CHAPTER 6

Mental Health Care for Hispanic Americans

Current Status

Geographic Distribution

Hispanics are highly concentrated in the U.S. Southwest (see Table 6–1). In 2000, 60 percent lived in five Southwestern States (California, Arizona, New Mexico, Colorado, and Texas). Approximately half of all Hispanic Americans live in two States, California and Texas (U.S. Census Bureau, 2001b). While many Southwestern Latinos are recent immigrants, others are descendants of Mexican and Spanish settlers who lived in the territory before it belonged to the United States. Some of these descendants, particularly those in New Mexico and Colorado, refer to themselves as “Hispanos.” More recent immigrants from Mexico and Central America are drawn to the Southwest because of its proximity to their home countries, its employment opportunities, and its established Latino communities, which can help them find jobs.

Table 6-1 gives the percentage of Hispanic Americans in State populations based on the 2000 Census. Data are provided for the 10 States with the highest proportion of Hispanics in their populations: New Mexico, California, Texas, Arizona, Nevada, Colorado, Florida, New York, New Jersey, and Illinois.

Outside the Southwest, New York, Florida, and Illinois are home to the largest concentrations of Hispanics. New York has 8.1 percent, Florida, 7.6 per-cent, and Illinois, 4.3 percent of all the Latinos estimated to reside in the United States in 2000 (U.S. Census Bureau, 2001b). Two-thirds of Puerto Ricans on the mainland live in New York and New Jersey, and two-thirds of Cuban Americans live in Florida (Population Reference Bureau, 2000).

Although specific subgroups of Latinos are associated with specific geographical regions, important demo-graphic shifts have resulted in the increased visibility of Latinos throughout the United States. From 1990 to 2000, Latinos more than doubled in number in the following six states: Arkansas (170 %), Nevada (145 %), North Carolina (129 %), Georgia (120 %), Nebraska (108 %), and Tennessee (105 %) (U.S. Census Bureau, 2000c). Of the six States, Nevada is the only one located in a region with traditionally high concentrations of Latinos. Thus, in addition to growing in numbers, Hispanic Americans are spreading throughout the United States.

Family Structure

Latinos are often referred to as family oriented (Sabogal et al., 1987). It is important to note that familism is as much a reflection of social processes as of cultural practice (Lopez & Guarnaccia, 2000). Specifically, the shared experience of immigrating to a new land or of experiencing difficult social conditions in one’s homeland can pro-mote adherence to family ties. In many cases, family connections facilitate survival and adjustment.

The importance of family can be seen in Hispanic living arrangements. Although family characteristics vary by Latino subgroups, as a whole, Latinos, like Asian Americans and Pacific Islanders, are most likely to live in family households and least likely to live alone. In addition, children (especially the females) tend to remain in the family until they marry. Nearly 30 percent of both white and black households consisted of a single person in 1998, compared to just 14 percent of Hispanic house-holds (Riche, 2000). Almost two-thirds (63 %) of Hispanic family households included children under age 18 in 1999, while fewer white families (47 %) and black families (56 %) included children (U.S. Census Bureau, 2001).

Education

Overall, Hispanics have less formal education than the national average. Of Latinos over 25 years of age, only 56 percent have graduated from high school, and only 11 percent have graduated from college. Nationally, 83 per-cent and 25 percent of the same age group have graduated from high school and college respectively (U.S. Census Bureau, 2000b). Hispanics’ educational attainment is related to their place of birth. In 1999, only 44 percent of foreign-born Hispanic adults 25 years and older were high school graduates, compared to 70 percent of U.S.-born Hispanic adults (U.S. Census Bureau, 2000b). The dropout rate for foreign-born Hispanics ages 16 to 24 is more than twice the dropout rate for U.S.-born Hispanics in the same age range (Kaufman et al., 1999).

A recent study of middle school Latino students questions why foreign-born adolescents and adults have the worst educational outcomes (C. Suarez-Orozco & M. Suarez-Orozco, 1995). The study concluded that recent immigrants from Mexico and El Salvador had at least the same, or in some cases greater motivation to achieve than white or U.S.-born Mexican American students. (See also M. Suarez-Orozco, 1989.)

It is not clear how to reconcilethese data on motivation with the national picture of poor educational out-comes for many Latino immigrants. One explanation may be that the high dropout rate reflects a large number of youth and young adults with little education who come to the United States to work, not to attend school (National Center for Education Statistics, 2000). Another explanation may be that many Latino immigrants who attend school lose their motivation over time, given the social, linguistic, and economic difficulties they face. Some may even turn to involvement in urban gangs (Vigil, 1988).

The educational achievement of three of the main Hispanic subgroups reveals further variability. Cubans have the highest percentage of formally educated people. Of persons over 25 years of age, 70 percent of Cuban Americans have graduated from high school, whereas 64 percent of Puerto Ricans and 50 percent of Mexican Americans have graduated from high school (U.S. Census Bureau, 2000d). Moreover, one-fourth of Cuban Americans have graduated from college, which is identical to the college graduation rate of Americans overall. In contrast, Puerto Rican and Mexican-origin adults have lower college graduation rates, 11 percent and 7 percent respectively. Although Latinos as a group have poorer educational outcomes than other ethnic groups, there is sufficient variability to offer hope for improving Latinos’ educational success.

Income

The economic status of three of the main subgroups parallels their educational status. Cuban Americans are more affluent in standing than Puerto Ricans and Mexican Americans, as reflected in median family incomes (Cubans, $39,530; Puerto Ricans, $28,953; Mexicans, $27,883), the percentage of persons below the poverty line (Puerto Ricans, 31 %; Mexicans, 27 %; Cubans, 14 %) and the unemployment rates of persons 16 years and older (Puerto Ricans, 7 %; Mexicans, 7 %; Cubans, 5 %) (U.S. Census Bureau, 2000d). The current income levels of the Latino subgroups are also related to the political and historical circumstances of their immigration. Elite Cuban immigrants have contributed in part to the relatively strong economic status of Cuban Americans. Their experience, however, stands in stark contrast to that of Mexican Americans, Puerto Ricans, and Central Americans, most of whom came to the United States as unskilled laborers.

Physical Health Status

Infant mortality is one sensitive indicator of a population’s health. Hispanic Americans have lower infant mortality rates than do white Americans. For most groups, infant mortality tends to be related to the educational level of mothers. For example, white infants born to mothers with fewer than 12 years of education are 2.4 times as likely to die as those born to mothers with 16 or more years of education. Although Cubans and Puerto Ricans show this general pattern, the pattern is not so prominent for Mexican Americans or immigrants from Central America. Furthermore, although Mexican Americans and African Americans have similar socioeconomic profiles, infant mortality among Mexican Americans is less than half that of African Americans. Mexican American women who were born in Mexico are less likely to give birth to a baby of low birthweight than are U.S.-born Mexican American women (Becerra et al., 1991). This difference is partially explained by the fact that Mexican-born women are less likely to use cigarettes and alcohol than Mexican American women who were born in the United States (Scribner & Dwyer, 1989).

Other statistics show that Latinos in the United States suffer from more health disorders than white Americans. Latinos are twice as likely as whites to die from diabetes (Department of Health and Human Services, [DHHS], 2000). Although they comprised only 11 percent of the total U.S. population in 1996, Latinos had 20 percent of the new cases of tuberculosis in the United States that year. Latinos also exceed whites in rates of high blood pressure and obesity.

Health indicators for Puerto Rican Americans are worse than such indicators for other Latinos. According to the results of a nationally representative interview conducted in English and Spanish, Puerto Rican Americans reported more days in which they had to restrict their activities due to health disability, more days spent in bed, and more hospitalizations than did Mexican Americans and Cuban Americans (National Health Interview Survey, 1992–1995, see Hajat, 2000).