Review article
Cultural factors in preventive care: Latinos

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Values

Despite the complexity and diversity within the Latino culture, there exist certain values that Hispanics seem to have in common. Regardless of national, racial, and social background there is a strong family orientation known as familialism. Familialism is a central value for Latin Americans. Families tend to be large and extended and are the main source of emotional, physical, and economic support in times of illness. The family makes decisions about health care issues. Family members often

Demographics

According to the US Census Bureau, there were approximately 35.3 million Hispanics residing in the United States in the year 2000, making up 12.5% of the US population. The figures show that the US Hispanic population increased 58% during the 1990s, which has lead to a virtual tie with the African-American population as the nation's largest minority group.

Most Hispanics tend to live in metropolitan areas of the western and southern US. Hispanics of Mexican origin are more likely to live in the

Immigrant Hispanics

Immigrants from Latin America usually come to the US for economic or political reasons. They come from a broad spectrum of socioeconomic backgrounds and enter a variety of living conditions in the United States that impact enormously on immigrant and public health.

Poverty, unemployment, and low level of education usually account for adverse health in this population. Anti-immigrant sentiment and discrimination in health care and education add adversity to the immigrant's experience. Lack of

Elderly

The number of elderly Hispanic (>65 y) in the US will continue to rise over the next decade (>2 million by 2010). Data suggests that elderly Hispanics may be at greater risk than other minority elders for various economic, social, mental health, and medical problems [16].

Among Latino sub-groups, Mexican Americans have the highest incidence of diabetes, while Puerto Ricans report more psychological distress than other Latinos. They also have the highest rate of disability among all minorities

Women

Traditional Latinas who are neither in school nor part of the workforce in the US may be less assimilated or acculturated than Latino children or men. External obstacles for optimal health care include lack of health insurance, unemployment, non-utilization of prenatal care, and inaccessibility of clinic services. Internal influences include communication difficulties, cultural differences, and differing health beliefs. The patient-physician encounter can realize its maximum potential when the

Epidemiology

Between 1996 and 1999, the Community Tracking Study Household Surveys, revealed a lack of improvement in preventive care for Hispanics compared with whites and African Americans in the US. As opposed to our earlier comments regarding Puerto Rican elderly, only 68% of Hispanics reported seeing a physician in the last year, compared to 80% of non-Hispanics surveyed. Only 71% of eligible Latinas received mammograms in contrast to 74% of the non-Hispanic women over 50. In the 1998 to 1999 influenza

Communication/Language

Non-English-speaking Americans are less likely to see a primary care provider and receive preventive care regardless of insurance coverage. Spanish-speaking Hispanics have been found to report more health problems than English-speaking Hispanics [29].

Attempts to break down the language barrier include: patients learning English; acquiring more bilingual health providers; teaching other languages to the provider; using professional in-person interpreters; using English speaking family members or

Satisfaction/health outcomes

Once they have access to health care, Latino Spanish-speaking patients are significantly more dissatisfied with provider communication than Latino English-speaking patients, who were slightly more dissatisfied than whites. Spanish-speaking Latino patients are at increased risk for lower quality of care and poor health outcomes. Bilingual physicians have been shown to improve outcomes of Spanish-speaking patients with hypertension and diabetes [33].

Studies have found that Latinos place higher

Strategies

Physicians should be taught to be more culturally sensitive and more patient-centered [34]. In order to increase cultural competence among health care providers in a practical way and improve the patient-physician relationship, a curriculum has been established for medical students, residents, and practicing physicians that emphasize the understanding of a patient's health beliefs in a social and cultural context. Providers must avoid categorizing and stereotyping the ethnic patient.

Carrillo et

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