives**
-  Bilingual brochures
-  Posters (English and Spanish)
-  DVD’s (English and Spanish)
-  Incentives (bilingual)
**Collaborate with:**
-  Public agencies
-  Local and statewide
-  Community-based organizations
-  National partners

**Notes:**
NCHS data

## Examples of educational materials

## Slide 18

## Slide 19

## Slide 20

## Slide 21

## Slide 22

## Slide 23

## Radio Public Service Announcement 

## Television Public Service Announcement  

## Questions?