Volume 30 · Number 3 · Spring 2013
¡Salud!
Latino youth
and mental health
“Growing Up Latino and Surviving to 25”— a panel discussion exploring the mental-health challenges faced by Latino youth in the United States — will be held at UC Davis on April 23 and moderated by award-winning journalist and host of the National Public Radio program “Latino USA" Maria Hinojosa.
The nation’s fastest-growing demographic group is also the longest living, but Latino Americans face serious health challenges. UC Davis experts are working to improve the quality of life for Latinos—from birth to old age.
The Latino health outlook is both más y menos—more and less.
The significant upside is longevity — with the Centers for Disease Control and Prevention reporting the Hispanic life expectancy at 81.3 years, 2.6 years longer than the national average.
But consider these major downsides, according to federal health statistics: Latino Americans are more likely to be born without the benefit of prenatal care. More than other ethnic groups, they go through life without health insurance or regular doctor visits. And they struggle with obesity and develop asthma, AIDS and diabetes — which can have a devastating cost in lost eyesight, limbs and lives.
With Latinos totaling 15 percent of the U.S. population, and growing faster than any other group, their health affects us all — in terms of medical costs and lost productivity.
Nowhere is the impact bigger than in California, which has the nation’s largest Hispanic population — 14 million, or about 38 percent of its more than 37 million people. By this summer, Latinos in California are projected to equal non-Hispanic whites in numbers and overtake them in early 2014.
In Salinas, farmworkers participate in Zumba exercise classes and learn about healthy eating in a new public health program called Paso Saludables, or Healthy Steps. The program is the result of a UC Davis partnership with farming company, Reiter Affiliated.
“Asthma rates double or triple among Latinos who migrate from Latin America to the United States,” said public health professor Marc Schenker. “In terms of the burden of disease, the estimate is that by 2020, one in two Latino immigrants to the U.S. will have diabetes — one in two.”
Reversing those trends will require culturally appropriate measures, Schenker said. “These disparities are very complex in causation, and you can’t just assume that programs that exist for the dominant culture are going to have any impact or relevance for a Latino immigrant population.”
Luckily for Hispanics in California and beyond, Schenker and others at UC Davis have long been working to erase disparities in health care access and improve their health prognosis. Those efforts involve a broad team of experts — including doctors, nurses and researchers at the UC Davis Health System in Sacramento and scholars on the Davis campus — who are studying Latino health from the cradle to the grave.
Their approach is both multidisciplinary and community based, examining cultural barriers to better health and engaging Latinos in developing healthy lifestyles.
Major grants from federal agencies reflect UC Davis expertise across the Latino lifespan. Some recent and notable examples:
- The National Institute on Aging last fall awarded the UC Davis Health System a $3 million grant to establish a Latino Aging Research Resource Center. The center is one of just seven such Resource Centers for Minority Aging Research nationwide, and the only one to focus solely on the cognitive health of older Latinos. The center brings together a team of physician, nurse researchers and mental health researchers.
- A $4.8 million grant from the U.S. Department of Agriculture launched a program, Niños Sanos, Familia Sana, or Healthy Children, Healthy Families, that seeks to reduce obesity rates among Mexican American children in the Central Valley.
From left, Mary Lou de Leon Siantz, Marc Schenker andAdela de la Torre say research and culturally appropriate programs are essential for improving Latino health.
“Research at UC Davis offers unparalleled opportunities in the realm of discovery to make changes in the lives of Latinos,” said Mary Lou de Leon Siantz, who came from the University of Pennsylvania to join the faculty of UC Davis’ new Betty Irene Moore School of Nursing. She is also associate director of the Community Engagement and Research Program of the UC Davis Clinical and Translational Science Center.
The School of Nursing, which accepted its first graduate class in fall 2010, will help make an even bigger difference as its faculty, students and alumni collaborate with doctors and other researchers, de Leon said. Nurses, who hold “a high level of trust in the community,” can play a unique leadership role in translating scientific findings into practical health advice.
UC Davis research on Latino health goes back at least to the early 1980s, with Schenker’s studies on health hazards facing California’s predominately Latino farmworkers.
His work also uncovered a host of health problems that were not related to agricultural work, but rather to being an immigrant. Among them were asthma, and pre-term and low-birth-weight deliveries by Latina mothers.
Schenker is founder and director of the Western Center for Agricultural Health and Safety, co-director of the UC Migration and Health Center of Expertise of the Global Health Institute and the founding director of the Migration and Health Research Center. In these positions, he explores ways to reduce health disparities among Latino immigrants to the U.S. as well as migrants around the globe.
“UC Davis has made enormous contributions to understanding issues of migration and health, particularly as it relates to Latinos,” said Schenker, who is also associate vice provost for outreach and engagement. “But I would like to go beyond identifying disparities and inadequacies, and develop interventions to improve the health of Latino immigrants.”
Improving Latino health early in life is the focus of Niños Sanos, Familia Sana, a five-year study launched last spring by Adela de la Torre, director and professor of Chicana/o Studies, and interim vice chancellor for student affairs.
Centered in the Fresno County community of Firebaugh, where more than 90 percent of the 7,600 residents are Latino, the study gives families tools to eat healthier and be more active.
Four out of every 10 children of Mexican descent in the Central Valley are overweight or obese, placing them at far greater risk of high blood pressure, heart disease and diabetes, de la Torre said.
Such community-based research is crucial to understanding the many factors that influence Latino health, she said.
One Firebaugh man recently told de la Torre that, for his food-insecure family, a fast-food meal was a special treat. “The father asked, ‘Am I a bad father because the only thing I can offer my child is going to McDonald’s, because I can’t afford to go to Disneyland?’
“To tell someone to eat fruit and vegetables when you can barely put food on the table is really not recognizing what is at the root of the problem,” de la Torre said. “Until we understand why they can’t do it, you really can’t move forward with doing good research in this community.”
In Salinas, farmworkers participate in Zumba exercise classes and learn about healthy eating in a new public health program called Paso Saludables, or Healthy Steps. The program is the result of a Department of Public Health Sciences partnership with a major North American farming company, Reiter Affiliated.
The voluntary 11-week class is aimed at reducing obesity. “We dance and exercise a lot!” participant Vicente Pérez said through a translator. “I learned a lot of things that I didn’t know before. I learned to control my diet and my cholesterol and diabetes.”
Schenker said the benefits of the program go beyond the physical. “Not only did we see more lost weight, better eating habits, but mental health outcomes were improved as well.”
Adapting to an American lifestyle, in addition to changing diet, can have serious mental health consequences as well, internal medicine professor Sergio Aguilar-Gaxiola and colleagues found in a landmark 1998 study.
In what was the largest study of its kind, the researchers surveyed more than 3,000 people of Mexican origin in Fresno County, and found that Mexican immigrants had fewer psychiatric disorders than Mexican Americans.
“We were in urban areas. We were in small towns, and we were in rural, unincorporated areas. And our most striking finding was that where people were born was the variable that was the most powerful and the strongest predictor of mental-health disorders,” Aguilar-Gaxiola said.
“When we analyzed the data more deeply, we found that those who were in the United States for the shortest duration — fewer than 13 years — had the lowest rates of major mental illness. The highest rates of major mental-health disorders were among those with the longest stays in the United States.”
Aguilar-Gaxiola now directs the UC Davis Center for Reducing Health Disparities and collaborates widely with colleagues across UC Davis, including the Latino Aging Research Resource Center, as well as nationwide. He recently was appointed to co-chair the statewide Taskforce on Equity and Diversity for Regional Center Autism Services.
Last June, he and collaborators released a report identifying barriers to improved mental health for California Latinos — including the negative stigma of mental illness, limited access to culturally and linguistically appropriate care, and socioeconomic factors — as well as strategies to address them. The study was conducted under the auspices of the California Department of Mental Health and in collaboration with the statewide Latino Mental Health Concilio.
Other cultural barriers may be preventing autistic children from getting the early help that can improve their condition.
A recent study by former postdoctoral fellow Virginia Chaidez and investigators at the UC Davis MIND Institute found that diagnosis of autism or developmental delay is often missed for Latino children, even when testing is conducted in the child’s preferred language.
In findings published last summer, the researchers said many Latino parents do not receive accurate, culturally relevant information about children’s developmental milestones.
“Autism and developmental delay tend to go undiagnosed when parents are not aware of the signs to look for, and the conditions are often misdiagnosed when parents don’t have access to adequate developmental surveillance and screening,” Chaidez said.
With its launch in October, the Latino Aging Research Resource Center announced grants to medical and nursing faculty members for its first pilot research projects. Among them:
Diabetes — Lorena Garcia, assistant professor in the Department of Public Health Sciences, is examining the impact of neighborhood context on older Latinos’ risk of diabetes.
Volunteerism — Sarah Farias, associate professor in the Department of Neurology, is interviewing older Latinos about barriers to and benefits of volunteering for cognitive health.
Latina caregivers — Ester Carolina Apesoa-Varano, a sociologist and assistant professor in the School of Nursing, is studying the mental health of Hispanic women who care for family members with Alzheimer’s disease and suffer high levels of burden, depression and stress. Apesoa-Verano also is engaged in a study of depression among elderly women from a range of backgrounds including Caucasians, African Americans and Latinas.
In studying the cognitive health of older Hispanics, the center aims to also train a new generation of researchers from a wide array of professional and cultural backgrounds.
“To more effectively reduce health disparities for older Latinos, it is critical to train the next generation of researchers and to diversify the research workforce,” said Ladson Hinton, director of geriatric psychiatry in the UC Davis Department of Psychiatry and Behavioral Sciences and the center’s co-director.
“Research of a population’s health-care needs must take into account health, socioeconomic factors and historical cultural perspectives,” said center co-director Heather M. Young, associate vice chancellor for nursing and founding dean of the nursing school. “It is essential that researchers, clinicians and educators come from the populations we serve, and this center provides new opportunities for partnership with members of the Latino community.”