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Hispanics and Health Carein the United States:Access, Information and Knowledge

A Joint Pew Hispanic Center and Robert WoodJohnson Foundation Research Report

Written by:Gretchen Livingston,Senior Researcher

Susan Minushkin,Deputy DirectorPew Hispanic Center

D’Vera Cohn,Senior Writer

Hispanics and Health Care in the United States: Access, Information and KnowledgeB

� TABLE OF CONTENTS

ACKNOWLEDGMENTS ......................................................................................1

FOREWORD.........................................................................................................3

OVERVIEW AND EXECUTIVE SUMMARY ...................................................4The Likelihood of Having a Usual Health Care Provider .......................................6

Profile of Persons Who Lack a Usual Health Care Provider..................................7

Quality of Health Care ........................................................................................8

Health Information Sources .................................................................................8

Diabetes Knowledge ...........................................................................................9

CHAPTER 1 – INTRODUCTION: HISPANICS AND CHRONICDISEASE IN THE U.S. .......................................................................................10

CHAPTER 2 – UTILIZATION OF A USUAL HEALTH CARE PROVIDERAND SATISFACTION WITH HEALTH CARE ...............................................13

Importance of Having a Usual Health Care Provider ..........................................14

The Likelihood of Having a Usual Health Care Provider .....................................15

Getting Care Outside of the U.S. ......................................................................18

Profile of Latinos Lacking a Usual Health Care Provider.....................................19

Why Don’t People Have a Usual Place for Health Care?....................................21

Folk Healing ......................................................................................................22

Quality of Health Care .......................................................................................22

CHAPTER 3 – SOURCES OF INFORMATION ON HEALTHAND HEALTH CARE .........................................................................................26

Where Do Hispanics Get Health Care Information? ...........................................26

Who Gets Information from the Medical Community? .......................................28

Who Gets Information from the Media?.............................................................30

Who Gets Health Information from the Media in Spanish, andWho Gets It in English? .....................................................................................32

CHAPTER 4 – HOW MUCH DO HISPANICS KNOW ABOUTDIABETES?.........................................................................................................35

Knowledge Differences by Demographic Group ................................................36

Knowledge Differences by Insurance Status andHealth Care Access ..........................................................................................39

Knowledge Differences by Sources of Information.............................................39

Composition of the Low-Scoring Group............................................................40

Diabetics’ Knowledge of Diabetes.....................................................................43

REFERENCES ......................................................................................................44

APPENDIX A: METHODOLOGY............................................................................45

APPENDIX B: DETAILED TABLES.........................................................................48

Hispanics and Health Care in the United States: Access, Information and Knowledge1

� ACKNOWLEDGMENTS

About the Pew Hispanic Center

Founded in 2001, the Pew Hispanic Center is a nonpartisan research organizationthat seeks to improve understanding of the U.S. Hispanic population and tochronicle Latinos’ growing impact on the nation. The Center does not takepositions on policy issues. It is a project of the Pew Research Center, anonpartisan “fact tank” in Washington, D.C., that provides information on theissues, attitudes and trends shaping America and the world. It is funded bythe Pew Charitable Trusts, a public charity based in Philadelphia.

The Pew Hispanic Center conducts and commissions studies on a wide range oftopics with the aim of presenting research that at once meets the most rigorousscientific standards and is accessible to the interested public. The Center alsoregularly conducts public opinion surveys that aim to illuminate Latino viewson a range of social matters and public policy issues. For more information,visit www.pewhispanic.org.

About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing our country. As the nation’s largest philanthropy devotedexclusively to improving the health and health care of all Americans, theFoundation works with a diverse group of organizations and individuals toidentify solutions and achieve comprehensive, meaningful and timely change.For more than 35 years, the Foundation has brought experience, commitment,and a rigorous, balanced approach to the problems that affect the health andhealth care of those it serves. When it comes to helping Americans leadhealthier lives and get the care they need, we expect to make a difference inyour lifetime. For more information, visit www.rwjf.org.


� ACKNOWLEDGMENTS

This project would not have been possible without the intellectual leadership ofRoberto Suro, previously director of the Pew Hispanic Center and the project’sprincipal investigator, and the insightful comments and input of an exceptionalgroup of senior scholars who make up the project’s Scientific Advisory Groupand are experts in the field of health and health care research among Latinos.The Pew Hispanic Center and the Robert Wood Johnson Foundation areparticularly indebted to William Vega of the University of California, LosAngeles, project director of the Scientific Advisory Group, for his leadership andwisdom in identifying the important challenges and helping us overcome them.We are also grateful for the contribution of other members of the ScientificAdvisory Group: Margarita Alegria, Harvard University; Glorisa Canino,University of Puerto Rico; Jose Escarce, University of California, Los Angeles;Michael Rodriguez, University of California, Los Angeles; Ruben Rumbaut,University of California, Irvine; William Sribney, independent consultant;and Marta Tienda, Princeton University. We are also very appreciative of thework of Michael Rodriguez for his ability to help us move the project forward.In addition, RWJF would like to thank Anne Weiss and the Quality/EqualityTeam for advising on this project and understanding how these data caninform our work on reducing disparities; and Adam Coyne, Gina Ivey andHope Woodhead for their contributions to the development, productionand dissemination of the findings.


� FOREWORD

The Hispanic population in the United States has more than doubled in size inthe past 15 years and is now estimated to have reached 45 million. This rapidexpansion, combined with the increasing heterogeneity of the nationalitiescomposing the Hispanic population, underlines the need for up-to-date, accurateinformation on Hispanics that takes into account their growing diversity.

Health care is one realm where such information is especially critical. When itcomes to Latinos, what may appear to be the well-known effects of socio-economic inequality on health care may also be conditioned by unique social,cultural and economic circumstances confronting both Hispanic immigrantsand Hispanics born in the United States.

With the heterogeneity of the Latino population in mind, the Robert WoodJohnson Foundation and the Pew Hispanic Center designed this survey toprovide up-to-date, accurate information on Hispanics and health care in theUnited States. This report focuses on how the diverse characteristics of theLatino population influence their health information needs, their help-seekingbehaviors, their access to health services, their perceptions of the quality ofhealth care, and their level of understanding of chronic disease.

The vast growth and the increasing diversity of the Hispanic population createa challenge for improving public health interventions and reducing medical caredisparities. This report seeks to address that challenge by providing informationthat we hope will be of use to policy-makers, the medical and public healthcommunities, and the media.

Susan Minushkin, Ph.D. Debra Perez, Ph.D., M.P.A., M.A.Deputy Director Senior Program OfficerPew Hispanic Center Robert Wood Johnson Foundation


� OVERVIEW AND EXECUTIVE SUMMARY

Overview

More than one-fourth of Hispanic adults in the United States lack a usual healthcare provider, and a similar proportion report obtaining no health care informationfrom medical personnel in the past year. At the same time, more than eight in 10report receiving health information from alternative sources, such as televisionand radio, according to a Pew Hispanic Center (PHC) survey of Latino adults,conducted in conjunction with the Robert Wood Johnson Foundation (RWJF).

Hispanics are the nation’s largest and fastest growing minority group. Theycurrently make up about 15 percent of the U.S. population, and this figure isprojected to nearly double to 29 percent by 2050, if current demographic trendscontinue.1 Even after adjusting for their relative youth, Hispanic adults have alower prevalence of many chronic health conditions than the U.S. adult popula-tion as a whole. However, they have a higher prevalence of diabetes than donon-Hispanic white adults, and they are also more likely to be overweight. Thisgreater propensity to be overweight puts them at an increased risk to developdiabetes and other serious health conditions.2

Figure 1: Hispanic Adults’ Likelihood of Lacking a Usual HealthCare Provider

Nativity

Native born

Foreign born

Sex

Male

Female

Age

18–29

30–49

50–64

65 and older

Education

Less than a high school diploma

High school diploma

Some college or more

Health Insurance

Insured

Uninsured

20% 40% 60% 80% 100%

22

27

36

16

13

32

19

27

19

42

17

3726

30

TOTAL

Question wording: Is there a place that you usually go to when you are sick or needadvice about your health?Source: Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey.


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Previous research by the U.S. Centers for Disease Control and Prevention hasshown that Hispanics are twice as likely as non-Hispanic blacks and three timesas likely as non-Hispanic whites to lack a regular health care provider.3 Hispanicsare a diverse community, and the Pew Hispanic Center/Robert Wood JohnsonFoundation Latino Health survey of 4,013 Hispanic adults explores not onlytheir access to health care, but also their sources of health information and theirknowledge about a key disease (diabetes) at greater depth and breadth than anynational survey done to date by other research organizations or the federalgovernment.

It finds that among Hispanic adults, the groups least likely to have a usual healthcare provider are men, the young, the less educated, and those with no healthinsurance. A similar demographic pattern applies to the non-Hispanic adultpopulation. The new survey also finds that foreign-born and less-assimilatedLatinos—those who mainly speak Spanish, who lack U.S. citizenship, or whohave been in the United States for a short time—are less likely than other Latinosto report that they have a usual place to go for medical treatment or advice.

Nevertheless, a significant share of Hispanics with no usual place to go formedical care are high school graduates (50 percent), were born in the UnitedStates (30 percent) and have health insurance (45 percent). Indeed, the primaryreason that survey respondents give for lacking a regular health care provider isnot related to the cost of health care or assimilation. Rather, when asked aboutwhy they lack a usual provider, a plurality of respondents (41 percent) say theprincipal reason is that they are seldom sick.

As for sources of health information, about seven in 10 Latinos (71 percent)report that they received information from a doctor in the past year. An equalproportion report obtaining health information through their social networks,including family, friends, churches, and community groups. An even largershare (83 percent) report that they obtained health information from somebranch of the media, with television being the dominant source.

Not only are most Latinos obtaining information from media sources, but asizeable proportion (79 percent) say they are acting on this information. It isbeyond the scope of this report to assess the accuracy and usefulness of healthinformation obtained from non-medical sources, but the survey findings clearlydemonstrate the power and potential of these alternative outlets to disseminatehealth information to the disparate segments of the Latino population.


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Regarding the quality of the health care they receive, Latinos are generally pleased,according to the survey. Among Latinos who have received health care in the pastyear, 78 percent rate that care as good or excellent. However, almost one in fourwho received health care in the past five years reported having received poorquality medical treatment. Those who believed that the quality of their medicalcare was poor attribute it to their financial limitations (31 percent), their race orethnicity (29 percent), or the way they speak English or their accent (23 percent).

The PHC/RWJF survey also asked respondents a battery of eight knowledgequestions about diabetes, a condition that afflicts an estimated 9.5 percent ofLatino adults, compared with 8.7 percent of non-Latino whites.4* Nearly six in10 respondents (58 percent) answered at least six of the eight diabetes questionscorrectly. Better educated and more assimilated Latinos scored better, as didthose with a usual health care provider.

These findings are from a bilingual telephone survey of a nationally representa-tive sample of 4,013 Hispanic adults conducted from July 16, 2007 throughSeptember 23, 2007. The survey’s margin of error is +/- 1.83 (see Appendix Afor a full description of the survey methodology). Among the key findings:

The Likelihood of Having a Usual Health Care Provider

� Some 73 percent of Latino adults report having a usual place where they seekmedical help or advice, while 27 percent have no usual health care provider.

� As in the general population, males, the young, and the less educated are lesslikely to have a usual health care provider.• 36 percent of men lack a usual provider, compared with 17 percent of women.

* These figures represent the overall prevalence of diabetes. For age-adjusted statistics on the prevalenceof diabetes, see Table 1.

71

83

70

Figure 2: Hispanic Adults Receiving Information About Health and HealthCare in the Past Year, by Source of Information

20%

0

40%

60%

80%

100%

Medical professional Media Social networks

Source: Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey.


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• 37 percent of persons ages 18–29 lack a regular place to obtain health care,compared with 13 percent of persons ages 65 or older.

• 32 percent of adults with less than a high school diploma lack access to aregular place for health care, compared with 19 percent of people with atleast some college education.

� Foreign-born and less assimilated Latinos are less likely than other Hispanicsto have a usual health care provider.• 30 percent of Latinos born outside of the 50 states lack a usual place forhealth care, compared with 22 percent of U.S.-born Latinos.

• 32 percent of Latinos who mainly speak Spanish lack a regular health careprovider, compared with 22 percent of Latinos who mainly speak English.

• 49 percent of Latinos who have lived in the United States for less than fiveyears lack a usual health care provider, compared with 21 percent of thosewho have lived in the United States for 15 years or more.

� Some 42 percent of the Latinos who have no health insurance lack a usualhealth care provider, compared with 19 percent of the insured.

Profile of Persons Who Lack a Usual Health Care Provider

� The primary reason that respondents give for not having a regular health careprovider is their belief that they do not need one.• 41 percent of those lacking a regular provider say that they are seldom sick,and 13 percent say they prefer to treat themselves.

• 17 percent report a lack of health insurance as the primary reason that theydon’t have a regular provider, and 11 percent report that the cost of healthcare is prohibitive.

• 3 percent report that they have trouble navigating the U.S. health care system.

� A significant share of Hispanic adults who lack a regular health care providerare native born, have a high school diploma, speak English and have healthinsurance.• 50 percent of those with no usual health care provider are at least highschool graduates.

• 30 percent of those with no usual health care provider were born in theUnited States.

• 52 percent of those with no usual health care provider speak predominantlyEnglish or are bilingual.

• 45 percent of those with no usual health care provider have health insurance.


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Quality of Health Care

� 77 percent of Latinos who have received health care in the past year rate thatcare as good or excellent.

� Of those Latinos who have received health care in the past year, assessmentsof the quality of care are higher rated among those who have health insuranceand a usual health care provider.• 80 percent of people with a usual health care provider state that their healthcare was good or excellent, compared with 64 percent of people with nousual health care provider.

• 80 percent of the insured rate their health care as good or excellent,compared with 70 percent of the uninsured.

� Of those respondents who have received health care in the past five years,23 percent report having received poor-quality medical treatment• A plurality (31 percent) attribute this poor treatment to their financiallimitations.

• 29 percent attribute the poor treatment to their race or ethnicity.• 23 percent report that their accent or the manner in which they speakEnglish contributed to their poor treatment.

Health Information Sources

� Some 71 percent of Latinos report getting information from a medicalprofessional in the past year, while 28 percent report having obtained noinformation at all from a health care professional in that time.

� Most Latinos receive information about health care either from the media,or from their families, friends, churches and community groups.• 83 percent report obtaining at least some information about health andhealth care from television, radio, newspapers, magazines or the Internetin the past year.

• 70 percent report obtaining information from family and friends, orchurches and community groups in the past year.

� Television is an especially powerful conduit of information; 68 percent ofLatinos report obtaining health information from television in the past year.


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� Not only are Latinos obtaining a substantial amount of health informationfrom the media, but they are making behavioral changes based on whatthey learn.*• 64 percent report that the health information that they obtained from themedia led them to change their diet or exercise regimes.

• 57 percent report that the health information they obtained from the medialed them to visit a health care professional.

• 41 percent say that the information they obtained from the media affectedtheir decision about how to treat an illness or medical condition.

Diabetes Knowledge

� In a battery of eight questions assessing diabetes knowledge, 58 percentof respondents scored “high,” meaning they correctly answered six or moreof the questions.

� Better-educated, more assimilated Latinos are more knowledgeableabout diabetes.• 50 percent of adults lacking a high school diploma score high on theknowledge battery, compared with 70 percent of adults with at leastsome college education.

• 60 percent of naturalized citizens score high on the knowledge battery,compared with 48 percent of immigrant respondents who are neithercitizens nor legal permanent residents.

• 50 percent of immigrants who have lived in the United States for less thanfive years score high on the knowledge battery, compared with 61 percentof immigrants who have lived in the United States for 15 years or more.

� 61 percent of adults with a usual place for health care scored high on thediabetes knowledge index, compared with 50 percent of adults with no usualplace for health care.

� Among adults diagnosed with diabetes, 73 percent scored high on theknowledge test, while 27 percent answered five or fewer questions correctly.

* The survey does not allow us to evaluate the validity of the health information obtained, or theappropriateness of subsequent behavioral changes that respondents make.


� CHAPTER 1 – INTRODUCTION: HISPANICS AND CHRONIC DISEASE IN THE U.S.

Chronic conditions have large impacts on U.S. health and medical spending.According to the Centers for Disease Control and Prevention, 133 millionU.S. residents have at least one chronic condition. Treating those diseases costs$1.5 trillion a year, which accounts for 75 percent of the nation’s spending ondirect medical costs.5 Given the aging of the U.S. population, the prevalenceof chronic disease and the rising costs of treatment, medical expenditures areexpected to continue to go up.6

The size and rapid growth of the Latino population offers considerable reason tofocus on its chronic disease management. Latinos will account for most of theU.S. population growth through 2050. While in 2007, Latinos comprised 15percent of the U.S. population, or about 45.5 million people,7 projections basedon current demographic trends suggest that by 2050, they will comprise upwardsof 29 percent of the population, or 128 million people.8

Though they are now relatively youthful compared with the general population,Latinos will account for a growing proportion of middle-aged and elderlyAmericans in the future. By 2050, for example, the Hispanic share of the elderlypopulation will almost triple to 17 percent from 6 percent in 2005. Furthermore,growth in the Hispanic population increasingly will be driven by births in theUnited States, rather than immigration from abroad.9 Since U.S.-born Hispanicstend to be less healthy than Hispanic immigrants, this compositional changemay further predispose the population to chronic illness.

At present, Hispanics have a lower prevalence of many conditions than thepopulation as a whole, but they have a higher prevalence of diabetes thannon-Hispanic whites (see Table 1). Furthermore, their rates of overweight andobese adults are relatively higher than those of non-Hispanic whites, whichputs Hispanics at greater risk for the development of diabetes and other healthconditions.10


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Table 1: Age-Adjusted Percentages of Disease Prevalence and RiskFactors for Persons Ages 18+, 2006

Hispanics % Non-Hispanic Non-HispanicWhite % Black %

Heart disease (includes coronary 7.6 11.7 10.0heart disease, angina pectoris, orany other heart condition or disease)

Hypertension 20.4 22.4 31.6

Asthma (ever had) 8.2 11.5 12.0

Chronic bronchitis 2.7 4.5 4.3

Cancer (ever had) 3.6 8.2 4.0

Diabetes (excludes gestational and 10.5 6.7 12.0borderline diabetes)

Overweight 39.6 34.5 33.7

Obese 27.4 24.7 35.3

When people don’t get the information or treatment that would allow themto manage illnesses at an early stage or avoid a disease altogether, the costs ofhealth care escalate and the burden of expensive late-stage medicine often falls topublicly funded health services. An important strategy to reduce chronic illness,and the costs associated with it, is through prevention via regular monitoringand educational initiatives.6

According to the CDC,3 the proportion of Hispanics who report that they haveno usual place to receive health care is more than double that of non-Hispanicwhites and non-Hispanic blacks.* Though it is more difficult to measure generalknowledge and education about health issues among the population, thesheer diversity of the Hispanic population creates a challenge to informationdissemination within medical environments as well as through public healthcampaigns.

In addition to divisions by gender, income and education, a number of otherkey characteristics distinguish Hispanics from each other. The language dividebetween Hispanics who are English speakers and those who are primarilySpanish speakers creates obstacles to public health campaigns and medical care.Differences between U.S.-born Hispanics and Hispanic immigrants, betweenHispanic immigrants from different countries of origin, as well as differing ratesof assimilation by Latino immigrants add to the complexity of understandingthis rapidly growing population and determining how best to convey healthinformation to it.

* This cross-group pattern persists even controlling for age differences among the populations.

Source: National Health Interview Survey data from Pleis and Lethbridge–Cejku (2007).


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Table 2: Profile of Hispanic Adults

Sex

Male 52

Female 48

Age

18–29 30

30–49 44

50–64 15

65 and older 8

Education

Less than a high school diploma 39

High school diploma 32

Some college or more 26

Language

English-dominant 24

Bilingual 35

Spanish-dominant 41

Origin

Mexico 63

Puerto Rico 8

Cuba 4

Dominican Republic 3

Central America 10

South America 6

Nativity

Native born 36

Foreign born 63

Citizenship

Native-born citizen 41

Naturalized 22

Legal permanent resident (LPR) 21

Foreign born, not LPR 16

Years in U.S. (Foreign born only)

Less than 5 years 13

5–9 years 18

10–14 years 14

15 years or more 54

Results based upon the PHC/RWJF 2007 Latino Health Survey.

Note: Percentage may not total 100 due to rounding and the exclusion of “don’t know” and “refused”responses.


� � CHAPTER 2 – UTILIZATION OF A USUAL HEALTH CARE PROVIDER AND SATISFACTIONWITH HEALTH CARE

According to the survey results, more than one in four Latinos (27 percent) lacka regular health care provider.* Latinos are a diverse population, and a varietyof factors need to be considered to understand why some have regular providersand some don’t. Immigration and assimilation are factors, as large shares ofLatinos born outside of the United States and those who speak little English lackregular health care. Socioeconomic factors, such as education, immigration andlanguage, weigh heavily in creating these disparities. However, there is also asubstantial share of U.S.-born, fully assimilated Latinos in the ranks of thosewith no usual health care provider.

Hispanics who are most likely to lack a usual place for health care include men(36 percent), the young (37 percent of those ages 18–29), and the less educated(32 percent of those lacking a high school diploma). Generally, Latinos who areless assimilated into U.S. life are also at a disadvantage: 30 percent of thoseborn outside of the 50 states, 32 percent of Spanish speakers and 43 percent ofimmigrants who are neither citizens nor legal permanent residents lack a regularhealth care provider.

The uninsured are more than twice as likely (42 percent) as the insured(19 percent) to lack a usual provider. Although lacking health insurance raisesthe likelihood of not having a usual health care provider, having healthinsurance in no way guarantees it. Of those without a usual source of healthcare, 45 percent have health insurance.

Finally, even though the poorly educated and less assimilated are less likely tohave a regular health care provider, they comprise only a portion of the populationthat falls into this category. A sizeable proportion of those with no usual placefor health care have at least a high school diploma (50 percent), are native born(30 percent), are proficient in English (52 percent) or are U.S. citizens (50 percent).

* These results differ slightly from the statistic (32 percent) cited from the CDC, which is based on theNational Health Interview Survey. For more information on NHIS methodology and variable definitions,see www.cdc.gov/nchs/nhis.htm.


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IMPORTANCE OF HAVING A USUAL HEALTH CARE PROVIDER

Access to health care can be defined in any number of ways, but one widely usedapproach is to consider whether a person reports having a usual place to seekhealth care and advice. As is common practice,13 we consider any respondentswho report having a place, other than an emergency room, “where they usually

go when they are sick or need advice abouttheir health,” other than an emergency room,as having a regular health care provider. Weconsider those who report having no usualplace to obtain health care, or whose onlyusual place for health care is an emergencyroom, to be lacking a health care provider.

Defined this way, having a usual providercorrelates with preventive care and monitor-ing. And preventive care and monitoring areboth associated with better long-term healthoutcomes, including better control of chronicconditions. Among Hispanics with a regularhealth care provider, 86 percent report a bloodpressure check in the past two years, whileonly 62 percent of those lacking a providerreport this. While almost three-fourths ofthose with a usual place to get health carereport having their cholesterol checked in thepast five years, fewer than half (44 percent) ofthose with no usual place have done so.Latinos generally are at heightened risk ofdiabetes, and three-fourths of those with aregular health care provider report having had

a blood test to check this in the past five years, compared with only 49 percent ofthose lacking a regular health care provider. Among already-diagnosed diabetics,it is especially noteworthy that, while 10 percent of those with a regular place forhealth care have not had a test to check their blood sugar in the past two years,this share jumps to 33 percent among those with no regular provider.*

USUAL HEALTH CAREPROVIDER

Respondents areconsidered to have a“usual” or “regular” healthcare provider or place toreceive health care if they:

1. Report that they have aplace where they usuallygo to when they are sickor need advice abouttheir health, and

2. This usual place is nota hospital emergencyroom

* These differences between Latinos with and without a usual provider persist, even controlling for age.


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THE LIKELIHOOD OF HAVING A USUAL HEALTH CARE PROVIDER

Our survey results find that 73 percent of respondents have a usual health careprovider and that 27 percent of respondents lack a provider.

The lack of a regular health care provider varies markedly within the Latinopopulation. For gender, age and education, the patterns mimic those in thegeneral population.14 Latino men (36 percent) are more likely to lack a regularhealth care provider than women (17 percent). Younger Hispanics are especially

likely to lack a regular health care provider: 37 percentof those ages 18–29 do not have one. This statisticdeclines with age; among respondents ages 65 andolder, only 13 percent lack a regular health careprovider. Higher levels of education are clearly associ-ated with a higher likelihood of having a usual placeto obtain health care. Only 19 percent of Hispanicswith at least some college education lack usual healthcare access. That rises to 27 percent for high schoolgraduates, and to nearly one-third (32 percent) forthose with less than a high school diploma.

Place of birth and assimilation also play a role in the likelihood of having a regularhealth care provider. While 22 percent of U.S.-born Latinos do not have a placewhere they usually go for medical care, this share increases to 30 percent amongthose born outside the 50 states. In general, less assimilated Hispanics are thosemost at risk of lacking a usual place for health care. Among naturalized andnative-born Hispanic citizens, 21 to 22 percent lack a usual health care provider.That compares with 31 percent of legal permanent residents and 43 percent of

86

6274

44

75

49

90

67

Figure 3: Differences in Preventive Care Monitoring BetweenLatinos With and Without a Usual Health Care Provider

20%

40%

60%

80%

100%

Blood pressure checkin past 2 years

Cholesterol checkin past 5 years

Blood sugar testin past 5 years

Blood sugar testin past 2 years

(diagnosed diabetics)� Usual provider � No usual provider

Nativity andassimilation areboth linked to thelikelihood of havinga regular healthcare provider.


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immigrants who are neither citizens nor legal permanent residents. Among allLatino immigrants, about half of recent arrivals—those in the country for less thanfive years—lack a usual place for health care, compared with 21 percent of those whohave lived in the United States for at least 15 years. Hispanics who are predomi-nantly Spanish speakers are much more likely to lack regular health care than theirpredominantly English-speaking counterparts (32 percent versus 22 percent).

Having health insurance is an important factor associated with having a usualplace to obtain health care. While 42 percent of the uninsured lack a health careprovider, only 19 percent of the insured do not have one.

Figure 4: Hispanic Adults’ Likelihood of Lacking a Usual Health CareProvider

Sex

Male

Female

Age

18–29

30–49

50–64

65 and older

Education


High school diploma


Health Insurance

Insured

Uninsured

Nativity

Native born

Foreign born

Origin

Mexico

Puerto Rico

Cuba

Dominican Republic

Central America

South America

Other

20% 40% 60% 80% 100%

27

36

16

13

32

19

27

19

42

17

37

26

TOTAL

22

29

31

17

23

16

24

21

30

continued

Figure 4: Hispanic Adults’ Likelihood of Lacking a Usual Health CareProvider, continued

Language

English-dominant

Bilingual

Spanish-dominant

Citizenship

Native-born citizen

Naturalized

Legal permanentresident (LPR)

Foreign born, not LPR

Years in U.S.(Foreign born only)

Less than 5

5–9

10–14

15 or more

20% 40% 60% 80% 100%

27TOTAL


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22

32

25

22

21

31

43

49

40

31

21


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GETTING CARE OUTSIDE OF THE U.S.

About one in 12 Hispanics (8 percent) in the U.S. have obtained medicalcare, treatment or drugs in Latin America during the previous year, andone in six (17 percent) knows a family member or friend who has done so.

Latinos who describe their recent medical care in the United States as onlyfair to poor are somewhat more likely to get medical services outside thecountry—11 percent have, compared with 6 percent of those who describetheir care in this country as excellent. Hispanics without health insurancealso are more likely to have received care in another country. Of thosewithout insurance, 11 percent did; of those with insurance, 7 percent did.Of Latinos with a regular provider in the U.S. medical system, 8 percentsay they have gotten care abroad, compared with 10 percent of those withno regular provider.

Hispanics ages 65 and older are the least likely to seek care outside theUnited States (4 percent) and those ages 50–64 are the most likely(9 percent). Foreign-born Latinos are somewhat more likely (9 percent)than the native born (6 percent) to get medical care in Latin America,and those from Mexico (10 percent) are more likely than non-Mexicansoverall. A higher share of bilingual (10 percent) and Spanish-dominant(9 percent) Hispanics seek medical care in Latin America than do Englishspeakers (4 percent).

One in 10 people with at least some college education report gettingrecent treatment or drugs in Latin America, compared with single-digitpercentages for those with less education.


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PROFILE OF LATINOS LACKING A USUAL HEALTH CARE PROVIDER

Who are the Hispanics who are not being reached by the health care system?This section looks at the characteristics of people who lack a usual health careprovider.

Most Hispanics who lack a provider are male (69 percent). The population alsotends to be young: 41 percent are 18–29 years of age, and 43 percent are 30–49.As is expected, Hispanics with low educational attainment comprise a largeproportion of those lacking a provider; 47 percent report having less than ahigh school diploma. The vast majority of those with no usual place for healthcare are of Mexican origin (69 percent), and an additional 11 percent are ofCentral American origin.

Yet, what is also notable about those lacking a usual health care provider isthe prevalence of Latinos whose characteristics suggest assimilation. While mostLatinos who lack a provider are foreign born (70 percent), a full 30 percent wereborn in the 50 states. Half of those lacking a usual place for health care arecitizens. A sizeable minority of immigrants who lack regular health care(45 percent) have lived in the United States for fewer than 10 years, but themajority (52 percent) have lived in the United States for 10 years or more.

On a similar note, a slight majority of those with nousual health care provider is English-dominant orbilingual (52 percent).

Finally, 45 percent of Hispanics who have no usualplace for health care say they have health insurance.So though health insurance is correlated with usualcare, it does not guarantee it.

Of those Hispanicswho have no usualplace for health care,45 percent havehealth insurance.


� �

Figure 5: Profile of Those Lacking a Usual Health Care Provider

Sex

Male

Female

Age

18–29

30–49

50–64

65+

Education


High school diploma


Health Insurance

Has insurance

No insurance

Nativity

Native born

Foreign born

Origin

Mexico

Puerto Rico

Cuba

Dominican Republic

Central America

South America

Language

English-dominant

Bilingual

Spanish-dominant

Citizenship

Native-born citizen

Naturalized

Legal permanent resident (LPR)

Foreign born, not LPR

Years in U.S.(Foreign born only)

Less than 5

5–9

10–14

15 or more

20% 40% 60% 80% 100%

69

41

47

32

45

51

30

20

48

32

33

25

26

22

23

14

38

17

70

69

18

43

9

4

5

4

3

5

11

31



� �

WHY DON’T PEOPLE HAVE A USUAL PLACE FOR HEALTH CARE?

The survey asked respondents who lacked a usual place to get medical care oradvice why they did not have one.* By far the most commonly cited reason wasthat they felt they did not need one because they are seldom sick (41 percent).An additional 13 percent report that they prefer to treat themselves than to seekhelp from medical doctors.

The next most prevalent set of responses relates to finances: 17 percent reportthat they lack health insurance, and 11 percent report that the cost of health careprevents them from having a regular health care provider.

About 3 percent of Hispanics respond that difficulties navigating the health caresystem are to blame for their lack of a regular provider: 2 percent report that theydo not know where to get regular health care, and about 1 percent reports thatthey were unable to find a provider who spoke their language.

Finally, 3 percent say they prefer to go to a number of different health careproviders, not just to one place, and 4 percent say they have just moved to thearea, so presumably have yet to establish a relationship with a provider.

Table 3: What is the One Main Reason You Do Not Have a PlaceThat You Usually Go To When You Are Sick or Need Advice AboutYour Health?

No Need PercentageSeldom/never sick 41

Don’t use doctors/treat myself 13

Financial ReasonsNo health insurance 17

Cost of medical care 11

Trouble Negotiating Health Care SystemDon’t know where to go for care 2

Can’t find provider who speaks my language 1

OtherLike different places for different health care needs 3

Recently moved to area 4

* Respondents who reported that their usual health care provider was an emergency room were not askedthis question.



� �

QUALITY OF HEALTH CARE

While visiting a health care provider is important, the perceived quality of carereceived during health care visits is equally important. To assess the perceivedquality of care, respondents who received any medical care in the past year wereasked to rate that care as “excellent”, “good”, “fair”, or “poor.”

More than three-quarters of Hispanics who have had medical care withinthe past year rate it as good to excellent: 32 percent say it was excellent, and46 percent say it was good. At the other extreme, 17 percent say their carewas only fair, and 4 percent report poor care.

FOLK HEALING

An overwhelming majority of Latinos believe that sick people should obtaintreatment only from medical professionals, but a small minority say they seekhealth care from folk healers. Those who receive care from folk healers areslightly more likely to be U.S.-born than foreign born and to speak mainlyEnglish, not Spanish.

Asked whether they obtain care from a curandero, shaman or someoneelse with special powers to heal the sick, 6 percent of Hispanics say they doand 10 percent report that someone in their household receives such care.

About one in 12 Hispanics born in the 50 states use folk medicine, comparedwith one in 20 of those born in other countries or Puerto Rico. Similarly,one in 12 English-dominant Hispanics use folk medicine, as do one in 20Spanish-dominant Latinos. Hispanics of Cuban ancestry (11 percent) are morelikely to obtain such care than other Latino groups. Hispanics without healthinsurance or a usual place for care are no more likely to seek folk care thanthose with health insurance or a usual place for care.

Most Hispanics (87 percent) say that sick people should seek care only frommedical professionals; only 8 percent say there is a role for folk medicine.Opinions about this echo usage patterns to some extent. Hispanics who speakEnglish (14 percent), as well as those born in the United States (12 percent),are the most likely to say there is a role for potions and folk healing. So areyounger Hispanics, as well as those with at least some college education.


� �

In general, more educated Latinos, and those who have access to the medicalsystem, give better evaluations of the quality of their medical care than doLatinos with lower education levels, no insurance or no regular source of care.

Women are more likely than men to say their recent medical care was good orexcellent, 80 percent to 74 percent. Eighty-one percent of the college-educated

report being satisfied with their care, as compared with75 percent of people lacking a high school diploma.

Among Hispanics with health insurance, 80 percentrate their care as good to excellent; among the unin-sured, 70 percent do. Similarly, 80 percent of Latinoswho have a usual health care provider rate their care asgood to excellent, compared with 64 percent who haveno usual provider. Among those with a usual provider,Hispanics who usually get care in doctors’ offices givehigher ratings than those who go to medical clinics.Fully four in 10 who go to a doctor’s office rate their

care as excellent, compared with 27 percent of those who get care from a clinic.

32

46

17 4

Figure 6: Overall How Would You Rate the Quality of Medical CareThat You Received in the Past 12 Months?

20%

40%

60%

80%

100%

Excellent Good Fair Poor

Having healthinsurance or a usualhealth care provideris associated withbetter perceivedquality of care.



� �

Generally, nativity and assimilation are not strongly associated with perceivedquality of care. However, a mismatch between a Hispanic’s primary language andthe language spoken at his or her appointment lowered the satisfaction ratingssomewhat. For example, 30 percent of Spanish speakers whose appointmentsusually are conducted in English rate their care fair to poor, compared with 19percent of those whose appointments are in Spanish.

Reasons for Poor TreatmentRespondents were also queried as to whether they had received poor service atthe hands of a health care professional in the past five years. Those 23 percentwho said they had received poor treatment were asked about four potentialreasons. The largest share of Hispanics (31 percent) cited their inability to pay asthe reason for poor treatment, followed by their race or ethnicity (29 percent),their accent or how they speak English (23 percent) and their medical history(20 percent).

Figure 7: Prevalence and Perceived Reasons for Poor Treatment

10% 20% 30% 40% 50%

23

29

31

20

During the past 5 yearshave you ever felt that youreceived poor quality ofmedical treatment or care?

Was the poor treatmentbecause…

you were not able to pay?

of your racial or ethicalbackground?

of your accent or how youspeak English?

of something in yourmedical history?

23


� �

Respondents who lacked health insurance, or a usual health care provider, wereespecially likely to claim that their inability to pay, their race, or their languageskills contributed to their poor treatment. Forty-one percent of Hispanics with nousual place for health care, and 53 percent of Hispanics with no health insurance,reported that their inability to pay contributed to poor treatment. In comparison,27 percent of Latinos with a usual provider reported as much, as did 20 percentof Latinos with health insurance. Thirty-eight percent of Latinos with no usualprovider and 34 percent of those with no health insurance reported that their racecontributed to poor treatment by medical professionals, as compared to 25 percentof those with a usual provider and 26 percent of those with health insurance.Thirty-two percent of Latinos who lacked either health insurance or a usualprovider reported that their accent or poor English skills led to poor treatment,while 20 percent of the insured and those with a usual provider reported as much.

Other groups more likely than Hispanics overall to cite a lack of money as areason for poor treatment include immigrants who aren’t citizens or legalpermanent residents (45 percent), Spanish speakers (38 percent) and Latinoswho did not graduate from high school (41 percent).

Among the groups that are more likely than Hispanics overall to cite race as areason they were treated poorly are Spanish speakers (36 percent), and non-citizens (38 percent of legal permanent residents and 35 percent of immigrantswho are not citizens or legal permanent residents).

Among the groups most likely to cite language as the reason they receivedpoor care are Hispanics with less than a high school education (37 percent),immigrants (33 percent) and those who mainly speak Spanish (43 percent).

Medical history is given as a reason for poor care by a somewhat higher shareof older Hispanics (25 percent) and those whose primary language is Spanish(25 percent).


� � � CHAPTER 3 - SOURCES OF INFORMATION ON HEALTH AND HEALTH CARE

While preventive care and regular health monitoring are essential in maintaininggood long-term health and limiting the severity of chronic diseases, more thanone in four Hispanics say they received no information regarding health orhealth care from doctors or health care professionals in the past year. This groupincludes a wide cross-section of the Hispanic population.

However, medical professionals are not the only ones providing health andmedical information. Specific information regarding the importance of preventa-tive care and regular health monitoring as well as the symptoms and treatment ofchronic diseases can be delivered through alternate sources. Print and broadcastmedia, churches, community groups, family and friends, and the Internet are allsources of health and medical information for many Hispanics. Though thesurvey results do not address the validity or quality of the health informationobtained through sources other than medical personnel, results do suggest thatthe information from these alternative sources has an impact on respondents’behaviors.

Different sub-groups of Hispanics rely on different types of media. In general,U.S.-born Hispanics and those who have higher levels of education are morelikely to get information in English from sources such as television, newspapers,magazines and the Internet. Immigrant Hispanics and those who have lowerlevels of education rely more on Spanish-language media, including televisionand print media, for information.

WHERE DO HISPANICS GET HEALTH CARE INFORMATION?

Respondents were queried as to how much information about health and healthcare they got from several different sources in the past year. For each potentialinformation source, they could report getting “a lot” of information, “a little”information, or no information at all. Results show that doctors and othermedical professionals are the most common source of health and medicalinformation for Hispanics, as they are likely to be for most groups. Nearly athird of Hispanics say they received a lot of health and health care informationfrom doctors or other medical professionals over the past year, and 39 percentsay they received a little information.


� � �

The second most important source of health information is television; 23 percentof Hispanics received a lot of information from TV and 45 percent received alittle. Family and friends are next in rank: they supplied a lot of information to

20 percent of Hispanics and a little information toan additional 43 percent.

Radio, newspapers and magazines, and the Internetare also important sources of health care information.Among Hispanics, 40 percent get health care informa-tion from the radio, 51 percent get some informationfrom newspapers and magazines, and 35 percent getinformation from the Internet.

Churches and community organizations are anothersource of health information for many Hispanics. Aboutone in three Latinos (31 percent) say that they rely onthe information they get from their churches and localcommunity groups.

Figure 8: Latinos’ Sources of Health Information

Doctor or other medicalprofessional

Television

Radio

Internet

Print media

Family or friends

Churches or communitygroups

20% 40% 60% 80% 100%

AA LLOOTT NNOONNEEAA LLIITTTTLLEE

3932 28

4523 31

319 60

2015 65

3714 49

4320 36

229 68

Question wording: How much information about health and health care did you get over the past yearfrom a doctor or other medical professional, family or friends, the radio, the Internet, television, achurch or community organization, newspaper or magazine?

Seventy-one percentof Latinos receivedhealth informationfrom a medical professional in thepast year, but 83 percent got health or health care information from the media.


� � �

WHO GETS INFORMATION FROM THE MEDICAL COMMUNITY?

Hispanic women are more likely than are men to report getting health informationfrom doctors and the medical community in the past year—77 percent report asmuch, compared with 66 percent of men. Overall, the age differences in receivingany information from medical professionals are not huge, but respondents ages65 and older are more likely to have gotten a lot of health information from aprofessional (41 percent) than respondents under age 30 (28 percent).

As is the case with usual health care providers, those who are more educated and more assimilated are more likely to report exposure to the medical system.People with at least some college education are almost 33 percent more likely tohave gotten a medical professional’s advice than people lacking a high school diploma. Seventy-nine percent of Latinos who speak primarily English and three-fourths of those who are bilingual report obtaining information from medical providers in the past year, while 62 percent of Spanish-dominant Latinos have done so. Legal status is also correlated with the likelihood of obtaining health advice from a medical professional. Citizens born in the United States or Puerto Rico are most likely to have received medical advice (80 percent) from a professional, followed by naturalized citizens (70 percent),and legal permanent residents (64 percent). Fifty-nine percent of immigrants who are neither naturalized nor legal permanent residents reported obtaininghealth information from a medical professional.

Respondents of Puerto Rican (80 percent) and Cuban (78 percent) origin are especially likely to have received help from a medical professional in the pastyear. Conversely, Mexican-origin persons (69 percent) and Central Americans (69 percent) were less likely to report as much.


� � �

Table 4: Sources of Health Information Family Churches

Medical TV Radio Internet Print or or comm.media friends groups

Total 71% 68% 40% 35% 51% 63% 31%

SexMale 66 67 43 33 50 62 32Female 77 69 36 37 52 64 31

Age18–29 71 69 41 43 51 71 3530–49 71 69 43 35 52 63 3050–65 69 69 34 30 51 57 2865 and older 77 61 29 14 46 46 32

EducationLess than a high 62 66 39 16 40 55 34school diplomaHigh school diploma 74 73 43 36 55 67 33Some college or more 82 67 39 63 63 71 26

LanguageEnglish-dominant 79 63 35 53 56 73 25Bilingual 75 69 40 43 56 64 32Spanish-dominant 62 70 42 17 42 56 35

OriginMexico 69 69 41 31 49 63 32Puerto Rico 80 65 34 49 55 68 31Cuba 78 61 40 37 51 62 28Dominican Republic 72 67 42 42 55 65 34Central American 69 70 38 29 48 58 33South American 71 72 39 51 58 61 29

NativityNative born 80 64 35 53 57 71 28Foreign born 66 70 43 25 47 58 33

CitizenshipNative-born citizen 80 65 36 51 56 69 29Naturalized 70 68 38 30 50 56 29Legal permanent resident 64 71 45 23 48 60 35Foreign born, not 59 71 45 18 42 60 35LPR

Years in U.S. (Foreign born only)Less than 5 years 58 72 42 27 45 63 365–9 62 73 46 25 47 61 37

10–14 66 72 46 22 45 58 315 or more 69 69 41 25 49 57 32

Health insuranceInsured 78 69 40 41 53 64 31Not insured 59 68 40 24 47 61 32

Usual health care provider

Has 78 70 39 38 53 65 32Does not have 53 64 42 27 44 58 30

Question wording: How much information about health and health care did you get over the past yearfrom a doctor or other medical professional, family or friends, the radio, the Internet, television, a churchor community group, newspaper or magazine?


� � �

WHO GETS HEALTH INFORMATION FROM THE MEDIA?

While most Hispanics look to the medical community for answers to theirhealth care questions, the media, and particularly television, also play a large rolein providing health information. This role is especially important for Hispanicswho do not typically utilize the health care system. Somewhat more than half(53 percent) of all Hispanics who lack a regular health care provider say they receive at least some information from doctors, but 64 percent of them say theyget information from television. In contrast, among Hispanics who do have access to a usual place for their medical care, the relationship reverses: 78 percent say they get health information from the medical community, compared with 70 percent who say they get information from television.

This pattern is similar for Hispanics with and without health insurance. While 78 percent of Hispanics who have medical insurance get some information fromdoctors and other health care professionals, 69 percent say they get informationfrom television. Conversely, while 59 percent of the uninsured say they get information from doctors, 68 percent obtain health information from television.

The use of television for health information issomewhat more prevalent among the foreign bornand the less assimilated. Twenty-six percent of theforeign born report obtaining a lot of health information from this source in the past year, asdid 19 percent of the native born. Twenty-sevenpercent of Spanish-dominant respondents reportedobtaining a lot of information from television, compared with 18 percent of English-dominant respondents.

7870

53

6478

6959

68

20%

40%

60%

80%

100%

Usual provider No usual provider Insured Uninsured� Information from doctors � Information from TV

Television is the most pervasive media outlet, in terms of disseminatinghealth information; 68 percent of respondentsreceived information from television in the past year.

Question wording: How much information about health and health care did you get over the past yearfrom a doctor or other medical professional? On television?

Figure 9: Sources of Health information, by Usual Provider and Insurance Status


� � �

Radio also is an important source of health care information for Hispanics.Radio’s role as an information source is roughly similar for Hispanics with ahealth care provider (39 percent) and those without one (42 percent). Likewisefor Hispanics who have health insurance and those who do not—40 percent inboth cases obtain health information from the radio.

Like television, radio as an information source is somewhat skewed toward immigrants and those whose primary language is Spanish. Thirty-five percent ofEnglish-dominant respondents get health information from the radio, comparedwith 42 percent of Spanish-dominant respondents. The results are similar whenconsidering nativity. Thirty-five percent of the native born use the radio as asource for health information, compared with 42 percent of the foreign born.

More than half of all Hispanics say they received a lot of information (14 percent) or a little information (37 percent) from print sources. Higher educationlevels, being native born and assimilation are all associated with higher likelihoodsof retrieving health information from these print media. Forty-one percent ofLatinos with less than a high school diploma report getting information fromnewspapers or magazines, compared with 63 percent of people with at least some college education. Fifty-seven percent of the native born use print media,as do 47 percent of the foreign born. While 56 percent of English-dominant and bilingual Latinos obtained at least some health information from these sources,the share drops to 42 percent among Spanish-dominant Latinos.

Youth, education, nativity and assimilation are all strongly linked to Internetusage for Latinos in general,15 and to the likelihood of using the Internet forhealth information in particular. Younger Hispanics use the Internet more thanolder Hispanics—42 percent of those ages 18 to 29 say they get information from the Internet, compared with 14 percent of those ages 65 and older. The educational differences in the likelihood of getting health care informationfrom the Internet are stark. While only 16 percent of Hispanics with less than ahigh school diploma and 36 percent of those with a high school diploma get information on health issues from the Internet, 63 percent of Hispanics whohave at least some college education say that they get a lot or a little informationfrom the Internet. Hispanics born in the United States are twice as likely as areimmigrants to get health care information from the Internet—52 percent versus25 percent. English dominance, too, is strongly associated with using the Internetfor health information; 53 percent of the English-dominant do so, comparedwith 17 percent of the Spanish-dominant.


� � �

WHO GETS HEALTH CARE INFORMATION FROM THE MEDIA INSPANISH, AND WHO GETS IT IN ENGLISH?

Among Hispanics who receive any health-related information from television, 40 percent get that information from only Spanish-language television stations,32 percent from a mix of Spanish and English-language stations and 28 percentfrom only English-language stations. Similarly, among the Hispanics who useradio to obtain any of their health care information, 47 percent rely on Spanish-language radio stations, 26 percent listen to Spanish and English-language stations and 27 percent rely on only English stations.

Women are more likely than men to get their healthinformation in Spanish (44 percent versus 36 percentfor television viewers, and 53 percent versus 43 percentfor radio listeners). Age is also correlated with obtain-ing health information from Spanish-language broad-casts. Thirty-eight percent of respondents younger than30, and 48 percent of respondents ages 65 and olderwho got health information from television got it inSpanish. Similarly for radio listeners, 44 percent ofthose ages 18 to 29 and 54 percent of those ages 65 orolder received their health information in Spanish.

Among those who watch television and those wholisten to the radio, there is a strong association between educational levels andlanguage use. In both cases, people with less than a high school diploma weremore likely to get their information in Spanish (56 percent for television, 64 percent for radio) compared to those with at least some college education(17 percent for television, 20 percent for radio).

Figure 10: Language of Health Information Obtained in Past Year

Television

Radio

Internet

Print media

20% 40% 60% 80% 100%

SSPPAANNIISSHH EENNGGLLIISSHHBBOOTTHH

3240 28

2647 27

2913 58

2927 43

Question wording: Was the information mainly in Spanish or in English or in both languages?

More than half of respondents who getinformation from television or radio report getting that information in Spanish,or in a mix of Spanishand English.


� � �

Of course, being native born and assimilated are associated with lower likelihoods of obtaining broadcast media health information in Spanish.

Most frequently, the information obtained from the Internet was solely in English (58 percent). However, 13 percent of respondents reported obtainingonly Spanish-language Internet health care information. Twenty-nine percent of respondents got Internet health information in both English and Spanish. The pattern is similar for newspapers and magazines. Hispanics who get some information from print media are most likely to read English-language newspapers and magazines (43 percent), though 27 percent read Spanish-only publications and 29 percent got health information from both Spanish and English publications.

Health Care Information from Social NetworksMore than 60 percent of Hispanics report that they received health informationfrom their family and friends in the past year: 19 percent got a lot of informationthat way, and 43 percent got a little. Immigrants are less likely to get informationfrom family and friends (59 percent) than are native-born Hispanics (71 percent),plausibly because they have smaller networks of family and friends in the United States. Younger Latinos are more likely to get information from familyand friends than are older Latinos—those ages 18 to 29 are 25 percentage pointsmore likely to get information from family and friends than are Hispanics ages65 and older.

Churches and community groups also play a role in providing health and healthcare information to Hispanics. Roughly 9 percent of Hispanics say they receive alot of information from churches and community groups, and 22 percent say theyreceive a little information from these sources. There are few notable differencesamong demographic groups here. Around one-third of Hispanics with a high

school education or less get information from churchesand community groups, compared with 26 percent of people without at least some college education.Another group that relies more heavily on churches andcommunity groups are Spanish-dominant respondents;34 percent report obtaining health information fromthese sources, compared with 25 percent of English-dominant Latinos.

As such, it’s no surprise that the information that Hispanics received from churches or communitygroups was more likely to be in Spanish only (49 percent) or in both Spanish and English (31 percent)

than only in English (19 percent). This is similar to the language of informationobtained from the radio and quite distinct from that of information obtainedfrom the Internet, newspapers and magazines.

Seventy-nine percentof respondents who received healthor health care information from themedia acted uponthat information.


� � �

Health information provided by the media led 57 percent of Hispanics to ask adoctor or medical professional new questions. Six in 10 Hispanics who have ausual provider say this. So do nearly half of all Hispanics who do not have ausual provider. Latinos whose primary language is Spanish are more likely to asknew questions to health care professionals as a result of media coverage than areEnglish speakers, pointing again to the important role played by the Spanish-language media.

The media even influence how some 41 percent of Hispanics make decisions on how to treat an illness or medical condition. Here, demographic differencesamong Latinos are not great. Both those who have a usual provider (42 percent)and those who do not (38 percent) are nearly as likely to say that what theylearned from the media affected how they think about treatment.

4157

64

Figure 11: Thinking About the Past Year, Did Any Information You Found from the Media…

20%

0

40%

60%

80%

100%

Affect decisions about how totreat an illness of medical

condition?

Lead you to ask a doctor orother medical professional

new questions?

Change the way you thinkabout diet or exercise?

Note: This question was asked only of those who reported obtaining information from the media in thepast year.

The Impact of the Media Though the survey data do not allow for an evaluation of the appropriateness of the behavioral changes that result from media exposure to health information,results clearly indicate that alternative channels of health information have an effect on Latinos’ behavior.

The media’s impact is strongest in producing reported changes in how Hispanicsthink about diet and exercise. Almost two-thirds of all Hispanics who receivedhealth and health care information last year from broadcast or print media, orfrom the Internet, say that what they learned changed the way they think aboutdiet or exercise.

Younger Latinos and women are more receptive to these types of changes than areolder Hispanics or men. And while immigrants (69 percent) are more likely to saythat health information from the television, radio, newspapers or the Internet ledthem to change how they think about diet and exercise, a majority of native-bornHispanics (56 percent) also report making changes in how they think about nutrition and physical activity because of what they learned from the media.


� � � � CHAPTER 4 – HOW MUCH DO HISPANICS KNOW ABOUT DIABETES?

According to the American Diabetes Association, millions of Americans are unaware that they have diabetes. Although there is no cure for diabetes, people who know they have the disease often can keep it under control, and reduce the risk of serious side effects or death, through treatment that includesdiet and medication.

Three-quarters (76 percent) of Hispanics know that there are effective treatmentsfor diabetes that reduce the chances of death or serious side effects; the sameshare correctly say there is no medicine or treatment “that can permanently fixit.” A slightly lower share (72 percent) of Hispanics is aware that maintaining ahealthy weight is more helpful in preventing diabetes than avoiding all sugar.Seven in 10 Latinos (71 percent) say correctly that even people without a familyhistory of diabetes have a risk of developing it.

These findings emerge from a battery of eight questions testing basic knowledgeabout the causes, symptoms and treatment of diabetes. Although most Latinos doreasonably well (58 percent answered at least six questions correctly), a sizeable minority faltered on the test with nearly a third (32 percent) giving three to fivecorrect answers and 10 percent scoring even lower.

Among the less knowledgeableHispanics are men, Spanishspeakers and Latinos who are foreign born. The best-informedHispanics about diabetes arethose with at least some collegeeducation, or with high levels ofassimilation—U.S. citizens andlong-term immigrants. Hispanicswho have been diagnosed with diabetes score higher on the knowl-edge test than other Latinos, but a

DIABETES KNOWLEDGE BATTERY SCORING � High: Respondents answered at least

six out of eight questions correctly.

� Medium: Respondents answered three to five questions correctly.

� Low: Respondents answered two or fewer questions correctly.

Diabetes Knowledge Battery

As far as you know, are any of the following a symptom of diabetes?• Frequent urination • Increased fatigue • Excessive thirst • Blurry vision

As far as you know, is there a cure for diabetes, meaning that there is a medicine or a treatment that can permanently fix it?

Once someone has been diagnosed with diabetes, do you happen to know whether there are effective treatments that will significantly reduce the chances of blindness, death or otherserious complications?

What’s more helpful in preventing diabetes? (1) Avoiding all sugar (2) Maintaining a healthyweight.

If none of your relatives has a history of diabetes, do you have a risk of getting it yourself?


� � � �

notable share (27 percent) answered at least three of the eight questions wrong.Having health insurance and a regular health care provider are both associatedwith more diabetes knowledge but they do not guarantee being well-informed.Similarly, obtaining health information from medical personnel is associatedwith higher levels of knowledge but certainly does not guarantee them. Obtaininghealth information from some other sources is also associated with higher levelsof diabetes knowledge. Respondents who report obtaining health informationfrom family and friends and from print media, in particular, score better on thebattery of diabetes knowledge questions.

Knowledge Differences by Demographic GroupThere are notable differences by demographic characteristic in which Hispanicsscore high (six to eight correct answers), medium (three to five correct answers) or low (two or fewer correct answers) on a battery of eight questions testing basic diabetes knowledge.

About two-thirds of women (65 percent) correctly answer six or more questions,compared with half (51 percent) of men. Men also are more likely to get a lowscore, 13 percent compared with 7 percent of women.

The youngest and oldest Latinos know less than those in the middle: 48 percentof those ages 18–29 and 65 and older score well, compared with substantial majorities of those ages 30 to 49 (63 percent) and 50 to 64 (68 percent). Among theoldest Hispanics, 15 percent score low, a larger share than for other age groups.

There are differences across several demographic measures that point to greaterknowledge by more assimilated, established Hispanics.

Looking at differences by education level, 13 percent of Latinos who did notcomplete high school score low on diabetes knowledge, compared with 6 percentof those with at least some college education. Although half of Latinos without ahigh school diploma score high, that compares with 70 percent of those with at

least some college education.

Similarly, U.S.-born Hispanics are more likely to scorehigh on diabetes knowledge (62 percent) than thosewho are foreign born or Puerto Rican (56 percent).When responses are analyzed by citizenship status, naturalized citizens are more likely to score high (60percent) than are legal permanent residents (55 percent)or immigrants who are neither citizens nor legal permanent residents (48 percent). Among long-term

immigrants, those who have been in the country for 15 years or more, 61 percentscore high, compared with about half of shorter-term immigrants.

Nativity and assimilation are associated with higher levels of diabetes knowledge.


� � � �

Examining differences by national origin, at least 14 percent of persons ofCuban, South American and Central American origin score low on diabetesknowledge, which is a larger share than for other groups. Central Americans (46 percent) and South Americans (47 percent) also have smaller shares of the highest-scoring respondents.

Figure 12: Diabetes Knowledge Index

SexMaleFemale

AgeYounger than 3030–4950–6465 and older

EducationLess than a high school diplomaHigh school diplomaSome college or more

LanguageEnglish-dominantBilingualSpanish-dominant

Origin MexicoPuerto RicoCubaDominican RepublicCentral AmericaSouth AmericaOther

NativityNative bornForeign born

20% 40% 60%

513613

65277

484012

68248

63289

503713

70246

483715

60319

613010

59329

59329

553312

642710

602614

60337

463915

473815

71246

MMiiddddllee ((33––55)) HHiigghh ((66––88))LLooww ((00––22))

continued

100%

62307

563312

583210TOTAL80%

20% 40% 60% 100%80%

Figure 12: Diabetes Knowledge Index, continued

CitizenshipNative-born citizenNaturalizedLegal permanent resident (LPR)Foreign born, not LPR

Years in U.S. (Foreign born only)Less than 55–910–1415 or more

Usual health care providerHasDoes not have

Health insuranceInsuredUninsured

Respondent has diabetesYesNo

Respondent, family member or close friend has diabetesYesNo

Health information sourcesDoctor or other medical professionalTelevisionRadioInternetPrint mediaFamily or friendsChurches or community groups

62308

553410

603010

503614

483912

483516

493516

61309

61309

613010

503614

553511

62308

61309

62307

65296

65278

MMiiddddllee ((33––55)) HHiigghh ((66––88))LLooww ((00––22))

62308

73243

573310

553311

67285

443818


� � � �



� � � �

Knowledge Differences by Insurance Status and Health Care Access Hispanics with health insurance are somewhat more likely to score high thanthose without insurance (61 percent versus 55 percent), but they are no less likely to get a low diabetes knowledge score than respondents with no insurance. There are, however, differences between Hispanics with and without a usualsource of care: 61 percent of those with a usual source score high, compared with 50 percent of those who have no usual provider. A higher share of Latinos(14 percent) with no usual source of care scores low, as compared with Hispanicswho do have a usual source of care (9 percent). Among those with a usualprovider, the type of place where care is obtained also factors into diabetesknowledge. Respondents who visit a doctor regularly score better on diabetesknowledge questions than respondents who primarily visit clinics for their care;65 percent score high, as compared with 57 percent of respondents who frequent clinics.

Knowledge Differences by Sources of InformationLatinos who get a lot of health information from doctors are more likely to scorehigh (65 percent) on diabetes knowledge than those who get little (59 percent) orno information (49 percent) from doctors. Those who get a lot of informationfrom newspapers and magazines also are more likely to score high (69 percent)than those who get no information from those sources (50 percent). Those whoget a lot of information from family and friends or the Internet also are morelikely to score higher (62 percent and 71 percent, respectively) than those who do not (51 percent and 54 percent).

However, the gap in persons scoring high on diabetes knowledge is smaller whencomparing respondents who report getting a lot of health information from television (59 percent) with those who report getting no health information from television (52 percent). The same is true for radio: 60 percent of those whoget a lot of health information from radio score high, compared with 55 percentwho get no health information from radio. Among those who get a lot of information from churches or community groups, a larger share scores low(58 percent) than high (52 percent).*

* Even when controlling for educational differences, the association between diabetes knowledge and use ofcertain information sources persisted. Latinos who get a lot of information from doctors, family and friends,radio and print still scored better than those who do not.


� � � �

When these responses are analyzed another way—comparing people who get atleast some health information from any source with those obtaining no health information from any source—getting information is associated with betterknowledge scores. One in four Hispanics who get no health information scorelow on diabetes knowledge, compared with one in 11 who get at least some information. Four in 10 of those who get no health information score high on diabetes knowledge, compared with six in 10 of those who get at least some information from any source.

Composition of the Low-Scoring GroupThis section will look at the survey data on diabetes knowledge from another per-spective: The makeup of the low-scoring group. Although less educated and lessassimilated Hispanics generally score lower on a test of diabetes knowledge, theleast knowledgeable group also includes a notable share of higher-status Latinos.

Nearly two-thirds of the low-scoring group (65 percent) are men. A third of thelow scorers are ages 18–29, a slightly higher share (38 percent) are ages 30–49, 12 percent are ages 50–64, and the remaining 12 percent are 65 years and older.

Half of the group that knows little about diabetes consists of Hispanics who didnot complete high school. High school graduates account for 27 percent andLatinos with at least some college education make up 15 percent.

Foreign-born Hispanics account for more than seven in 10 of the low-scoringgroup. The foreign-born low-scoring group is split nearly evenly into citizens (20 percent of all low scorers), legal permanent residents (22 percent) and persons

lacking citizenship or legal permanent residency(26 percent). Although Spanish speakers account fornearly half of low scorers (47 percent), one in five areEnglish-dominant and one in three are bilingual.

Most Hispanics who score low on the knowledge testabout diabetes have health insurance (59 percent), and a usual place to go for medical care (63 percent).About six in 10 of the low-scoring group (58 percent)say they get health information from medical professionals.

The majority of Hispanics scoring low on the diabetesknowledge index have health insuranceor a usual health care provider.

20% 40% 60% 80% 100%


� � � �

65

35

33

38

12

12

50

15

27

20

47

34

58

8

6

2

14

3

9

27

73

32

20

22

26

16

23

14

43

Figure 13: Profile of Persons Scoring Low on Diabetes Knowledge Index

SexMaleFemale

Age18–2930–4950–6465 and older

EducationLess than a high school diplomaHigh school diplomaSome college or more

LanguageEnglish-dominantBilingualSpanish-dominant

Origin MexicoPuerto RicoCubaDominican RepublicCentral AmericaSouth AmericaOther

NativityNative bornForeign born

CitizenshipNative-born citizenNaturalizedLegal permanent resident (LPR)Foreign born, not LPR

Years in U.S. (Foreign born only)Less than 55–910–1415 or more

Low (0–2)

continued


� � � �

Figure 13: Profile of Persons Scoring Low on Diabetes Knowledge Index,continued

Usual health care providerHas Does not have

Health insurance

InsuredUninsured

Respondent has diabetesYesNo

Respondent, family memberor close friend has diabetesYesNo

Health information sourcesDoctor or other medical professionalTelevisionRadioInternetPrint mediaFamily or friendsChurches or community groups

20% 40% 60% 80% 100%

59

34

4

93

28

65

58

29

58

37

19

48

30

63

36



� � � �

Diabetics’ Knowledge of Diabetes Diabetics are more likely to know the basic facts about their condition than thegeneral population does, but not all diabetics are well-informed: 73 percent scorehigh on the knowledge test, 24 percent get a medium score and 3 percent get alow score.

Generally, diabetics have the same pattern of answersas the general population, but at higher levels ofknowledge. For example, they are more likely to know that blurry vision is a symptom (82 percent)than increased fatigue (69 percent). However, diabeticsare no more likely than all Hispanics (76 percent) to know that effective treatments are available to reduce the chances of blindness, death or other serious complications. Nor are they more likely toknow that maintaining a healthy weight is a betterway to prevent diabetes than avoiding sugar intake(71 percent of diabetics are aware of this, as compared

with 72 percent of non-diabetics).

With diabetics, as in the general population, the most educated and establishedHispanics score the highest on a test of knowledge about diabetes. Eighty-six percent of diabetic Hispanics with at least some college education score high onthe knowledge battery, compared with 71 percent of people lacking a high schooldiploma, and diabetics with regular care providers are more likely to score high(75 percent) than those without a usual place for care (66 percent).

Twenty-seven percentof diabetics correctlyanswered fewer thansix out of eight questions on the diabetes knowledgebattery.


� REFERENCES

1 Passel J, and Cohn D’Vera. “U.S. Population Projections: 2005–2050.” Pew Research Center, 2008.

2 www.diabetes.org. American Diabetes Association. Accessed 6/18/2008.

3 Pleis JR, and Lethbridge-Cejku M. “Summary Health Statistics for U.S.Adults: National Health Interview Survey, 2006.” National Center for Health Statistics Vital and Health Statistics Series 10:235, 2007.

4 National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Centers for Disease Control and Prevention, 2005.

5 www.cdc.gov/nccdphp/overview.htm. Chronic Disease Overview. Accessed 4/8/2008.

6 The Power of Prevention: Reducing the Health and Economic Burden of Chronic Disease. Centers for Disease Control and Prevention, 2003.

7 www.census.gov/Press-Release/www/releases/archives/population/011910.html. “U.S. Hispanic Population Surpasses 45 Million—Now 15 Percent of Total.” U.S. Census Bureau Press Release. Accessed 6/2/2008.

8 Passel et al.

9 Passel et al.

10 www.diabetes.org et al.

11 The Power of Prevention et al.

12 Pleis et al.

13 Zuvekas S, and Taliaferro G. “Pathways to Access: Health Insurance, The Health Care Delivery System, and Racial/Ethnic Disparities, 1996–1999.” Health Affairs 22: 139–153, 2003.

14 Pleis et al.

15 Fox S, and Livingston, G. “Latinos Online.” Pew Hispanic Center and Pew Internet and American Life Project, 2007.


� APPENDIX A: METHODOLOGY

The Pew Hispanic Center conducted a public opinion survey among people of Latino background or descent that was designed to elicit opinions on issuesrelated to health care. To fully represent the opinions of Latino people living inthe United States, ICR conducted interviews with a statistically representativesample of Latinos so they could be examined nationally.

The study was conducted for the Pew Hispanic Center via telephone by ICR,an independent research company. Interviews were conducted from July 16 toSeptember 23, 2007, among a nationally representative sample of 4,013 Latinorespondents ages 18 and older. Of those respondents, 1,625 were native born(including Puerto Rico) and 2,378 were foreign born (excluding Puerto Rico).The margin of error for total respondents is +/-1.83 at the 95 percentconfidence level. The margin of error for native-born respondents is +/-3.42 at the 95 percent confidence level. The margin of error for foreign-born respondents is +/- 2.11 at the 95 percent confidence level.

For this survey, ICR maintained a staff of Spanish-speaking interviewers whom,when contacting a household, were able to offer respondents the option ofcompleting the survey in Spanish or in English. A total of 1,320 respondentswere surveyed in English and 2,639 in Spanish (and 54 were interviewedequally in both languages).

Eligible RespondentThe survey was administered to any male or female age 18 and older who is of Latino origin or descent.

Field PeriodThe field period for this study was July 16 to September 23, 2007. The interviewing was conducted by ICR/International Communications Research in Media, Pennsylvania. All interviews were conducted using theComputer Assisted Telephone Interviewing (CATI) system. The CATI systemensured that questions followed logical skip patterns and that the listed attributes automatically rotated, eliminating “question position” bias.



Sampling Methodology

A stratified sample via the Optimal Sample Allocation sampling technique was used for the survey. By utilizing a stratified sample, one sample source wasused to complete all interviews. This technique provides a highly accurate sampling frame, thereby reducing the cost per effective interview. In this case,we examined a list of all telephone exchanges within a target area (national, bystate, etc.) and listed them based on concentration of Latino households. We then divided these exchanges into various groups, or strata.

Consequently, we used a disproportionate stratified RDD sample of Latinohouseholds. The primary stratification variables are the estimates of Latinohousehold incidence and heritage in each NPA-NXX (area code and exchange)as provided by the GENESYS System—these estimates are derived from Claritas and are updated at the NXX level with each quarterly GENESYS database update. The basic procedure was to rank all NPA-NXXs in the U.S. bythe incidence of Latino households. This produced strata that were called VeryHigh, High, Medium, and Low Latino. These strata were then run against InfoUSA and other listed databases, and then scrubbed against known Latinosurnames. Any “hits” were subdivided into a “surname” strata, with all othersample remaining in their originally designated strata. Overall, then, the studyemployed five strata. It is important to note that the existence of surnamestrata does not mean this was a surname sample design. The sample is RDD;telephone numbers were then divided by whether they were found to be associated with or without a Latino surname. This was done simply to increasethe number of strata (thereby increasing the control we have to meet ethnictargets) and to ease administration (allowing for more effective assignment ofinterviewers and labor hours).

For purposes of estimation, we employed an optimal allocation scheme. This“textbook” approach allocates interviews to a stratum proportionate to thenumber of Latino HH, but inversely proportionate to the square root of therelative cost, the relative cost in this situation being a simple function of the incidence. As such, the number of completed interviews increases as you movefrom a lower incidence strata to higher incidence strata. Again, this is a known,formulaic approach to allocation that provides a starting point for discussions ofsample allocation and associated costs. We have also provided estimates of the“effective sample size” associated with the resultant disproportionate allocation.



Weighting and EstimationA two-stage weighting design was executed to ensure an accurate representationof the national Hispanic population.

The first stage takes the disproportionality of the stratified design and rebalances cases back to nationally representative counts of Hispanics. Thus,cases in strata that were under-sampled (for example, Low), attained weights inexcess of 1, while cases in strata that were over-sampled (for example, Surnameand Very High) were given weights under 1.

The second stage comprised of post-stratification weighting to nationally representative counts of Latinos by region, age, education, heritage, born inU.S./years in U.S., and gender. An industry standard ranking program was utilized to produce final post-stratification weights.

Response RateThe overall response rate for this study was calculated to be 46.3 percent usingAAPOR’s RR3 formula. Following is a full disposition of the sample selectedfor this survey:

TTOOTTAALL

TOTAL NUMBERS DIALED 196,828

INTERVIEW (Category 1)Completes 4,013Short completes (non-Hispanics) 20,926

ELIGIBLE, NON-INTERVIEW (Category 2)Refusals 17,996

UNKNOWN ELIGIBILITY, NON-INTERVIEW (Category 3)No answer 31, 121Busy 1,528No screener completed 7,277

NOT ELIGIBLE (Category 4)Data/modem/fax line 12,770Non-working, disconnected, business or government 78,858Non-residence 10,903No eligible respondent 1,550Quota filled 9,714Other 172


� � APPENDIX B: DETAILED TABLES

Access to Health Care (row %)

Connected DisconnectedTOTAL 73 27

SexMale 63 36Female 83 17

Age18–29 63 3730–49 73 2650–64 83 1665 and older 86 13

EducationLess than a high school diploma 68 32High school diploma 72 27Some college or more 80 19

EmploymentEmployed 70 30Unemployed 72 28Not in labor force 80 20

Household incomeLess than $30,000 69 31$30,000–$49,999 73 26$50,000 or more 84 16Income missing 70 29

Marital statusMarried/Has a partner 75 25Widowed/Divorced/Separated 77 23Single 62 37

RegionNortheast 77 22North Central 74 25South 69 30West 74 26

AreaUrban 72 28Suburban 75 25Rural 73 26

LanguageEnglish-dominant 77 22Bilingual 75 25Spanish-dominant 68 32

continued

Note: “Not in labor force” includes those who reported that they were a homemaker or stay-at-homeparent, retired or a student.



Origin Mexico 70 29Puerto Rico 84 16Cuba 76 24Dominican Republic 79 21Central America 68 31South America 76 23Other 83 17

NativityNative born 77 22Foreign born 70 30

GenerationFirst 70 30Second 77 23Third or higher 78 21

CitizenshipNative-born citizen 78 22Naturalized 79 21Legal permanent resident (LPR) 69 31Foreign born, not LPR 57 43

Years in U.S. (Foreign born only)Less than 5 51 495–9 60 4010–14 68 3115 or more 79 21

Health insuranceInsured 81 19Uninsured 58 42

Access to Health Care, continued(row %)




Access to Health Care (column %)

Connected DisconnectedTOTAL 100 100


Age18–29 26 4130–49 44 4350–64 18 965 and older 10 4


Employment Employed 60 69Unemployed 7 7Not in labor force 31 21





LanguageEnglish-dominant 25 20Bilingual 36 32Spanish-dominant 38 48

continued




Access to Health Care, continued(column %)

Origin Mexico 61 69Puerto Rico 10 5Cuba 4 4Dominican Republic 3 3Central America 9 11South America 6 5Other 6 3









TOTA

L41

42

13

1713

114

Sex

Mal

e45

42

13

1314

104

Fem

ale

316

25

2710

133

Age

18–2

938

61

14

1714

76

30–4

945

34

13

1810

132

50–6

4—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

65 a

nd o

lder

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-Education

Less

than

a h

igh

scho

ol d

iplo

ma

404

41

017

1313

4H

igh

scho

ol d

iplo

ma

454

11

619

138

1S

ome

colle

ge o

r mor

e34

61

17

1713

107

Employment

Empl

oyed

454

21

316

1310

3U

nem

ploy

ed—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Not

in la

bor f

orce

296

21

024

1313

7Household income

Less

than

$30

,000

383

11

522

1113

4$3

0,00

0–$4

9,99

948

51

12

205

112

$50,

000

or m

ore

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-In

com

e m

issi

ng43

74

01

920

85

Marital status

Mar

ried/

Has

a p

artn

er41

33

13

2010

124

Wid

owed

/Div

orce

d/S

epar

ated

357

22

415

217

4S

ingl

e—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Region

Nor

thea

st—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Nor

th C

entr

al—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Sou

th41

63

13

1714

83

Wes

t40

22

04

2011

145

Area

Urb

an40

43

13

1713

124

Sub

urba

n43

22

23

2210

93

Rur

al—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Rea

sons

for D

isco

nnec

tion

(for tho

se w

ith no ac

cess only)

Sel

dom

/N

ever

sic

kR

ecen

tlym

oved

toar

ea

Don

’t kn

oww

here

to g

ofo

r car

e

Can

’t fin

dpr

ovid

er w

hosp

eaks

my

lang

uage

Like

diff

eren

tpl

aces

for

diffe

rent

hea

lthca

re n

eed

No

heal

th

insu

ranc

e/Lo

stin

sura

nce

Don

’t us

edo

ctor

s/Tr

eat m

ysel

f

Cos

t of

med

ical

car

eO

ther

Not

e: “

Not

in la

bor f

orce

” in

clud

es th

ose

who

repo

rted

that

they

wer

e a

hom

emak

er o

r sta

y-at

-hom

e pa

rent

, ret

ired

or a

stu

dent

.



Language

Engl

ish-

dom

inan

t—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Bilin

gual

393

32

420

1111

3S

pani

sh-d

omin

ant

454

31

116

1312

4Origin

Mex

ico

423

21

217

1510

4P

uerto

Ric

o—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Cub

a—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Dom

inic

an R

epub

lic—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Cen

tral

Am

eric

a—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Sou

th A

mer

ica

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-O

ther

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-Nativity

Nat

ive

born

345

11

617

187

5Fo

reig

n bo

rn44

43

12

1811

123

Generation

Firs

t44

43

12

1811

123

Sec

ond

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-Th

ird o

r hig

her

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-Citizenship

Nat

ive-

born

citi

zen

345

11

716

187

5N

atur

aliz

ed43

22

12

1610

144

Lega

l per

man

ent r

esid

ent (

LPR

)42

61

12

2013

103

Fore

ign-

born

, not

LP

R46

35

12

1710

133

Years in U.S.(

Fore

ign

born

onl

y)Le

ss th

an 5

468

51

213

1011

45–

941

22

21

2013

152

10–1

445

21

123

612

615

or m

ore

433

31

417

1312

2Health insurance

Insu

red

485

21

47

178

6U

nins

ured

354

21

325

1113

3

Rea

sons

for D

isco

nnec

tion,

con

tinue

d(fo

r tho

se w

ith no ac

cess only)

Sel

dom

/N

ever

sic

kR

ecen

tlym

oved

toar

ea

Don

’t kn

oww

here

to g

ofo

r car

e

Can

’t fin

dpr

ovid

er w

hosp

eaks

my

lang

uage

Like

diff

eren

tpl

aces

for

diffe

rent

hea

lthca

re n

eed

No

heal

th

insu

ranc

e/Lo

stin

sura

nce

Don

’t us

edo

ctor

s/Tr

eat m

ysel

f

Cos

t of

med

ical

car

eO

ther

Not

e: P

erce

ntag

e m

ay n

ot to

tal 1

00 d

ue to

roun

ding

and

the

excl

usio

n of

“do

n’t k

now

” an

d “r

efus

ed”

resp

onse

s.



TOTAL 43 49 4 1 2

SexMale 41 50 6 1 2Female 45 49 3 1 2

Age18–29 49 43 5 0 330–49 42 52 3 1 250–64 42 52 4 1 165 and older 36 53 8 1 1

EducationLess than a high school diploma 58 36 4 0 2High school diploma 44 48 5 1 2Some college or more 24 68 4 1 3

EmploymentEmployed 40 52 4 1 2Unemployed 42 48 5 1 5Not in labor force 49 44 5 0 1

Household incomeLess than $30,000 56 37 4 0 3$30,000–$49,999 40 54 3 2 2$50,000 or more 19 75 4 2 1Income missing 45 45 7 0 2

Marital statusMarried/Has a partner 43 50 4 1 2Widowed/Divorced/Separated 44 49 4 2 1Single 42 48 7 0 3

RegionNortheast 36 58 5 0 1North Central 50 45 4 0 1South 36 56 4 0 3West 51 42 4 2 2

AreaUrban 43 49 6 1 2Suburban 41 54 3 2 1Rural 49 44 4 0 3

LanguageEnglish-dominant 29 61 5 2 3Bilingual 36 56 5 1 2Spanish-dominant 60 35 3 0 1

Usual Place of Care for Those with Access (connected only)

CommunityClinic orHealth Center

Doctor’s Office

HospitalOutpatient

Department

HMO Other

continued

Note: “Not in labor force” includes those who reported that they were a homemaker or stay-at-home parent, retired or a student.



OriginMexico 49 44 4 1 2Puerto Rico 27 64 5 2 2Cuba 33 58 7 1 0Dominican Republic 39 52 10 0 0Central America 50 44 4 1 2South America 29 64 5 0 1Other 29 65 1 1 3

NativityNative born 28 63 5 2 2Foreign born 53 41 4 0 2

GenerationFirst 53 41 4 0 2Second 30 62 6 1 1Third or higher 26 64 4 3 3

CitizenshipNative-born citizen 29 62 5 2 2Naturalized 42 51 4 0 3Legal permanent resident (LPR) 59 37 3 0 1Foreign born, not LPR 71 24 2 1 2

Years in U.S. (Foreign born only)Less than 5 64 31 3 1 25–9 65 29 3 1 210–14 63 32 3 0 215 or more 46 48 4 0 2

Health insuranceInsured 38 55 4 1 2Uninsured 57 35 5 0 3

Usual Place of Care for Those with Access, continued(connected only)

CommunityClinic orHealth Center

Doctor’s Office

HospitalOutpatient

Department

HMO Other




TOTAL 32 46 17 4

SexMale 29 45 19 5Female 34 46 15 4

Age18–29 26 47 20 530–49 32 46 17 450–64 36 44 14 465 and older 38 46 14 2

EducationLess than high school diploma 25 50 19 5High school diploma 33 43 19 3Some college or more 38 43 13 4

EmploymentEmployed 31 45 17 5Unemployed 30 43 21 5Not in labor force 32 47 15 4

Household incomeLess than $30,000 28 46 20 5$30,000–$49,999 26 51 17 5$50,000 or more 45 39 12 2Income missing 31 48 14 4

Marital statusMarried/Has a partner 32 47 15 4Widowed/Divorced/Separated 34 43 17 5Single 27 46 21 4

RegionNortheast 31 48 17 3North Central 28 52 15 3South 35 43 15 4West 30 46 18 5

AreaUrban 33 45 16 4Suburban 31 46 16 4Rural 26 49 21 3

LanguageEnglish-dominant 37 42 15 5Bilingual 37 41 17 4Spanish-dominant 23 52 18 4

Quality of Care(For those getting medical care in the past 12 months only)


continued




Quality of Care, continued(For those getting medical care in the past 12 months only)


OriginMexico 31 47 16 4Puerto Rico 37 44 15 2Cuba 30 46 17 6Dominican Republic 27 52 19 2Central America 26 43 22 5South America 32 52 11 3Other 41 37 17 4

NativityNative born 39 40 15 5Foreign born 27 50 18 4

GenerationFirst 27 50 18 4Second 38 40 17 5Third or higher 40 40 13 5

CitizenshipNative-born citizen 39 40 16 5Naturalized 32 45 17 4Legal permanent resident (LPR) 23 53 17 5Foreign born, not LPR 22 55 18 3

Years in U.S. (Foreign born only)Less than 5 24 49 22 15–9 18 54 21 310–14 25 52 17 415 or more 30 48 16 5

Usual health care providerHas 34 46 16 4Does not have 19 45 22 7

Health insuranceInsured 35 45 15 4Uninsured 23 47 22 5


continued



TOTAL 23 31 29 20 23

SexMale 22 33 29 20 25Female 25 28 29 19 22

Age18–29 28 36 30 21 2330–49 25 28 28 17 2450–64 19 26 32 25 2765 and older 12 ——- ——- ——- ——-

EducationLess than a high school diploma 19 41 33 23 37High school diploma 23 34 28 22 23Some college or more 32 19 26 15 12

EmploymentEmployed 24 28 26 18 22Unemployed 27 ——- ——- ——- ——-Not in labor force 22 32 27 23 25

Household incomeLess than $30,000 22 40 35 24 30$30,000–$49,999 26 28 22 17 25$50,000 or more 30 12 19 12 11Income missing 18 ——- ——- ——- ——-

Marital statusMarried/Has a partner 22 30 28 19 25Widowed/Divorced/ 24 28 33 25 21SeparatedSingle 26 32 26 18 21

RegionNortheast 23 24 28 16 25North Central 21 ——- ——- ——- ——-South 24 35 31 18 24West 23 32 29 23 24

AreaUrban 23 29 27 19 23Suburban 25 37 30 22 31Rural 24 ——- ——- ——- ——-

LanguageEnglish-dominant 30 27 20 20 8Bilingual 25 27 30 16 20Spanish-dominant 18 38 36 25 43

Reasons for Bad Care(% responding yes to each reason)

Experiencedbad care in thepast five years

Not able to pay (money)

Race/Ethnicity

Language(accent or poor

English)

Medical history




OriginMexico 21 34 32 22 27Puerto Rico 29 18 21 22 13Cuban 33 ——- ——- ——- ——-Dominican Republic 24 ——- ——- ——- ——-Central America 24 ——- ——- ——- ——-South America 20 ——- ——- ——- ——-Other 36 ——- ——- ——- ——-

NativityNative born 30 31 26 18 12Foreign born 20 31 32 21 33

GenerationFirst 20 31 32 21 33Second 29 36 29 23 17Third or higher 31 24 22 13 6

CitizenshipNative-born citizen 29 29 25 18 14Naturalized 21 22 28 23 26Legal permanent resident (LPR) 18 37 38 19 37Foreign born, not LPR 17 45 35 22 43

Years in U.S.(Foreign born only)Less than 5 16 ——- ——- ——- ——-5–9 18 ——- ——- ——- ——-10–14 14 ——- ——- ——- ——-15 or more 22 26 30 20 28

Usual health care providerHas 23 27 25 19 20Does not have 24 41 38 23 32

Health insuranceInsured 24 20 26 19 20Uninsured 22 53 34 22 32

Reasons for Bad Care, continued(% responding yes to each reason)

Experiencedbad care in thepast five years

Not able to pay (money)

Race/Ethnicity

Medical history

Language(accent or

poor English)



A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

e

TOTA

L32

3928

2345

319

3160

1520

6514

3749

2043

369

2268

Sex

Mal

e28

3833

2344

3210

3456

1420

6611

3850

1943

3710

2268

Fem

ale

3541

2224

4531

828

6417

2063

1735

4821

4335

922

69

Age

18–2

928

4329

2247

318

3359

1824

5712

3948

2447

299

2565

30–4

931

4028

2446

3010

3356

1719

6414

3848

2043

3610

2170

50–6

436

3329

2742

319

2565

1218

6917

3448

1840

428

2072

65 a

nd o

lder

4136

2223

3838

921

706

885

1927

5216

3053

1221

67

Education

Less

than

a h

igh

2537

3726

4034

1028

616

1083

1130

5918

3744

1123

66sc

hool

dip

lom

aH

igh

scho

ol d

iplo

ma

3241

2626

4826

1033

5715

2163

1441

4521

4633

1023

67S

ome

colle

ge o

r m

ore

4141

1717

4933

633

6131

3237

2043

3723

4828

719

74

Employment

Em

ploy

ed29

4129

2346

3110

3357

1821

6114

3847

2044

359

2169

Une

mpl

oyed

3434

3021

4336

627

6712

1969

1538

4519

4534

725

68N

ot in

labo

r fo

rce

3638

2526

4331

927

6412

1572

1434

5121

3940

1122

67

Household income

Less

than

$30

,000

2740

3325

4529

1031

5810

1376

1335

5219

4337

1123

66$3

0,00

0–$4

9,99

934

4025

2643

318

3656

2025

5414

3946

2047

339

2269

$50,

000

or m

ore

4242

1518

4933

732

6130

3337

2046

3421

4831

518

76In

com

e m

issi

ng31

3334

2340

369

2467

1016

7411

3057

2233

449

2367

Marital status

Mar

ried/

Has

a p

artn

er32

3928

2345

319

3159

1520

6513

3749

1944

369

2269

Wid

owed

/Div

orce

d/S

epar

ated

3635

2824

4234

1027

6313

1769

1732

5120

3940

1121

68S

ingl

e28

4527

2346

319

3159

2022

5813

3947

2442

3311

2267

Region

Nor

thea

st37

3923

2741

3110

2762

1921

5918

3645

2245

3211

2365

Nor

th C

entr

al28

4130

2149

298

2864

1820

6212

3651

2243

3510

2466

Sou

th31

3929

2544

328

3359

1619

6416

3746

2042

3710

2169

Wes

t31

4028

2246

329

3160

1319

6711

3752

1943

378

2270

Area

Urb

an32

3928

2345

319

3259

1620

6415

3748

2143

369

2269

Sub

urba

n29

4326

2542

3210

3159

1722

6112

3552

1845

378

2468

Rur

al32

3631

2245

327

2567

1215

7313

3848

2240

3811

1870

Language

Eng

lish-

dom

inan

t36

4421

1844

374

3165

2132

4612

4543

2449

276

1975

Bilin

gual

3838

2323

4630

931

5921

2257

1838

4321

4435

923

68S

pani

sh-d

omin

ant

2438

3627

4429

1230

587

1082

1131

5718

3843

1123

65

Sou

rces

of H

ealth

Info

rmat

ion

Doc

tor/

Oth

erTe

levi

sion

Rad

ioIn

tern

etP

rint M

edia

Fam

ily/F

riend

s

Chu

rche

s or

C

omm

unity

G

roup

s continue

d

Not

e: “

Not

in la

bor

forc

e” in

clud

es th

ose

who

repo

rted

that

they

wer

e a

hom

emak

er o

r st

ay-a

t-ho

me

pare

nt, r

etire

d or

a s

tude

nt.



A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

eA

Lot

Litt

leN

one

A L

otLi

ttle

Non

e

Origin

Mex

ico

3039

3024

4531

933

5813

1968

1237

5119

4436

923

68P

uert

o R

ico

3941

1928

3834

925

6623

2650

2035

4525

4331

1120

68C

uba

3345

2218

4339

1228

6020

1763

1735

4725

3738

1018

73D

omin

ican

Rep

ublic

3636

2526

4132

1627

5718

2457

1640

4223

4234

1222

66C

entr

al A

mer

ica

2842

3024

4629

1127

6214

1570

1236

5220

3841

1023

67S

outh

Am

eric

a33

3829

2250

277

3360

2526

4916

4241

1745

3810

1971

Oth

er44

3916

1848

344

3066

2223

5623

3938

2741

326

1579

Nativity

Nat

ive

born

3941

2019

4635

530

6523

2947

1542

4325

4629

721

72Fo

reig

n bo

rn28

3833

2644

2911

3157

1114

7513

3452

1841

4111

2366

Generation

Firs

t28

3833

2644

2911

3157

1114

7513

3452

1841

4111

2366

Sec

ond

3840

2220

4535

628

6624

2847

1442

4324

4431

724

69Th

ird o

r hi

gher

3943

1817

4637

333

6522

3146

1642

4225

4926

617

77

Citizenship

Nat

ive-

born

citi

zen

3941

2020

4535

530

6423

2848

1641

4324

4530

821

71N

atur

aliz

ed34

3628

2445

3110

2861

1317

7017

3349

1739

439

2071

Lega

l per

man

ent

resi

dent

(LP

R)

2539

3528

4428

1232

5510

1277

1236

5221

3939

1223

65Fo

reig

n-bo

rn, n

ot L

PR

1940

4025

4628

1233

557

1281

933

5814

4539

1124

64

Years in U.S. (

Fore

ign

born

onl

y)Le

ss th

an 5

1939

4226

4628

1132

5711

1673

1332

5521

4237

1026

645–

919

4337

3142

2713

3353

916

7410

3753

1546

3811

2563

10–1

427

3833

2745

2812

3454

913

7713

3255

1840

4113

2166

15 o

r m

ore

3237

2925

4430

1130

5912

1374

1534

5018

3942

1022

68


Has

3741

2124

4630

930

6117

2162

1538

4621

4435

922

68D

oes

not h

ave

1736

4622

4235

1032

5811

1673

1033

5618

4041

921

69

Health insurance

Insu

red

3840

2224

4431

931

5918

2359

1638

4621

4335

1021

69U

nins

ured

1939

4022

4632

1030

6011

1376

1136

5319

4239

923

68

Sou

rces

of H

ealth

Info

rmat

ion,

con

tinue

d

Doc

tor/

Oth

erTe

levi

sion

Rad

ioIn

tern

etP

rint M

edia

Fam

ily/F

riend

s

Chu

rche

s or

C

omm

unity

G

roup

s

Not

e: P

erce

ntag

e m

ay n

ot to

tal 1

00 d

ue to

roun

ding

and

the

excl

usio

n of

“do

n’t k

now

” an

d “r

efus

ed”

resp

onse

s.



TOTA

L40

2832

4727

2613

5829

2743

2949

1931

Sex

Mal

e36

3033

4328

2911

5632

2643

3248

1734

Fem

ale

4426

3053

2521

1460

2629

4427

5120

29

Age

18–2

938

2735

4427

2812

5533

2443

3344

1640

30–4

940

2931

4827

2413

6027

3042

2851

1931

50–6

438

3230

4627

2710

6524

2645

2953

2521

65 a

nd o

lder

4826

2554

2123

——

-—

—-

——

-31

4624

5722

21

Education

Less

than

a h

igh

scho

ol d

iplo

ma

5614

3064

1124

3029

4048

2328

6510

24H

igh

scho

ol d

iplo

ma

3831

3148

2526

1158

3125

4531

4621

33S

ome

colle

ge o

r mor

e17

4834

2051

296

7023

1061

2922

3345

Employment

Empl

oyed

3828

3446

2727

1161

2825

4431

4718

35U

nem

ploy

ed31

3335

——

-—

—-

——

-—

—-

——

-—

—-

3447

19—

—-

——

-—

—-

Labo

r for

ce s

tatu

s46

2726

5225

2220

4931

3141

2752

1928

Household income

Less

than

$30

,000

5119

3058

1626

2044

3540

3029

5714

29$3

0,00

0–$4

9,99

933

3235

4230

278

6229

2144

3542

2236

$50,

000

or m

ore

1255

3318

5427

673

217

6924

2134

44In

com

e m

issi

ng46

2330

5521

2221

4533

3139

2957

1924

Marital status

Mar

ried/

Has

a p

artn

er41

2732

5124

2513

5730

2942

2852

1829

Wid

owed

/Div

orce

d/S

epar

ated

4130

2946

2923

1558

2829

4229

4825

27S

ingl

e33

3334

3733

3010

6227

2048

3242

1642

Region

Nor

thea

st35

3628

3931

3012

6027

2642

3147

1934

Nor

th C

entra

l35

3629

4139

19—

—-

——

-—

—-

2746

2742

2335

Sou

th40

2734

4729

2413

5433

2643

3149

1832

Wes

t42

2632

5121

2713

6126

2943

2852

1930

Area

Urb

an40

2832

4727

2613

5928

2742

3050

1732

Sub

urba

n43

2632

5024

2512

5532

3140

2948

2131

Rur

al36

3727

4333

23—

—-

——

-—

—-

2354

2348

2427

Language

Engl

ish-

dom

inan

t6

7024

1173

174

8214

476

2013

4937

Bilin

gual

2732

4136

2637

759

3417

5033

4120

39S

pani

sh-d

omin

ant

684

2874

521

4014

4558

1032

716

23

Lang

uage

of H

ealth

Inf

orm

atio

n R

ecei

ved

(for tho

se gettin

g an

y info from

eac

h so

urce

) Tele

visi

onS

pani

sh

Eng

lish

Bot

hR

adio

Spa

nish

E

nglis

h B

oth

Inte

rnet

Spa

nish

E

nglis

h B

oth

Prin

t Med

iaS

pani

sh

Eng

lish

Bot

hC

hurc

hes

or C

omm

unity

Gro

ups

Spa

nish

E

nglis

h B

oth

continue

d

Not

e: “

Not

in la

bor f

orce

” in

clud

es th

ose

who

repo

rted

that

they

wer

e a

hom

emak

er o

r sta

y-at

-hom

e pa

rent

, ret

ired

or a

stu

dent

.



Origin

Mex

ico

4325

3252

2325

1359

2831

4029

5117

31P

uerto

Ric

o22

4928

2849

239

6427

1558

2738

2141

Cub

a—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Dom

inic

an R

epub

lic39

2437

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Cen

tral A

mer

ica

4918

3256

1331

1844

3732

2839

619

30S

outh

Am

eric

a36

2835

——

-—

—-

——

-12

4839

2441

34—

—-

——

-—

—-

Oth

er10

6129

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

——

-—

—-

Nativity

Nat

ive

born

1160

2815

5925

576

186

7123

2237

39Fo

reig

n bo

rn54

1233

6211

2621

3642

4224

3462

1028

Generation

Firs

t54

1233

6211

2621

3642

4224

3462

1028

Sec

ond

1650

3521

4730

670

238

6626

2629

43Th

ird o

r hig

her

575

197

7617

485

113

7818

1554

31

Citizenship

Nat

ive-

born

citi

zen

1557

2919

5625

674

197

6924

2634

38N

atur

aliz

ed44

1938

4918

3311

5337

3035

3554

1729

Lega

l per

man

ent r

esid

ent (

LPR

)59

734

687

2525

2647

4817

3569

526

Fore

ign

born

, not

LP

R67

528

745

2138

1151

609

3164

728

Years in U.S.(

Fore

ign

born

onl

y)Le

ss th

an 5

676

2673

423

——

-—

—-

——

-57

1330

658

265–

965

531

695

2531

1455

5112

3864

333

10–1

458

636

695

26—

—-

——

-—

—-

5018

3262

731

15 o

r mor

e47

1735

5617

2712

5236

3432

3460

1426


Has

3731

3146

2826

1161

2725

4629

4821

31D

oes

not h

ave

4819

3352

2126

1746

3634

3432

5412

32

Health insurance

Insu

red

3434

3242

3225

1163

2623

5027

4523

32U

nins

ured

5117

3257

1626

1845

3736

2935

5711

31

Lang

uage

of H

ealth

Inf

orm

atio

n R

ecei

ved,

con

tinue

d(fo

r tho

se gettin

g an

y info from

eac

h so

urce

) Tele

visi

onS

pani

sh

Eng

lish

Bot

hR

adio

Spa

nish

E

nglis

h B

oth

Inte

rnet

Spa

nish

E

nglis

h B

oth

Prin

t Med

iaS

pani

sh

Eng

lish

Bot

hC

hurc

hes

or C

omm

unity

Gro

ups

Spa

nish

E

nglis

h B

oth

Not

e: P

erce

ntag

e m

ay n

ot to

tal 1

00 d

ue to

roun

ding

and

the

excl

usio

n of

“do

n’t k

now

” an

d “r

efus

ed”

resp

onse

s.



TOTAL 41 57 64

SexMale 40 51 60Female 42 62 68

Age18–29 42 57 6530–49 41 58 6750–64 40 55 6165 and older 39 50 49

EducationLess than a high school diploma 38 56 66High school diploma 41 56 66Some college or more 45 59 60

EmploymentEmployed 40 56 65Unemployed 47 55 54Not in labor force 41 60 64

Household incomeLess than $30,000 40 59 67$30,000–$49,999 39 57 64$50,000 or more 44 52 61Income missing 41 53 61

Marital statusMarried/Has a partner 40 59 66Widowed/Divorced/Separated 43 53 61Single 42 51 61

RegionNortheast 43 61 62North Central 37 54 63South 45 57 63West 37 55 67

AreaUrban 42 57 65Suburban 40 59 64Rural 36 50 59

LanguageEnglish-dominant 37 47 54Bilingual 46 57 64Spanish-dominant 39 62 71

Impact of Media on Behavior(For anyone who received any health information by television, radio, Internet, printmedia)

Affect decisionabout how to treat

an illness or medical condition

Ask a doctor orother medical

professional newquestions

Change thinkingabout diet or

exercise

continued




OriginMexico 40 57 67Puerto Rico 45 55 55Cuban 44 57 45Dominican Republic 44 67 68Central America 43 63 73South America 34 53 60Other 36 42 48

NativityNative born 41 51 56Foreign born 41 60 69

GenerationFirst 41 60 69Second 41 55 56Third or higher 39 46 56

CitizenshipNative-born citizen 41 52 57Naturalized 42 58 66Legal permanent resident (LPR) 40 61 71Foreign born, not LPR 40 62 72

Years in U.S. (Foreign born only)Less than 5 44 62 685–9 43 60 7210–14 37 60 7215 or more 41 60 67

Usual health care providerHas 42 60 65Does not have 38 48 61

Health insuranceInsured 41 57 64Uninsured 41 56 65

Impact of Media on Behavior, continued(For anyone who received any health information by television, radio, Internet, printmedia)

Affect decisionabout how to treat

an illness or medical condition

Ask a doctor orother medical

professional newquestions

Change thinkingabout diet or

exercise



TOTA

L63

5963

7076

7672

71

Sex

Mal

e58

5556

6572

7770

69Fe

mal

e69

6471

7580

7575

72

Age

18–2

952

5352

6274

7675

7130

–49

6764

6773

7877

7273

50–6

472

6475

7879

7971

7265

and

old

er67

5362

6670

6963

58

Education

Less

than

a h

igh

scho

ol d

iplo

ma

6154

5866

7174

6667

Hig

h sc

hool

dip

lom

a63

6064

7077

7674

73S

ome

colle

ge o

r mor

e66

6973

7782

8280

75

Employment

Empl

oyed

6261

6370

7679

7372

Une

mpl

oyed

6354

5868

7574

7769

Not

in la

bor f

orce

6759

6670

7773

6970

Household income

Less

than

$30

,000

6457

6370

7575

6869

$30,

000–

$49,

999

6561

6170

7780

7672

$50,

000

or m

ore

6673

7478

8483

8381

Inco

me

mis

sing

5550

5461

6969

6561

Marital status

Mar

ried/

Has

a p

artn

er65

6265

7277

7773

72W

idow

ed/D

ivor

ced/

Sep

arat

ed68

5970

7276

7671

69S

ingl

e52

5253

6173

7670

69

Region

Nor

thea

st67

5365

7475

7969

69N

orth

Cen

tral

5660

5965

7776

7172

Sou

th63

6064

6976

7571

68W

est

6361

6370

7677

7473

Area

Urb

an62

6064

7177

7672

70S

ubur

ban

6559

6369

7678

7073

Rur

al62

5762

6772

7672

72

Language

Engl

ish-

dom

inan

t57

6165

6780

7679

76B

ilingu

al65

6364

7276

7774

71S

pani

sh-d

omin

ant

6555

6269

7376

6667

Kno

wle

dge

of D

iabe

tes

(% ans

wering co

rrec

tly)

Freq

uent

urin

atio

nIn

crea

sed

fatig

ueEx

cess

ive

thirs

tB

lurr

y vi

sion

No

perm

anen

tcu

reEf

fect

ive

treat

men

tsex

ist

Mai

ntai

ning

ahe

alth

y w

eigh

t as

apr

even

tion

tact

ic

Ris

k ev

en if

no

fam

ily m

embe

rsha

ve d

iabe

tes

continue

d

Not

e: “

Not

in la

bor f

orce

” in

clud

es th

ose

who

repo

rted

that

they

wer

e a

hom

emak

er o

r sta

y-at

-hom

e pa

rent

, ret

ired

or a

stu

dent

.



Origin

Mex

ico

6461

6470

7675

7373

Pue

rto R

ico

6954

6676

7781

7276

Cub

a67

5965

6475

7876

64D

omin

ican

Rep

ublic

7160

6869

7779

7662

Cen

tral A

mer

ica

5754

5464

7475

6064

Sou

th A

mer

ica

4454

5766

7377

6561

Oth

er68

7173

7684

8381

73

Nativity

Nat

ive

born

6064

6770

8077

8075

Fore

ign

born

6457

6170

7476

6768

Generation

Firs

t64

5761

7074

7667

68S

econ

d60

6262

6880

7882

74Th

ird o

r hig

her

6167

7373

8075

7977

Citizenship

Nat

ive-

born

citi

zen

6263

6771

7977

7975

Nat

ural

ized

70

6065

7277

7769

67Le

gal p

erm

anen

t res

iden

t (LP

R)

6458

6370

7577

6568

Fore

ign

born

, not

LP

R55

5453

6568

7367

67

Years in U.S. (

FB o

nly)

Less

than

558

5256

6167

7665

675–

958

5152

6869

7365

6710

–14

5757

5866

7478

6766

15 o

r mor

e70

6066

7477

7668

69


Has

6561

6673

7977

7372

Doe

s no

t hav

e57

5456

6369

7468

68

Health insurance

Insu

red

6561

6672

7777

7472

Uni

nsur

ed61

5760

6774

7569

70

Respondent has diabetes

Yes

8069

7882

8176

7186

No

6058

6168

7577

7268

Kno

wle

dge

of D

iabe

tes,

con

tinue

d(%

ans

wering co

rrec

tly)

Freq

uent

urin

atio

nIn

crea

sed

fatig

ueEx

cess

ive

thirs

tB

lurr

y vi

sion

No

perm

anen

tcu

reEf

fect

ive

treat

men

tsex

ist

Mai

ntai

ning

ahe

alth

y w

eigh

t as

apr

even

tion

tact

ic

Ris

k ev

en if

no

fam

ily m

embe

rsha

ve d

iabe

tes

continue

d



Respondent, fam

ily mem

ber, or

close friend has diabetes

Yes

6966

7177

8080

7579

No

5349

5160

7171

6857

Health information sources

Doc

tor o

r oth

er m

edic

al p

rofe

ssio

nal

6563

6673

7878

7372

Tele

visi

on65

6265

7278

7872

73R

adio

6663

6474

7779

7373

Inte

rnet

6367

6874

8081

7976

Prin

t med

ia67

6568

7479

8074

73Fa

mily

or f

riend

s64

6366

7278

7874

73C

hurc

hes

or c

omm

unity

gro

ups

6359

6268

7478

7069

Kno

wle

dge

of D

iabe

tes,

con

tinue

d(%

ans

wering co

rrec

tly)

Freq

uent

urin

atio

nIn

crea

sed

fatig

ueEx

cess

ive

thirs

tB

lurr

y vi

sion

No

perm

anen

tcu

reEf

fect

ive

treat

men

tsex

ist

Mai

ntai

ning

ahe

alth

y w

eigh

t as

apr

even

tion

tact

ic

Ris

k ev

en if

no

fam

ily m

embe

rsha

ve d

iabe

tes



TOTAL 10 32 58


Age18–29 12 40 4830–49 9 28 6350–64 8 24 6865 and older 15 37 48








Diabetes Knowledge Index(row % of correct answers)

Low (0–2) Middle (3–5) High (6–8)

continued





OriginMexico 9 32 59Puerto Rico 10 27 64Cuba 14 26 60Dominican Republic 7 33 60Central America 15 39 46South America 15 38 47Other 6 24 71







Respondent has diabetesYes 3 24 73No 11 33 55

Respondent, family member, or close friend has diabetesYes 5 28 67No 18 38 44

Health information sourcesDoctor/other medical professional 8 30 62Television 9 30 61Radio 7 30 62Internet 6 29 65Print media 8 27 65Family or friends 8 30 62Churches or community groups 10 33 57

Diabetes Knowledge Index, continued(row % or correct answers)

Low (0–2) Middle (3–5) High (6–8)



TOTAL 100 100 100


Age18–29 33 38 2530–49 38 38 4850–64 12 12 1865 and older 12 9 7








Profile of Persons by Diabetes Knowledge Index(column % of correct answers)

Low (0–2) Middle (3–5) High (6–8)

continued





OriginMexico 58 63 64Puerto Rico 8 7 9Cuba 6 3 4Dominican Republic 2 3 3Central America 14 12 8South America 9 7 5Other 3 4 6







Respondent has diabetesYes 4 11 18No 93 89 81

Respondent, family member, orclose friend has diabetesYes 29 55 71No 65 44 29

Health information sourceDoctor/other medical professional 58 67 76Television 58 65 72Radio 29 38 43Internet 19 32 39Print media 37 43 57Family or friends 48 60 67Churches or community groups 30 32 31

Profile of Persons by Diabetes Knowledge Index, continued(column % of correct answers)

Low (0–2) Middle (3–5) High (6–8)



TOTAL 8

SexMale 8Female 9

Age18–29 830–49 950–64 965 and older 4

EducationLess than a high school diploma 7High school diploma 8Some college or more 10

EmploymentEmployed 9Unemployed 9Not in labor force 7

Household incomeLess than $30,000 9$30,000–$49,999 8$50,000 or more 7Income missing 9

Marital statusMarried/Has a partner 9Widowed/Divorced/Separated 7Single 7

RegionNortheast 4North Central 5South 11West 8

AreaUrban 8Suburban 7Rural 10

LanguageEnglish-dominant 4Bilingual 10Spanish-dominant 9

Sought Medical Care or Medicines in Another Country(% responding yes)

continued




OriginMexico 10Puerto Rico 2Cuba 1Dominican Republic 12Central America 5South America 7Other 10

NativityNative born 6Foreign born 9

GenerationFirst 9Second 7Third or higher 4

CitizenshipNative-born citizen 6Naturalized 13Legal permanent resident (LPR) 11Foreign born, not LPR 5

Years in U.S. (Foreign born only)Less than 5 115–9 710–14 515 or more 11

Usual health care providerHas 8Does not have 10

Health insuranceInsured 7Uninsured 11

Sought Medical Care or Medicines in Another Country, continued(% responding yes)



TOTAL 6

SexMale 7Female 5

Age18–29 730–49 650–64 665 and older 5

EducationLess than a high school diploma 6High school diploma 6Some college or more 8

EmploymentEmployed 7Unemployed 10Not in labor force 5

Household incomeLess than $30,000 6$30,000-$49,999 7$50,000 or more 6Income missing 6

Marital statusMarried/Has a partner 6Widowed/Divorced/Separated 7Single 7

RegionNortheast 7North Central 7South 7West 5

AreaUrban 6Suburban 6Rural 8

LanguageEnglish-dominant 8Bilingual 7Spanish-dominant 5

Sought Medical Care from a Curandero(% responding yes)

continued




OriginMexico 6Puerto Rico 5Cuba 11Dominican Republic 8Central America 5South America 7Other 8

NativityNative born 8Foreign born 5

GenerationFirst 5Second 7Third or higher 8

CitizenshipNative-born citizen 7Naturalized 5Legal permanent resident (LPR) 6Foreign born, not LPR 5

Years in U.S. (Foreign born only)Less than 5 85-9 410-14 615 or more 5

Usual health care providerHas 6Does not have 7

Health insuranceInsured 6Uninsured 7

Sought Medical Care from a Curandero, continued(% responding yes)



TOTAL 87 8


Age18–29 85 1030–49 88 850–64 88 565 and older 90 3


EmploymentEmployed 87 9Unemployed 83 8Not in labor force 90 5





LanguageEnglish–dominant 79 14Bilingual 89 7Spanish-dominant 90 5

Opinions of Different Treatments

continued

Sick persons should rely ONLY on treatments

recommended by doctors orother medical professionals

Treatments in the form of potions, powders,

spells or healing rituals can ALSO be useful




OriginMexico 88 8Puerto Rico 88 7Cuba 86 6Dominican Republic 81 11Central America 88 6South America 85 8Other 82 13





Usual health care providerHas 87 8Does not have 87 8


Opinions of Different Treatments, continued

Sick persons should rely ONLY on treatments

recommended by doctors orother medical professionals

Treatments in the form of potions, powders,

spells or healing rituals can ALSO be useful


Route 1 and College Road EastP.O. Box 2316Princeton, NJ 08543-2316www.rwjf.org

1615 L Street, NW Suite 700 Washington, DC 20036-5610www.pewhispanic.org

August 2008

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