Healthiest Wisconsin 2020 Baseline and Health Disparities Report Hispanics/Latinos

1. Healthiest Wisconsin 2020 Baseline and Health Disparities Report Hispanics/Latinos

2. Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Key points Data • Demographic and socioeconomic data • Access to and use of health care services • Risk behaviors and health outcomes References Links to additional reports and resources Contacts

3. Report overview Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

4. Report overview Report Format Sample annotated slide Full Report • Format: PDF • Intended use: reference document Chapters • Format: Annotated PowerPoint slide set • Intended uses: presentations to • Decision-makers • Service providers • Community leaders • The public

5. Report overview Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes

6. Report overview Report Outline: Detail Section 3: Health focus areas Section 4: Infrastructure focus areas

7. Report overview Report Outline: Detail Section 5: Data summaries by population

8. Report overview Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

9. Report overview Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

10. Report overview Historical trauma • Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations. • Descendants of those who experienced the traumatic stressor may still exhibit symptoms. • Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty. • Current manifestations may include: • Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and • Higher rates of chronic diseases. • Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp

11. Key points Key Points: Hispanic/Latino population • Demographics: The Hispanic/Latino population in Wisconsin is younger than the general population, widely distributed geographically, and growing. • Socioeconomic status: Hispanics in Wisconsin are more likely to live in poverty and less likely to have a college degree compared to non-Hispanic Whites. • Access to health care: Hispanics have less access to health care compared to other racial/ethnic groups.

12. Key points Key Points: Hispanic/Latino population • Key health issues for Hispanic adults include: consequences of lack of exercise, obesity, high blood pressure, diabetes, unintended pregnancies, lack of emotional support, and (among Hispanic men) alcohol and tobacco use. • Better data on Hispanics are needed due to small sample sizes, racial/ethnic misclassification, data access issues, and differences between foreign- and U.S. born- Hispanics.

13. Demographic and socioeconomic data

14. Demographic and socioeconomic data Demographic characteristics Wisconsin’s Hispanic/Latino population is increasing in numbers, young, and diverse in terms of country of origin. Nearly one-third are foreign born. • Wisconsin's Hispanic population, 2010: 336,056; 5.9%of state total • Change in the Hispanic population, 2000 to 2010: 73%increase • Median age, 2010: Hispanic, 23years (Whites, 41.5 years) The median age is the age at which half the population is older and half is younger. • Percent of Hispanics who were foreign-born, 2010: 32% (Total population, 4%) Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.

15. Demographic and socioeconomic data Socioeconomic data Wisconsin’s Hispanic population has a higher poverty rate and less education compared to Whites. • Median household income in Wisconsin, 2008-2010: Hispanics, $36,800 (Whites, $53,000) • Poverty rate, 2010: Hispanics, 28%(Whites, 10%) The poverty rate is the percent living below the federal poverty level. • Bachelor’s degree or more education (age 25 and older), 2007-2010: Hispanics, 11%(Whites, 27%) • Married-couple households as a percent of family households, 2008-2010: Hispanics: 61% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%) Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau, American Community Health Survey.

16. Demographic and socioeconomic data Hispanic/Latino population by county, Wisconsin, 2010 Source: U.S. Census, 2010.

17. Demographic and socioeconomic data Level of urbanization of Wisconsin residents, by race/ethnicity, 2007-2011 Source: American Community Survey, 2007-2011. .

18. Demographic and socioeconomic data Country of origin of foreign-born Hispanic/Latino residents, Wisconsin, 2010 Source: American Community Survey, 2010.

19. Access to and use of health care services

20. Access to health care Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

21. Access to heath care Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by race/ethnicity, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children.

22. Access to health care Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

23. Oral Health Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010.

24. Access to health care Lack of routine preventive medical and dental care among children, by race/ethnicity, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children.

25. Risk factors among youth and adults

26. Physical health Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

27. Physical Activity Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

28. Nutrition Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010 Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey, 2010. Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.

29. Mental health Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Question asked in 2009-2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

30. Mental health Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by race/ethnicity, 2008-2010 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were not asked in 2011. Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age-adjusted. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

31. Tobacco use and exposure Age-adjusted rate of smoking among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

32. Healthy growth and development Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009-2011 Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009-2011.

33. Health Outcomes

34. Chronic diseases Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

35. Chronic diseases Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

36. Chronic diseases Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010 Source: Wisconsin Inpatient Hospitalization Discharges, 2010. Note: Hospitalization rates considered unreliable are excluded.

37. Chronic diseases Incidence of end-stage renal disease incidence among Wisconsin adults, by race/ethnicity, age-adjusted rate per 100,000, 2009 Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System. Note: Incidence rates considered unreliable are excluded.

38. Reproductive and sexual health Reported cases of HIV (ages 15-59) by race and ethnicity, rate per 100,000, Wisconsin, 2007-2011 Source: Wisconsin HIV Surveillance System. Note: Hispanic population may include individuals of various races.

39. References References Overview of Race and Hispanic Origin: 2010, 2010. Census Briefs, March 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf LaVeistTA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters. http://www.cdc.gov/features/vitalsigns/HealthcareAccess/ Cheung PT, Wiler JL, Lowe RA, GindeAA (2012). National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries. Annals of Emergency Medicine. 60(1). http://www.annemergmed.com/webfiles/images/journals/ymem/FA-PTCheung.pdf

40. References • Kaiser Commission on Medicaid and the Uninsured. Next Steps in Covering Uninsured Children. Findings from the Kaiser Survey of Children’s Health Coverage. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7844.pdf • CDC. Regular Check-Ups Are Important. http://www.cdc.gov/family/checkup/ • American Dental Association. American Dental Association Statement on Regular Dental Visits. http://www.ada.org/8700.aspx • CDC: Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html • CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm • CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993—2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htm • CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep/ • CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four • CDC. PNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators

41. References • CDC. Unintended Pregnancy Prevention. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/ • CDC. Cholesterol. http://www.cdc.gov/cholesterol/ • CDC. High Blood Pressure Facts. http://www.cdc.gov/bloodpressure/facts.htm • CDC. National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf • Agency for Healthcare Research and Quality. Diabetes mellitus: hospital admission rate for long-term complications. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38559 • National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, 2011. http://diabetes.niddk.nih.gov/dm/pubs/statistics/ • Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. http://care.diabetesjournals.org/content/32/6/1032.full.pdf+html • CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

42. Links Links to additional reports and resources • Centers for Disease Control and Prevention, Minority Health, Hispanic or Latino Populations: http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html • Centers for Disease Control and Prevention, Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/ • U.S. Department of Health and Human Services, Office of Minority Health, Hispanics/Latinos: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=33 • American Diabetes Association: Información en Español: http://www.diabetes.org/espanol/ • The National Women’s Health Information Center (en Español): http://es.bodylogicmd.com/enlaces/the-national-womens-health-information-center • National Alliance for Hispanic Health: http://www.hispanichealth.org/ • National Council of La Raza: http://www.nclr.org/

43. Contacts Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment E-mail: Evelyn2.Cruz@dhs.wisconsin.gov Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics E-mail: KarlT.Pearson@dhs.wisconsin.gov