LATINOS\HISPANICS AND DISABILITY:
An Annotated Resource Bibliography

Prepared by Jose O. Arrom, Research Coordinator
Midwest Latino Health Research, Training, and Policy Center
University
of Illinois at Chicago

Under a grant from the
National Institute of Disability and Rehabilitation Research (NIDDR)
to the
UIC Center on Emergent Disabilities-
Institute on Disabilities and Human Development

Edition: September 1997

Midwest Latino Health Research, Training, and Policy Center

Jane Addams College of Social Work
University of Illinois at Chicago
1640 W. Roosevelt Rd.
Suite 636 M/C 625
Chicago, IL 60608
312-413-1952
josarrom@uic.edu

INTRODUCTION

There is very little known or published about disabilities and their trends among Latino (or Hispanic) populations in the U.S. This bibliography has the purpose of collecting some of the studies and writing about Latinos and disabilities in general as a first step in assessing this state of affairs. The literature tends to be both limited and scattered. In fact, most works deal with Latinos only in passing.

Definitions of Disability

Disability has many varying definitions. Cultural groups define disability differently. The concept of disability has changed over time in response to advocacy by the disabled, changing resource availability (economic development), concepts of work and human productivity, perspectives on the disabled as deviants or minorities, and social policy. For example, just within the U.S. government, there are different definitions of disability based on specific legislation such as the Rehabilitation Act of 1992, Americans with Disability Act (1990), Social Security legislation and regulations, and so forth.

Some definitions are work-related or educationally-related and tend to be global, focusing on a time-measure of inability to work or go to school. Others are concerned with functional limitations or a person’s capacity and\or independence to perform activities of daily living (ADL's and IADL's). Some investigators view disability as a consequence of certain chronic conditions and aging - which have predisposing risk factors and which may or may not have an endpoint in death (mortality). Others are concerned with their risk factors in term of how the disabilities and their defining conditions or events may be prevented. Other recent indicators of disability relate to the use of assistive (and communication) technology, physical access and employment, the use of social and health services and special education, and the receipt of social entitlements or benefits (i.e., SSI). Very recently, disability has been approached from more multidimensional "quality of life" (QOL) measures of health status. These different definitions result in different estimates of disability, and the need to have included various measures in the 1994-1995 National Health Interview Survey (NHIS).

Organization

This bibliography is divided into ten major sections:

  1. Latino Children and Disability- This section covers birth defects, developmental, congenital\genetic, and parental adaptation.
  2. Learning and Language Disabilities & Mental Retardation. This section covers a critical emerging area which profoundly impacts academic outcomes but the ability of these persons to participate effectively in the U.S. workforce which is increasingly knowledge-information based.
  3. Disability of Working Age Latinos. These abstracts cover mental health, injury, occupational, and other behaviorally related conditions occurring to persons 18-60 years of age. A subsection on post-traumatic stress disorders (PTSD) as a disabling condition is included.
  4. Chronic Conditions and Aging - Focusing on the slowly developing conditions of primarily the elderly, including diabetes and dementias.
  5. Service Delivery and Rehabilitation Issues - Reviews access and utilization of services, how disability is perceived in general by Latinos, and how services should be delivered in a culturally competent manner to persons with disabilities.
  6. Latino Health Status: Risk Factors for Chronic Conditions and Disability - which addresses the risk factors which places people at risk for developing chronic conditions, impairments, disabilities, and handicaps. A major subsection presents works related to risks and outcomes of injury and physical trauma.
  7. Multicultural and Cross-Cultural Perspectives in Disability - Presents additional studies for other U.S. ethnic-racial groups, as well as studies in other (international) settings.
  8. Measurement, Research, and Surveillance Issues - How to measure and monitor disability, risk factors, and chronic conditions in Latino and other ethnic-racial populations.
  9. Disability Databases - Briefly lists the major databases where one may find data on Latinos and disability, chronic conditions, and risk factors and presents key articles describing them.
  10. Disability Statistics and Studies - Includes key recent general publications which may include some disability statistics or which may guide the reader to the disability field.

There is an overlap between the different sections. It was extremely difficult to decide how to classify many items or which classifications to use. There are dozens of disabling conditions, yet the literature and the availability of data on Latinos and their specific disabilities is scarce. For example, the literature on Latinos and diabetes mellitus is rapidly growing. In the Southwest US, most of the work on diabetes is being conducted with Latinos, given its high levels of prevalence. Yet, the disability data is only beginning to emerge. We choose age groups because they are broad enough to cover key groupings of conditions as they emerge throughout the lifespan. Ultimately, we hope to index this annotated bibliography to meet different user needs.

Methodology

We compiled this bibliography from a wide variety of sources, including the literature from aging, public health - chronic conditions, education, and rehabilitation. To do so, we searched MEDLINE, PsychLIT, CBIB, ERIC, CINAHL, CDC-WONDER, WSSI, and other electronic databases. In addition, we searched servers related to National Institute on Disability and Rehabilitation Research (http://dsc.ucsf.edu/indextxt.html) on the Internet. Documents available from the Internet are marked @. Some databases have limited time depth; others have some overlap. Key terms used were primarily "Hispanic or Latino", "disability", "handicap", "impairment", "functional limitation" and "rehabilitation", "injury or trauma". In addition, items have been included from our previous searches and bibliographies on the aging\elderly, chronic conditions, pregnancy outcomes, and research methodology. Most of the articles and items included have not been evaluated for quality, that is, how they include, identify, collect, disaggregate, and analyze data, particularly for Latino and other ethnic subgroups.

1. Latino Children and Disability 

BIRTH DEFECTS

Canfield, MA. Annexes, JF. Brender, JD. Cooper, SP. Greenberg, F. Hispanic Origin and Neural Tube Defects in Houston Harris County, Texas. 1. Descriptive Epidemiology. American Journal of Epidemiology. 1996, 143(1), 1-11. High prevalence of anencephaly and neural tube defects (NTDs) have recently been recorded for several Texas counties bordering Mexico. In addition, a few investigators have reported Hispanics to be at elevated risk for NTDs (anencephaly and spina bifida). Factors contributing to this risk have not been established. The authors conducted a study of NTDs in Harris County, Texas, to determine the prevalence of each defect. Prevalence was established by identifying cases among resident live births and fetal deaths (stillbirths at greater than or equal to 20 weeks) occurring from April 1, 1989, through December 31, 1991. Using multiple case ascertainment methods, 59 cases of anencephaly and 32 cases of spina bifida were detected, resulting in prevalence of 3.8 (95% confidence interval 2.9-4.9) and 2.0 (95% confidence interval 1.4-2.8) per 10,000 live births, respectively. The ratio of anencephaly prevalence to spina bifida prevalence was 2:1 in 1989, 1:1 in 1990, and 3:1 in 1991, with a significant difference in 1991. The female:male prevalence ratio was 1.0 for spina bifida and 2.2 for anencephaly, and was higher still for anencephaly among non-Hispanics (prevalence ratio = 5.6). For each defect, Hispanics experienced a prevalence approximately three times that of non-Hispanics. This ethnic difference was greater for males with anencephaly and for females with spina bifida. For anencephaly, the Hispanic: white/Anglo prevalence ratio (4.2) and the African- American: white/Anglo prevalence ratio (1.9) were greatly elevated and the Hispanic: African-American prevalence ratio (2.2) was similar, relative to comparable studies from the past two decades. The prevalence of anencephaly recorded for public hospitals (7.0 per 10,000) was three times greater than that for private hospitals (2.4 per 10,000). Spina bifida figures were similar for public (prevalence = 2.2 per 10,000) and private (prevalence = 2.0 per 10,000) hospitals. A significantly higher prevalence of both defects was documented among Hispanics in Harris County. The higher anencephaly rates among Hispanics, African-Americans, and those using public hospitals in an era of NTD screening, prenatal diagnosis, and elective pregnancy termination suggest that socioeconomic and perhaps cultural/religious factors might influence the recorded birth prevalence of this defect in particular groups.

Canfield, MA. Annexes, JF. Brender, JD. Cooper, SP. & Greenberg, F. Hispanic Origin and Neural Tube Defects in Houston Harris County, Texas. 2. Risk Factors. American Journal of Epidemiology. 1996, 143(1), 12-24. Several investigators have reported Hispanics to be at elevated risk for neural tube defects (anencephaly acid spina bifida). Factors contributing to this risk have not been established. The authors conducted a case-control study of neural tube defects (NTDs) among births occurring in Harris County, Texas, from April 1, 1989, through December 31, 1991. Through the use of multiple ascertainment methods, 59 cases of anencephaly and 32 cases of spina bifida were detected. Controls (n=451) were sampled for the same time period from Harris County vital records. Regardless of how Hispanic ethnicity was classified, having a Hispanic parent was a risk factor for both anencephaly and spina bifida. The primary etiologic question was whether increased NTD risk in Hispanics is explained by maternal diabetes or by other factors (e.g., maternal birthplace, prenatal care, reproductive history, age, socioeconomic status). Mexico-born Hispanics were no more likely than Texas-born Hispanics to deliver a fetus or infant with an NTD. Having a Hispanic mother was a risk factor for anencephaly among infants born to women with early prenatal care (odds ratio (OR) = 4.54, 95% confidence interval (Cl) 2.21-9.40) but not for those born to latecomers. Earlier prenatal care seemed "protective" for non-Hispanics (OR = 0.18, 95% Cl 0.06-0.65) but not for Hispanics. After simultaneous adjustment for eight variables in multivariate analysis, having a Hispanic (versus non-Hispanic) mother remained a strong risk factor for both anencephaly (OR = 2.58, 95% Cl 1.19-5.61) and spina bifida (OR = 3.71, 95% Cl 1.48-9.31). Any previous pregnancy termination/fetal loss was also associated with anencephaly in a final logistic regression model (OR = 2.48, 95% CI 1.20-5.10), and having a teenage mother (aged <20 years) approached significance (OR = 2.21, 95% Cl 0.92-5.31). "Hispanic mother" was the only study variable significantly associated with spina bifida in multivariate analysis. Results for diabetes suggested no association with anencephaly (OR = 1.24, 95% CI 0.25-6.17). An increased risk of NTDs among Hispanics remained after controlling for other factors. For anencephaly, this risk might be partially explained by economic and cultural differences between Hispanics and non-Hispanics, and the effect of these factors on rates of prenatal diagnosis acid elective pregnancy termination.

Harris, JA. Shaw, GM. Neural Tube Defects - Why Are Rates High among Populations of Mexican Descent. Environmental Health Perspectives. 1995, 103(6), 163-164. [KW: Anencephaly. Birth-defects. Folate. Spina bifida. Vitamins-prevalence.] (No abstract.)

Harris, J. Kallen, B. Robert, E. The Epidemiology of Anotia and Microtia. Journal of Medical Genetics. 1996, 33(10), 809-813. We studied a large data set from three registries of congenital malformations (central-east France, Sweden, and California), a total of 954 cases, known chromosome anomalies excluded. The prevalence at birth varied significantly between programmed, probably to a large extent because of different ascertainment and inclusion criteria, from 0.76 per 10,000 births in the French program to 2.35 in the Swedish. Within the California program, there is a racial variability in prevalence with lower values among whites (and probably blacks) than in Hispanics and Asians. Also the proportion of anotia and microtia varies between races with the lowest proportion of anotia in whites. Anotia and microtia are equally often associated with other malformations and show other similar epidemiological characteristics. In unilateral cases, the right side is more frequently malformed than the left side, especially when the ear malformation is isolated. There is a male excess, most pronounced in isolated forms. Among associated malformations, facial clefts and cardiac defects are the most common ones (each about 30% of infants with associated malformations), followed by anophthalmia or microphthalmia (14%), limb reduction defects or severe renal malformations (11%), and holoprosencephaly (7%). There is a maternal parity effect seen, an increased risk at parity 4+ (standardized for maternal age), more pronounced for anotia than microtia.

Shaw, GM. Jensvold, NG. Wasserman, CR. Lammer, EJ. Epidemiologic Characteristics of Phenotypically Distinct Neural Tube Defects among 0.7 Million California Births, 1983-1987. Teratology. 1994, 49(2), 143-149. Isolated neural tube defects (NTDs) appear to have different risk factors compared to nonisolated NTDs. To extend those observations, we explored routinely collected child and parental characteristics as possible risk factors among isolated versus nonisolated NTD cases, among high versus low spina bifida cases, and among open versus skin-covered spina bifida cases. Fetuses and liveborn infants with anencephaly or spina bifida among the 1983-87 cohort of births and fetal deaths (n=712,863) were ascertained by the California Birth Defects Monitoring Program. One hundred and ninety-three anencephalic cases and 272 spina bifida cases were compared to a random sample of 5,000 liveborn infants. Among anencephalic cases, 55% were live births and 85% were isolated. The proportion of males was similar to females across all subgroups. Increased risks were found for Hispanic whites, with risk estimates highest for nonisolated cases (odds ratio = 4.0, 95% confidence interval `1.5,10.5ï). Among spina bifida cases, 92% were live births, 81% isolated, 82% open, and 86% were low. More males were found among the group with isolated high open defects, and fewer males were found among the group of all closed defects. The proportion of males was similar to females in all other subgroups. Cases were more likely to be Hispanic with risks largest for high open defects (odds ratio = 2.9, '1.2,6.6ï), particularly for nonisolated cases. This study provides some evidence that further classifications of NTDs may reveal subgroupings of cases with different etiologies. (C) Wiley-Liss. [Birth Defects.]

Stierman, L. Birth Defects in Eleven California Counties: 1990-1992. Fresno, CA: California Birth Defects Monitoring Program, June 1996. This report presents data on birth defects from 11 registry counties in California by demographic characteristics and 10 sentinel defects. In general, children of women of Hispanic and Asian origins had fewer birth defects than those of White and African-American descent. However, Mexican-American women had a 50% higher risk of having children with neural tube defects, spina bifida, or anencephaly. [Address: 2511 West Shaw Ave., Fresno CA 97311-3325 FAX: 209-224-0252]


SENSORY\COMMUNICATION IMPAIRMENTS

Bennett, AT. Gateways to powerlessness: Incorporating Hispanic deaf children and families into formal schooling. Disability, Handicap & Society. 1988, 3(2), 119-151. Describes a 2-yr ethnographic field study of the formal intake process (assessment, programming, placement, and evaluation) involving 8 deaf Hispanic children (aged 3-6 yrs) in a private school for the deaf. Practices of noninvolvement of Hispanic parents in educational decision making are discussed, as well as the construction of particular ideological and social relations between participants in the intake process. The progress of one family through the intake is analyzed in detail to demonstrate the social and cultural complexities of these relationships. (PsycINFO)

Christensen, KM. Conceptual sign language acquisition by Spanish-speaking parents of hearing-impaired children. American Annals of the Deaf. 1986, 131(4), 285-287. Describes a trilingual (Spanish, English, and Sign Language) approach to conceptual Sign Language acquisition for monolingual Spanish- speaking parents of deaf children. Members of 58 families who were Spanish speakers participated in a 2-year televised trilingual class. Competence in conceptual Sign Language communication was achieved by Ss who viewed the program regularly. Positive attitudinal changes among Ss involved feelings about communication with their deaf child and about the school setting in general. (PsycINFO)

Correa, VI. Working with Hispanic parents of visually impaired children: Cultural implications. Journal of Visual Impairment & Blindness, 1987, 81(6), 260-264. Discusses 2 types of problems faced by teachers working with visually impaired Hispanic children and their families: difficulties associated with accepting the impairment and cultural and linguistic differences. A frame-work is provided for understanding the cultural differences in the Hispanic population so that teachers can be more sensitive to the needs of these families. (PsycINFO)

Ferullo, RJ. Objectivity in the assessment of preschool hearing impaired bilingual- Hispanic children. Journal of School Health. 1983, 53(2), 131-135. Public Law 94-142, the Education for All Handicapped Children Act, mandates the development of an individualized education plan for school-aged children with special needs. The development of such a plan requires a team meeting of various specialists who have conducted assessments of the children being "cored." Often such meetings become an arena for the enunciation of favored philosophical and methodological positions that tend to obstruct the development of scientifically based goals and objectives. The author stresses the importance of avoiding one's favored philosophy in the evaluation and assessment of preschool hearing-impaired Hispanic bilingual children. A case illustration is presented to demonstrate the need for objectivity in the team-evaluation process. Some guidelines for use in working with Hispanic families are offered. (PsycINFO)

Lee, DJ. Gomez Marin, O. Lee, HM. Prevalence of Childhood Hearing Loss - The Hispanic Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey II. American Journal of Epidemiology. 1996, 144(5), 442-449. Comparative analysis of the epidemiology of childhood hearing loss was undertaken among African-American, Hispanic- American, and non-Hispanic white children. Audiometric data on children aged 6-19 years were obtained from 688 African Americans, 330 Cuban Americans, 2,602 Mexican Americans, 1,025 Puerto Ricans, and 3,243 non-Hispanic whites who participated in either the National Health and Nutrition Examination Survey II, 1976-1980, or the Hispanic Health and Nutrition Examination Survey, 1982-1984, Hearing loss was defined as a pure-tone decibel hearing threshold level (averaged over 500, 1,000, and 2,000 Hz) greater than 15 in the ear with the best response. The prevalence (per 1,000) of bilateral hearing loss was 17.0 for African-American, 68.3 for Cuban-American, 27.6 for Mexican-American, 57.7 for Puerto Rican, and 15.5 for non-Hispanic white children. Differences in prevalence by ethnicity/race diminished when a more stringent definition of hearing loss (i.e., moderate or greater than 30 dB hearing threshold level) was used. There were no adolescent African-American males aged 16-19 years who had a hearing loss, After adjustment for age, the odds of hearing loss was significantly greater in males than in females only in non-Hispanic whites (odds ratio = 2.2; 95% confidence interval 1.6-3.3). On the basis of 1993 census population estimates in the United States, over 819,000 children aged 6-19 years have some degree of hearing impairment, and over 216,000 of these children have moderate or greater hearing impairment.


PARENTAL ADAPTATION TO DISABILITY

Espinosa, Maria E. Attitude of Hispanic and Anglo parents toward children with epilepsy in relation to selected variables of knowledge, demography, and epilepsy experience in six elementary schools in Oklahoma City. Dissertation Abstracts International. 1983, 43(10-B), 3183-3184. [Knowledge & demographic characteristics & epilepsy experience, attitudes toward children with epilepsy, Hispanic vs Anglo parents of elementary school students.]

Gary, SD. Perceived levels of stress of Black, White and Hispanic mothers of infants with disabilities. Dissertation Abstracts International. 1992, 52(7-A), 2499.

Hanline, MF. Daley, SE. Family coping strategies and strengths in Hispanic, African-American, and Caucasian families of young children. Topics in Early Childhood Special Education. 1992, 12(3), 351-366. Examined the relationship between maternal perceptions of family coping strategies and family strengths in 59 Hispanic, 66 African-American, and 81 Caucasian families of young children (aged <3 yrs) with and without disabilities. The use of internal family coping strategies tended to be more predictive of family strengths than was the use of social supports outside the family within all 3 ethnic groups. Analysis revealed no differences in family coping strategies and family strengths between Hispanic families of children with and without disabilities, one difference related to social support among the 2 types of African-American families, and multiple differences among the 2 types of Caucasian families. (PsycINFO) [Care giving, Parents.]

Lequerica, M. Stress in immigrant families with handicapped children: A child advocacy approach. American Journal of Orthopsychiatry. 1993, 63(4), 545-552. Discusses factors affecting the adjustment of Latinos who have immigrated to the US. Topics addressed include immigration and stress, based on such things as culture shock and crisis of loss and load; handicap and stress; and poverty and immigration. Also discussed are how factors related to the client and to the type of service required can impede service delivery. Since service delivery agencies are often overcrowded and lack coordinated outreach to families, and since the language barrier and cultural gap need to be overcome, an advocate is recommended. An advocate would be able to coordinate various providers' efforts by easing the communication between those involved and by giving to the immigrant family a sense of cohesion and unified effort. The advocate would also serve as a familiar and trusted source for help when a problem develops or when the party being aided becomes discouraged. (PsycINFO)

Mardiros, M. Conception of childhood disability among Mexican- American parents. Medical Anthropologist, 1989, 12(1), 55-68. [No abstract.]

Mary, NL. Reactions of Black, Hispanic, and White mothers to having a child with handicaps. Mental Retardation. 1990, 28(1), 1-5. Interviewed 20 Black, 20 Hispanic, and 20 White mothers of disabled children (DCs) aged <6 yrs to explore their feelings and reactions toward DCs. Trends revealed that Hispanic Ss reported an attitude of self-sacrifice toward DCs and greater spousal denial of disabilities more often than Black or White Ss. Stages of reaction from strong negative feelings to later periods of adjustment were most often reported by Hispanic and White Ss, and by 75% of Ss with DCs with Down's syndrome. Although severity of retardation was not predictive of parental reporting of stages, Ss who received diagnoses within 1 mo of the DCs' births were more likely to report subsequent adjustment stages. (PsycINFO)

Mary, NL. A cross-cultural study of mothers of young developmentally disabled children. Dissertation Abstracts International. 1986, 47(4-A), 1486.

Shapiro, J. Tittle, K. Maternal adaptation to child disability in a Hispanic population. Family Relations. 1990, 39(Apr.), 179-85.

Tirado, LA. Attitudes toward childhood disabilities among Puerto Rican parents. Dissertation Abstracts International. 1982, 43(1-B) 268. [Attitudes toward causes of childhood handicaps, utilization of social services; childrearing attitudes & practices, Puerto Rican parents.]


SERVICE DELIVERY

Brookins, GK. Culture, Ethnicity, and Bicultural Competence - Implications for Children with Chronic Illness and Disability. Pediatrics. 1993, 91(5), 1056-1062. [No abstract.]

Bruder, MB. Anderson, R. Schutz, G. Caldera, M. Niños Especiales Program: A culturally sensitive early intervention model. Journal of Early Intervention. 1991, 15(3), 268-277. Describes a 3-yr model demonstration designed to provide culturally sensitive early intervention services to Puerto Rican infants with severe disabilities and their families. The program delivered home-based interventions that emphasized the needs of the family unit. Elements of the model are described for cultural sensitivity, the transdisciplinary team process, interagency coordination, and transition. Assessments of 15 children and families who were in the program for at least 1 year show that as a family's support and informational needs were met, more attention was focused on child intervention needs. An illustrative case study is presented. (PsycINFO) [Service Delivery, Early Intervention.]

Butler, JA. Singer, JD. Palfrey, JS. Walker, DK. Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas. Pediatrics, 1987, 79 (1): 89-98. The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care. [Access.]

Eyman, RK. Boroskin, A. Hostetter, S. Use of alternative living plans for developmentally disabled children by minority parents. Mental Retardation. 1977, 15(1), 21-23. Investigated the current use of alternative living plans for developmentally disabled children by various groups of clients eligible for services. The sample consisted of 8,009 Ss, most of whom were mentally retarded, receiving developmental disabilities services in California, Colorado, and Nevada. Results show that the more severe the level of retardation, the more likely the Ss would be found in an institution regardless of race. However, 65% of the moderately and mildly retarded Ss from Black or Spanish- American homes remained with their families in contrast to about 50% of the White Ss. Differences between the groups were even greater for the severely retarded: 60% of the Black or Spanish- American Ss lived at home while only 33% of the White Ss lived at home. Two possible reasons for these findings are presented, and the need for increased communication concerning available community resources is noted. (PsycINFO)

Geber, G. Race and Ethnicity - Issues for Adolescents with Chronic Illnesses And Disabilities - An Annotated Bibliography. Pediatrics. 1993, 91(5), 1071-1081. (No abstract)

Kasper, MJ. Robbins, L. Root, L. Peterson, MG. Allegrante, JP. A musculoskeletal outreach screening, treatment, and education program for urban minority children. Arthritis Care Research, 1993, 6(3), 126-33. Purpose: A hospital-based outreach program was initiated to screen minority children in medically underserved areas of New York City for musculoskeletal diseases. We examine the number of such diseases in this population, and evaluate the program's success to facilitate referral and follow-up of children with referral conditions. Methods: Screenings were conducted at schools and day-care centers. Children requiring further evaluation were referred to the sponsoring hospital, a major referral center for musculoskeletal diseases. Bilingual educational strategies, transportation reimbursement, and coverage for uninsured children were used to foster participation and increase follow-up. Results: A total of 2,523 children were screened, 168 (6.7%) of whom were referred for one of 45 different musculoskeletal disorders, including scoliosis and back problems, foot problems, in- and out-toeing, knee or hip pain, and problems of joint range of motion. Sixty-seven percent of those referred had a follow-up medical consultation. Conclusions: A substantial proportion of urban minority children have previously undiagnosed musculoskeletal disorders that, if left untreated, have the potential to lead to significant disability in later life. Targeted screening programs can be effective in identifying such disorders, and providing and opportunity for early diagnosis, treatment, and education. [Disability Risk.]

Martinez, M. The satellite clinic: Providing access to intervention in rural Texas. Zero to Three. 1986, 6(5), 15-16. Describes a program designed for early detection of developmental problems and early intervention with low birthweight premature infants living in the rural Texas panhandle. A case study is presented in which one of the program's nurse coordinators investigated a young family having problems with a sick child and provided them with goals that would (1) help the mother to accept responsibility for the baby, (2) change their medical care regime to preventive and wellness measures, and (3) utilize local agency help. (PsycINFO)

McCubbin, HI. Thompson, EA. Thompson, AI. McCubbin, MA. Kaston, AJ. Culture, Ethnicity, and the Family - Critical Factors in Childhood Chronic Illnesses and Disabilities. Pediatrics. 1993, 91(5), 1063-1070.

Rueda, RS. Martinez, I. Fiesta Educativa: One community's approach to parent training in developmental disabilities for Latino families. Journal of the Association for Persons with Severe Handicaps. 1992, 17(2), 95-103. Describes the history and program of Fiesta Educativa, a successful education and training activity for Latino families with children with disabilities. It is suggested that many minority families do not become engaged in service delivery systems and treatment programs because of the inaccessibility of services, class and cultural barriers, and language barriers. The goal of Fiesta Educativa was to provide a large-scale 2-day special training event for Latino parents and families of children with developmental disabilities to acquaint them with the available service systems and to provide advocacy training for treatment planning and service. Indicators of effectiveness and adaptations are discussed. (PsycINFO) [Parent Training, Service Delivery.]

2. Learning and Language Disabilities & Mental Retardation 

This is one of the largest sections. There is a large amount of literature in this area specifically relating to Latinos. We have tried to include the literature on assessment/ identification/diagnosis, etiology, and epidemiology as well as the those relating to service delivery. There are major concerns about the misdiagnosis of learning disorders for Latino and minority populations. Some area related to the fact English is the second language of these children. Others to possible cultural bias of testing tools. On the other hand, there may be underdiagnosis because the evaluators may assume the problem may be related to language learning. However, these conditions may be increasing since more Latino children are surviving beyond infancy, are increasingly at risk of being exposed to environmental hazards (lead, pollutants, agricultural sprays), and receive less primary care.


Ambert, AN. Identifying language disorders in Spanish-speakers. Journal of Reading, Writing, & Learning Disabilities International. 1986, 2(1), 21-41. Collected Spanish language samples from the spontaneous speech productions of 30 5-12 yr old Puerto Rican children living in the US, who were both limited English proficient (LEP) and language disordered. Samples were analyzed for global linguistic performance, including structural and pragmatic analyses. The disorders identified were categorized into disorders of receptive language and of expressive language. Results show that the Ss’ language proficiency deviated from the language of Spanish-speaking children acquiring language normally. The Ss presented both structural difficulties and pragmatic problems. It is suggested that although the Ss were living in a bilingual setting, the impact of English on their language development was minimal. It is posited that LEP Hispanic children have been frequently misidentified as language disordered because they were assessed in English or assessed in Spanish by assessors who were not fluent in Spanish and/or not familiar with the regional variety of Spanish spoken by the child. (PsycINFO) [Assessment.]

Argulewicz, EN. Effects of ethnic membership, socioeconomic status, and home language on LD, EMR, and EH placements. Learning Disability Quarterly. 1983, 6(2), 195-200. Proportions of special education placements for Anglos, Blacks, and Hispanics were compiled for a large elementary school district in the Southwest. The data pool consisted of all students (N=9,950) in each of the 3 ethnic groups enrolled in kindergarten through 6th grade. Types of placements were also examined for each group within the context of SES (low or mid-high) and home language (Spanish or English). Results show significant Ethnicity * SES interaction effects, with mid-high Spanish-speaking Hispanics being placed at the highest rate and mid-high Blacks being placed least frequently. Data also revealed that the learning-disability category was by far the most frequently assigned placement. Factors that may have influenced the results and implications for placement decision making are discussed. (PsycINFO) [Service Delivery; Placement.]

Arrigo, HR. Language learning disabilities among Hispanic students: A statistical search for discriminants. Dissertation Abstracts International. 1990, 50(11-B), 5342.

Barona, A. Santos de Barona, M. Faykus, SP. The simultaneous effects of sociocultural variables and WISC--R factors on MR, LD, and non placement of ethnic minorities in special education. Education & Training in Mental Retardation. 1993, 28(1), 66-74. 300 students referred for consideration of special education placement and found to be either learning disabled, mentally retarded (MR), or not eligible (NE) were examined to determine the differential contribution of sociocultural variables on special education eligibility decisions when examined in the context of Wechsler Intelligence Scale for Children--Revised (WISC--R) factors. Mean ages were 117.76, 128.66, and 118.56 mo for the learning-disabled, NE, and MR groups, respectively. Analyses were conducted using WISC--R factors (Verbal Comprehension, Perceptual Organization, Freedom from Distractibility) and sociocultural variables (e.g., SES, ethnicity, family size, and father absence). Ethnicity made differential significant contributions to the prediction of the MR and NE groups when adjusted for WISC--R factors. SES accounted for a significant amount of the variance in MR eligibility with the exception of when Verbal Comprehension was adjusted for independently. (PsycINFO)

Barona, A. Faykus, SP. Differential effects of sociocultural variables on special education eligibility categories. Psychology in the Schools. 1992, 29(4), 313-320. Examined the influence of sociocultural factors (ethnicity, SES, father absence, and family size) on special education eligibility (SEDE) for 3 ethnic groups: White, Black, or Mexican-American. A multiple regression procedure was used to analyze the data on 300 students (aged 8-13.5 yrs) referred as mentally retarded or learning disabled. Only SES and ethnicity made a significant contribution to the prediction of SEDE for all 3 groups. Results suggest that legislative mandates to control for sociocultural factors in the determination of SEDE have been only partially successful. (PsycINFO)

Bauermeister, JJ. Vargas, I. Colberg, C. Gonzalez, LE., et al. Development of the Inventario de Comportamiento Escolar (IDCE) for Puerto Rican children. Hispanic Journal of Behavioral Sciences. 1987, 9(1), 49-67. Developed the Inventario de Comportamiento Escolar, a teacher rating inventory for the assessment of Puerto Rican children with attention deficit disorder, learning disabilities, or academic underachievement. Factor analysis of classroom behavior ratings of 961 Puerto Rican students (kindergarten to 6th grade) yielded 5 scales as did factor analysis of school performance ratings. (PsycINFO)

Bebout, L. Arthur, B. Cross-cultural attitudes toward speech disorders. Journal of Speech & Hearing Research. 1992, 35(1), 45-52. Used a questionnaire to look at attitudes toward 4 disorders (cleft palate, stuttering, hearing impairment, and misarticulations) among 166 university students (aged 17-48 yrs) representing English-speaking North American culture and other cultures (e.g., Chinese, Southeast Asian, Hispanic). Results show significant group differences on items involving Ss' beliefs about the emotional health of persons with speech disorders and about the potential ability of speech-disordered persons to improve their speech. Also: "On cultural sensitivity in assessing cross-cultural attitudes": Reply. Journal of Speech & Hearing Research. 1994, 37(2) 343. Replies to criticisms by A. Martinez et al of L. Bebout and B. Arthur's study on cross-cultural attitudes toward speech disorders. The questionnaire was not intended to assess into the attitudes of non-North American cultures, while the 'deficit' focus was on cultural misunderstanding or naivete that might impede treatment. (PsycINFO)

Beltran, D. Rafael, D. A comparative investigation of two adaptive behavior scales (CABS-SV and ABS-SE Part One): Across three educational program classifications (regular, learning disabled, and mildly retarded) using a sample of Hispanic children. Dissertation Abstracts International. 1984, 45(3-A), 820.

Benson, BA. Behavior disorders and mental retardation: Associations with age, sex, and level of functioning in an outpatient clinic sample. Applied Research in Mental Retardation. 1985, 6(1) 79-85. Expanded an earlier survey by S. Reiss (see PA, Vol 68:10652) that studied 66 clients by including 64 additional clients referred to an outpatient mental health clinic. The total sample, which included 53 children and adolescents and 77 adults, ranged in age from 4 to 55 yrs. There were 40 female and 90 male Ss. 53.9% of the Ss were mildly mentally retarded, 24.6% were moderately mentally retarded, and 21.5% were profoundly mentally retarded. The sample included 56 Blacks, 60 Whites, and 14 Hispanics. Three categories of behavior problems accounted for a majority of the referrals: schizoid-unresponsive and psychotic disorders, conduct disorder, and anxious-depressed withdrawal disorder. The distribution of referrals among the 3 categories was examined as a function of level of intellectual functioning, age, and client sex. Comparisons are made with previous surveys of mentally retarded and of nonretarded clinic populations. Implications of the survey results for planning mental health services with mentally retarded individuals are discussed. (PsycINFO)

Brosnan, FL. Overrepresentation of low-socioeconomic minority students in special education programs in California. Learning Disability Quarterly. 1983, 6(4), 517-525. Results of a survey conducted of 61 school districts in California indicate the following: (1) Black students from minority and low-SES school districts were overrepresented in mental retardation and specific learning disability programs. (2) Students from low-SES school districts were overrepresented in specific learning disabilities. (3) Overrepresentation of Hispanic students in classes for the mentally retarded no longer exists on a state level. (4) The number of students identified as learning disabled has increased as the number of students identified as mentally retarded has decreased. (PsycINFO)

Cardoza, D. Rueda, R. Educational and occupational outcomes of Hispanic learning-disabled high school students. Journal of Special Education, 1986, 20(1), 111-126. Examined educational characteristics of 6 subgroups (N=2,656) in the High School and Beyond (National Opinion Research Center, 1980) data set. These included senior learning disabled Hispanic students, senior learning disabled Anglo students, and a randomly selected Anglo senior nonhandicapped subsample. In addition, 3 parallel sophomore groups were included. The groups were compared in terms of their course-taking behavior, educational aspirations, and educational/occupational outcomes. Results indicate significant differences between the handicapped and nonhandicapped groups. However, in general, differences between the Anglo and Hispanic handicapped groups were not significant. (PsycINFO)

Collier, C. Hoover, JJ. Sociocultural considerations when referring minority children for learning disabilities. Learning Disabilities Focus, 1987, 3(1), 39-45. Discusses sociocultural considerations in dealing with culturally and linguistically different children referred for specific learning disabilities (LDs). In some instances behaviors that educators may believe to indicate LDs may be typical and normal for a specific cultural/linguistic background or a by-product of the acculturative process, including second-language acquisition. When a minority child is referred for suspected LDs, the child's native culture and language, as well as stage of acculturation, must be considered. Such considerations may help educators reduce unnecessary referrals and bias in decisions about special education placement. (PsycINFO) [Assessment.]

Coppock, BA. A comparison of suspension rates of secondary handicapped students by race, gender, handicap and school level. Dissertation Abstracts International. 1984, 45(2-A) 488-489. [ID: race & sex & handicap & school level, suspension rates, mainstreamed mildly handicapped vs emotionally disturbed vs mentally retarded vs learning disabled junior vs senior high school students.]

Correa, VI. Tulbert, B. Collaboration between school personnel in special education and Hispanic families. Journal of Educational & Psychological Consultation. 1993, 4(3), 253-265. Discusses the building of collaborative relationships between school personnel in special education and Hispanic families, focusing on issues paramount in understanding the values and beliefs of the Hispanic family. A 4-step collaboration action plan is proposed that includes (1) promoting a positive attitude toward school personnel, (2) assisting school personnel by providing training, (3) gathering information on the family, and (4) developing a culturally sensitive program based on need. School personnel who take the time to understand the unique values and beliefs of the Hispanic culture will more adequately provide culturally sensitive services to Hispanic families and their children with disabilities. (PsycINFO)

Collier, C. Hoover, JJ. Sociocultural considerations when referring minority children for learning disabilities. Learning Disabilities Focus. 1987, 3(1), 39-45. Discusses sociocultural considerations in dealing with culturally and linguistically different children referred for specific learning disabilities (LDs). In some instances behaviors that educators may believe to indicate LDs may be typical and normal for a specific cultural/linguistic background or a by-product of the acculturative process, including second-language acquisition. When a minority child is referred for suspected LDs, the child's native culture and language, as well as stage of acculturation, must be considered. Such considerations may help educators reduce unnecessary referrals and bias in decisions about special education placement. (PsycINFO) [Assessment, Bias.]

Echevarria, J. Interactive Reading Instruction - A Comparison of Proximal and Distal Effects of Instructional Conversations. Exceptional Children. 1995, 61(6), 536-552. This study examined the effects of an interactive approach, instructional conversations (IC), on the language and concept development of Hispanic students with learning disabilities. This study compared traditional instruction (basal approach) with instructional conversations. Results of proximal measures indicated higher levels of discourse and greater participation with IC than with a basal approach. The distal indexes yielded uneven results: evidence of greater understanding of the concept following IC but no differences in literal comprehension or post-lesson narrative results. The overall results suggest that IC may provide linguistically rich learning opportunities for culturally diverse students with learning disabilities. [Instructional Methods, Communication.]

Elliott, SN. Argulewicz, EN. The influence of student ethnicity on teachers' behavior ratings of normal and learning disabled children. Hispanic Journal of Behavioral Sciences. 1983, 5(3), 337-345. Behavioral rating scores on the Devereux Elementary School Behavior Rating Scale (DESBRS) for 64 learning disabled (LD) or non-LD Anglo and Mexican-American second-6th graders were analyzed to explore the influence of ethnicity and diagnostic label on behavior ratings by Anglo teachers and the relationship between the behavior ratings of a sample of Mexican-American children and the normative sample of the DESBRS. Significant multivariate F 's were observed for the main effects of ethnicity and diagnostic label. Univariate analyses of ethnicity revealed that Mexican-American and Anglo Ss were rated as being significantly different on 3 factors: Comprehension, Creative initiative, and Closeness to the Teacher. The LD and non-LD Ss differed significantly on such DESBRS factors as Classroom Disturbance, Inattentive-Withdrawn, and Slow Worker. (PsycINFO)

Fourqurean, JM. A K-ABC and WISC--R comparison for Latino learning-disabled children of limited English proficiency. Journal of School Psychology. 1987, 25(1), 15-21. Examined the performance of 42 Mexican-American learning-disabled children (aged 6-12.5 yrs) of limited English proficiency on the Kaufman Assessment Battery for Children (K-ABC) and the Wechsler Intelligence Scale for Children--Revised (WISC--R), using correlational procedures and direct comparisons. Results show that (1) the WISC-R Full Scale IQ was significantly lower than the K-ABC Mental Processing Composite; (2) the Full Scale IQ and the Mental Processing Composite standard scores correlated .63; and (3) all subscales of the WISC-R and the K-ABC correlated significantly except the K-ABC Sequential scale, which failed to correlate significantly with any WISC-R scales. Ss had particular difficulty with the WISC-R Verbal scale and the K-ABC Achievement scale (means = 68.14 and 67.67, respectively). It is concluded that claims of construct validity for the K-ABC are upheld. Subjects difficulty with sequential processing is discussed. (PsycINFO)

Garcia, SB. Yates, JR. Policy issues associated with serving bilingual exceptional children. Journal of Reading, Writing, & Learning Disabilities International. 1986, 2(2), 123-137. Discusses the need for improved policy and practice in the referral, assessment, and placement of learning-disabled and speech-impaired minority students, especially Hispanics. Specific implications for school districts are described, and professional development is discussed. Illustrative data from research conducted by the first author (unpublished) is provided, relating to the identification and placement of 111 Hispanic and non-Hispanic students in learning-disabled programs in Texas. Professional development implications involve higher education and in-service training. (PsycINFO)

Garcia, SB. Effects of student characteristics, school programs and organization on decision making for the placement of Hispanic students in classes for the learning disabled. Dissertation Abstracts International. 1985, 46(4-A), 855.

Goldstein BC. Harris KC. Klein, MD. Assessment of Oral Storytelling Abilities of Latino Junior High School Students with Learning Handicaps. Journal of Learning Disabilities. 1993, 26(2), 138-143. This study investigated the relationship between reading comprehension and oral storytelling abilities. Thirty-one Latino junior high school students with learning handicaps were selected as subjects based on learning handicapped designation, home language, and language proficiency status. Reading comprehension was measured by the Reading Comprehension subtest of the Peabody Individual Achievement Test. Storytelling was measured by (a) the Oral Production subtest of the Language Assessment Scales using the standard scoring protocol and (b) a story structure analysis. A comparison of the standard scoring protocol and reading comprehension revealed no relationship, while the comparison of the story structure analysis and reading comprehension revealed a significant correlation. The implications of these results for language assessment of bilingual students are discussed.

Goldstein, BSC. Critical pedagogy in a bilingual special education classroom. Journal of Learning Disabilities. 1995, 28(8), 463-475. Describes a program in which the author attempted to apply critical pedagogical principles, including language acquisition theory, holistic and constructivist learning, and bicultural development, in a first- and second grade bilingual day class. Participants were 11 Latino children with limited English proficiency and learning disabilities. The program illustrates the dialogical process between and among students and teacher and the students' subsequent recognition of their own abilities to name their world, engage with and critique existing knowledge, and create new forms of knowledge that will enable them to actively change their world. Recommendations for translating critical pedagogy to classroom practice are given. Children's awareness of economic and social barriers that education cannot bridge are discussed. (PsycINFO) [Instructional Methods.]

Goody, MH. A comparative study of cross-cultural patterns of intellectual abilities on WISC and WISC-R among Anglo, Chinese, and Hispanic educationally handicapped boys with reading disabilities. Dissertation Abstracts International. 1981, 42(1-A), 141. [ID: intellectual abilities as measured by WISC & WISC-R, 7.5-12.9 yr old monolingual Anglo vs bilingual Hispanic vs Chinese males with reading disabilities.]

Gottlieb, J. Gottlieb, BW. Trongone, S. Parent and teacher referrals for a psychoeducational evaluation. Journal of Special Education, 1991, 25(2), 155-167. Studied the school records of 439 first-8th graders who had been referred for special education evaluation: 5% were Asian, 21.2% were White, 38.3% were Black, and 40.5% were Hispanic. 328 Ss were referred by teachers and 111 by parents. Both parents and teachers referred Ss primarily for academic reasons, but parents did so more often. Parents referred higher functioning Ss than teachers referred. White parents were more likely than minority parents to refer Ss, whereas teachers referred more minority Ss. Seven Ss were eventually classified as neurologically impaired and emotionally handicapped and 72 as emotionally handicapped. 141 were classified as learning disabled and placed in self-contained classes, 154 were classified as learning disabled and placed in resource rooms, and 65 were ineligible for special education services. There were too few purely behavioral reasons for referral. (PsycINFO)

Gregory, JF. Shanahan, T. Walberg, HJ. Learning disabled 10th graders in mainstreamed settings: A descriptive analysis. RASE: Remedial and Special Education. 1985, 6(4), 25-33. Of the 30,030 10th graders for whom survey data from the national High School and Beyond study (J. Coleman et al, 1982; E. Page and T. Keith, 1981; S. Peng et al, 1981 and 1982) were complete, 810 identified themselves as having specific learning disabilities. Various comparisons between these learning disabled (LD) Ss and their non-LD (NLD) peers were made. The LD group was older, had a disproportionately high representation of Blacks and Hispanics and an underrepresentation of Whites, and reported more secondary handicapping conditions than did the NLD cohort. In all areas of academic achievement tested, the LD Ss showed significant deficits. The LD Ss also had lower indices of motivation, adjustment, locus of control, independence, self-perception of attractiveness and popularity, and scholastic orientation of close friends. They also evidenced more legal and school-related problems. However, the 2 groups acknowledged spending equal amounts of time in extracurricular activities. (PsycINFO)

Harry, B. These Families, Those Families - The Impact of Researcher Identities on the Research Act. Exceptional Children. 1996, 62(4), 292-300. This article discusses the various, sometimes competing, self-identities of the qualitative researcher and the impact of these identities on decision making in the research process. The author proposes that while culture provides the backdrop to identity, various aspects of the microcultures to which a researcher belongs may result in varying ''personas'' that influence decision making about the research process. The author illustrates these points with examples from her ethnographic research with African- American/Latino, low- to middle-income families of children with disabilities. [Methodology.]

Harry, B. An ethnographic study of cross-cultural communication with Puerto Rican-American families in the special education system. American Educational Research Journal. 1992, 29(3), 471-494. Addresses the challenge of parent-professional (PP) interaction in a cross-cultural context with 12 Spanish-speaking, Puerto Rican-American families whose children were classified as learning disabled or mildly mentally retarded. Parents' views and experiences were sought through ethnographic interviewing, review of students' documents, and participant observation of PP conferences and community events. The data revealed that inadequate provision of information on the meaning of events and the school district's reliance on formalized, written communi-cation led to mistrust and withdrawal on the part of parents. Deference to authority disguised parents' real opinions. Changes implemented in the school district were beginning to have a beneficial effect on PP relationships and to result in exemplary parent conferences. (PsycINFO)

Harry, B. Making sense of disability: low-income, Puerto Rican parents' theories of the problem. Exceptional Children, 1992, 59(1), 27-40. This article reports findings from an ethnographic study of the views of 12 low-income Puerto Rican parents whose children were classified as learning disabled or mildly mentally retarded. Different cultural meanings of disability and normalcy led parents to reject the notion of disability and focus on the impact of family identity, language confusion, and detrimental educational practices on children's school performance. Parents' views were in line with current arguments against labeling and English-only instruction. (Parental Perceptions.]

Heller, T. Markwardt, R. Rowitz, L. Farber, B. Adaptation of Hispanic families to a member with mental retardation. American Journal on Mental Retardation. 1994, 99(3), 289-300. Examined the adaptation of 51 Hispanic and 195 non-Hispanic White families to having a family member with mental retardation (MR). Primary caregivers completed surveys and interviews about the characteristics of the family and the member with MR, their religious values, support resources, and caregiver burden. Hispanic Ss had younger children with MR and a lower socioeconomic level than did non-Hispanic Ss. More Hispanic than non-Hispanic Ss reported that having a family member with MR increased their religiosity, and more Hispanic Ss believed that taking care of a family member with MR was a religious duty. Hispanic Ss viewed caring for a family member with MR as less of a burden than non-Hispanic Ss did. (PsycINFO)

Inglis, J. Lawson, JS. The cross-cultural validity of the Learning Disability Index: A reanalysis of Mishra's data. Journal of Clinical Psychology. 1985, 41(5), 680-5. This study investigated the nature of a learning disability index (LDI) for the objective assessment of verbal-nonverbal patterns of intellectual deficit on the WISC-R. The Factor II score coefficients derived from an unrotated principal components analysis of the WISC-R normative data, in combination with the individual's (or group's) average scaled scores, are used for this purpose. The mean LDI of various groups of learning disabled children, including Mishra's (1984a; 1984b) Mexican-American and Papago groups, are shown to be reliably different from the mean LDI of the normative population and thus demonstrate its cross-cultural validity.

Langdon, HW. English Language Learning by Immigrant Spanish Speakers - A United States Perspective. Topics in Language Disorders. 1996, 16(4), 38-53. This article discusses the impor-tance of three contextual variables in ensuring Hispanic individuals' success in learning English by citing various examples taken from the author's experience. These contexts include consideration of the impact of majority social context and its attitude toward immigrants, the individual's family views on the importance of acquiring English, and the classroom instructional strategies used. Implications for monolingual and bilingual speech-language pathologists evaluating Hispanic students who are suspected of having language-learning disabilities are discussed.

Leckart, B. A revised dissimulation scale applicable to the MMPI-2. American Journal of Forensic Psychology. 1994, 12(3), 5-15. Investigated the score comparability of the 29 remaining items of the original 40 on the Dissimulation Scale--Revised (Ds--R) included in the MMPI-2 (DSR-MMPI-2) to the entire 40 item Ds--R. 120 disability claimants who completed the MMPI were divided into 6 equal gender/ethnic groups: African- American, Hispanic, and Caucasian and males and females. Pearson product moment correlations were performed between the full Ds--R and the 29 items on the DSR-MMPI-2. Results reveal a small correlation of +.914 among the 6 groups indicating little difference between the 2 scores. (PsycINFO)

Maltzman, CM. Cross-cultural patterns of response to the WISC/WISC-R and Bender Gestalt Test by Chinese-American, Hispanic-American, and Occidental-American educationally handicapped boys. Dissertation Abstracts International. 1981, 42(2-A), 658. [ID: ethnicity, scores on WISC/WISC-R & Bender Gestalt Test, Chinese American vs Hispanic vs Occidental American 7.5-12 yr olds 1.5 yrs below grade level in reading, implications for remedial reading strategies.]

Merino, BJ. Language development in normal and language handicapped Spanish- speaking children. Hispanic Journal of Behavioral Sciences. 1983, 5(4), 379-400. Examined the language development of 22 5-8 yr old language-handicapped children who spoke Spanish as a first language and who were classified as being of limited English-speaking ability by comparing their language skills to those of a group of controls matched for age, ethnicity, SES, first language, exposure to school English, and language use patterns. The focus was on the differences and similarities found in the Ss' first language, Spanish. A battery of instruments, including measures of syntax, articulation, vocabulary, and competence in pragmatics, was administered to 50 monolingual Spanish speakers aged 3-8 yrs to establish baseline data. The language-delayed Ss were then administered the same instruments and procedures and comparisons were made to the control group. Handicapped Ss performed significantly worse than controls in the production of syntactic features, but not in comprehension. Handicapped Ss also exhibited a significantly higher number of articulation errors. It is concluded that such procedures are necessary to ensure the adequate provision of therapy for the bilingual handicapped child. (PsycINFO)

Meyers, CE. Borthwick, SA. Eyman, RK. Place of residence by age, ethnicity, and level of retardation of the mentally retarded/developmentally disabled population of California. American Journal of Mental Deficiency. 1985, 90(3), 266-270. Examined data from the California State Department of Developmental Services on the age, ethnicity, level of mental retardation, and kind of residence for 59,399 mentally retarded/developmentally disabled individuals. Findings indicate that 52.5% of the Ss lived in the natural home. The second and third most popular places of residence were small family care units and institutions, which held 14.2 and 12.8% of the Ss, respectively. The proportion of Ss in the natural home decreased with age and level of retardation, dropping precipitously among profoundly and severely impaired Ss. 44% of White Ss reside in the natural home, compared to 70% of Latino Ss, 64.3% of Black Ss, and 69% of Ss from other ethnic groups. Findings suggest that, while different states may operate under their own procedures and policies, ethnicity, level of retardation, and age are important factors in the determination of residential placement outside the natural home. (PsycINFO)

Miramontes, OB. Oral reading miscues of Hispanic students: Implications for assessment of learning disabilities. Journal of Learning Disabilities. 1987, 20(10), 627-632. Assessed 20 Hispanic successful readers and 20 Hispanic students (all 4th-6th graders) identified as having learning disabilities in reading in English and Spanish using the Reading Miscue Inventory. Oral reading miscues were analyzed to determine similarities and differences between the groups in their first and second reading languages. Data were analyzed for graphic similarity, sound similarity, grammatical function, comprehension, and grammatical relationships. Significant differences were found to exist in all these categories when analyzed in the students' first reading language and in the last 3 categories when analyzed for English reading. The data for students classified as learning disabled suggest the need for more extensive consideration of primary language reading in the determination of a learning disability. (PsycINFO)

Morrison, GM. Laughlin, J. Smith, D. Ollansky, E., et al. Preferences for sources of social support of Hispanic male adolescents with mild learning handicaps. Education & Training in Mental Retardation. 1992, 27(2), 132-144. Examined the preferences for social support of Hispanic male adolescents with and without mild learning handicaps for various kinds of life stressors. These junior high school students (22 with and 11 without mild learning handicaps) responded to questions concerning whom they would talk to about a variety of everyday stressors. Ss with mild learning handicaps in resource room and special day class settings had higher rates of choosing the category of "nobody" and lower rates of choosing siblings than their nonhandicapped peers. Differences existed between resource room and special day class students in their preferences for parents, peers, and teachers. Situational variations in these overall patterns are described. (PsycINFO)

Ochoa, AM. Pacheco, R. O'Mark, DR. Addressing the learning disability needs of limited-English proficient students: Beyond language and race issues. Learning Disability Quarterly. 1988, 11(3), 257-264. Argues that students with exceptional learning needs should not be denied access to special education programs because of their language or race. However, such factors should not be ignored either. The issue of disproportionate representation of limited-English proficient (LEP) Hispanic students in classes for the learning disabled is discussed, based on 1981 statistics from California. It is noted that fully English proficient Hispanic students are overreferred, while LEP students are underreferred. On-site reviews of school districts suggest inadequate assessment, evaluation, placement, and reevaluation of LEP Hispanic students. 16 policy considerations are provided in an effort to help school districts to ensure that LEP learning disabled students receive equal access to appropriate learning opportunities. (PsycINFO)

Ochoa, SH. Palmer, DJ. A sociometric analysis of between-group differences and within-group status variability of Hispanic learning disabled and nonhandicapped pupils in academic and play contexts. Learning Disability Quarterly. 1991, 14(3), 208-218. Assessed the sociometric status of mainstreamed Hispanic learning disabled (LD) and nonhandicapped pupils. 733 4th- and 5th-graders from a small metropolitan school district in the Southwest participated. Sociometric data were collected from 35 classrooms across 10 schools. Hispanic LD Ss received lower sociometric peer ratings than their nonhandicapped peers. However, a peer rating/nomination classification procedure resulted in considerable variability in sociometric status for both LD and nonhandicapped Ss. Although 30% of the LD Ss were in the rejected status group, almost 50% of the LD Ss attained average sociometric status. Sociometric context (i.e., academic and play) also influenced membership in status groups. (PsycINFO)

Olivarez, A. Palmer, DJ. Guillemard, L. Predictive bias with referred and nonreferred Black, Hispanic, and White pupils. Learning Disability Quarterly. 1992, 15(3), 175-186. Predictive bias between IQ and achievement was examined using data obtained from ethnically diverse referred and nonreferred samples in an extension of a study by D. J. Palmer et al. Achievement and intelligence measures included the Wechsler Intelligence Scale for Children--Revised (WISC--R), Kaufman Assessment Battery for Children, Woodcock-Johnson Psycho-Educational Battery, and the Woodcock Language Proficiency Battery. The sample consisted of 94 second-, 74 third-, and 68 4th-grade students (58 White, 57 Black, and 121 Hispanic) from a large urban district. Results revealed evidence of predictive bias in several sets of intelligence-achievement measures. The achievement performance of Black and Hispanic Ss was overpredicted. For the most part, intercept bias was more evident than slope bias (differential validity). (PsycINFO)

Ortiz, AA. Wilkinson, CY. Adapting IEPs for limited English proficient students. Academic Therapy. 1989, 24(5), 555-568. Examined the content of individualized education plans (IEPs) developed for 203 learning disabled and mentally handicapped Hispanic second-5th graders with limited English proficiency (LP) to determine how Ss' LP influenced the selection of IEP goals and objectives. Results suggest that Ss' degree of bilingualism and LP exerted little influence on the IEP committee's selection of instructional goals and objectives. Native language instruction and instruction in English as a second language were infrequently incorporated into special education services. (PsycINFO)

Ortiz, AA. Garcia, SB. Serving Hispanic Students with Learning Disabilities - Recommended Policies and Practices. Urban Education. 1995, 29(4), 471-481. Educators continue to have difficulty distinguishing learning disabilities from second language differences among Hispanic students. This article identifies major issues in the identification, assessment, and placement of Hispanic students in programs for students with learning disabilities, with a focus on limited English proficient Hispanic students. The authors recommend policies and practices which can help safeguard these students against inappropriate special education placement.

Ortiz, AA. Maldonado-Colon, E. Recognizing learning disabilities in bilingual children: How to lessen inappropriate referrals of language minority students to special education. Journal of Reading, Writing, & Learning Disabilities International. 1986, 2(1), 43-56. Discusses ways of reducing inappropriate special education placements/referrals due to behaviors erroneously identified as deviant because of linguistic, cultural, or economic characteristics. A student behavior checklist for special education referral is discussed in terms of what may be normal for some students. Two examples of normal but different behaviors are described: language, which constitutes the most frequent reason for referral of minority students, and learned helplessness, behaviors that predispose the student to school failure. It is suggested that the key to distinguishing differences from handicapping conditions is the careful documentation of prior interventions. Students' difficulties may be the result of a lack of adult-mediated learning experiences. It is concluded that if the student continues to experience difficulty after adaptation of the instructional environment to accommodate learning style, then a referral to special education becomes appropriate, since it can be assumed that problems are not the result of differences of language, culture, socioeconomic status (SES), or lack of opportunity. (PsycINFO)

Palmer, DJ. Olivarez, A. Willson, Victor, L. Fordyce, T. Ethnicity and language dominance: Influence on the prediction of achievement based on intelligence test scores in nonreferred and referred samples. Learning Disability Quarterly. 1989, 12(4), 261-274. Examined the influence of ethnicity on the prediction of achievement on intelligence tests in 236 referred and nonreferred Black, Hispanic, and Anglo second, third, and 4th grade pupils who were assessed with the Wechsler Intelligence Scale for Children--Revised (WISC--R) and Kaufman Assessment Battery for Children (K-ABC) cognitive and achievement scales. Approximately 38% of the Hispanic Ss were identified as limited-English proficient (LEP). Analysis of various procedures revealed differences in cognitive and achievement performance due to pupils' ethnicity, referral status, and LEP status. For both WISC-R and K-ABC IQ measures, a number of regressions on the K-ABC Total and Arithmetic achievement measures evidenced bias across ethnic groups for both referred and nonreferred Ss. Bias due to language dominance also was found for WISC-R and K-ABC composite scales. Implications of predictive bias are discussed for assessment and placement of minority and LEP children in special education classes. (PsycINFO)

Palmer, DJ. Hughes, JN. Juarez, L. School psychology training and the education of minority at-risk youth: The Texas A&M University program emphasis on handicapped Hispanic children and youth. School Psychology Review. 1991, 20(4), 472-484. Increasing the number of qualified Hispanic and bilingual school psychologists is essential to delivering effective educational and mental health services to Hispanic children with learning or emotional handicaps. The Texas A&M School Psychology Doctoral Program, with support from the US Department of Education/Office of Special Education, offers an ongoing training emphasis in Hispanic children and youth with handicaps. Factors related to the recruitment and retention of Hispanic trainees are identified and discussed. Graduates from this program have influenced the education of Hispanic students with handicaps through delivering services directly to that population, conducting related research and development activities, and training school psychologists and special and regular education teachers. (PsycINFO)

Payette, KA. Clarizio, HF. Discrepant team decisions: The effects of race, gender, achievement, and IQ on LD eligibility. Psychology in the Schools. 1994, 31(1), 40-48. Examined the racial, gender, intellectual, achievement, and grade-level status of 344 students (aged 5 yrs 6 mo to 18 yrs) who had been referred for learning disability (LD) diagnosis to determine whether student characteristics might influence the misclassification of Ss with respect to LD status. In one-fourth of the cases, Ss were declared either eligible without a severe discrepancy or ineligible with a severe discrepancy regardless of method used (standard score vs regressed standard score) or cutoff value employed (15-point vs 22-point discrepancy). Being White, older, and of higher intelligence and achievement were characteristics of those found ineligible despite a severe discrepancy. Being female and less academically able were characteristics of those declared eligible without a severe discrepancy. (PsycINFO)

Plata, M. Using Spanish-Speaking Interpreters in Special Education. Remedial and Special Education. 1993, 14(5), 19-24. An increasing Hispanic population, with its diverse academic needs, presents a challenge for public schools. The lack of available bilingual and other appropriately trained personnel who can effectively interact with Spanish-speaking students and parents magnifies this challenge, especially when students are considered for special education placement. In such situations, interpreters are needed to communicate with parents. This article proposes criteria for selecting interpreters, discusses responsibilities of, and potential problems in using, interpreters, and suggests elements of a management system and training program for interpreters and those who rely on their services. [Service Delivery. Cultural Competence.]

Poppe, RL. A study of the WISC-R scores of Hispanic and non-Hispanic gifted/learning disabled students. Dissertation Abstracts International: Section A: The Humanities & Social Sciences. 1994, 54(7-A), 2537.

Ratleff, J Echevarria. The effects of instructional conversations on the language and concept development of learning handicapped students. Dissertation Abstracts International. 1993, 54(3-A), 892. ID: instructional conversations, language & concept development, bilingual Hispanic learning disabled students.

Reschly, DJ. Identification and Assessment of Students with Disabilities. The Future of Children. 1996, 6(1), 40-53. Students with disabilities or suspected disabilities are evaluated by schools to determine whether they are eligible for special education services and, if eligible, to determine what services will be provided. In many states, the results of this evaluation also affect how much funding assistance the school will receive to meet the students' special needs. Special education classification is not uniform across states or regions. Students with identical characteristics can be diagnosed as disabled in one state but not in another and may be reclassified when they move across state or school district lines. Most disabilities with a clear medical basis are recognized by the child's physician or parents soon after birth or during the preschool years. In contrast, the majority of students with disabilities are initially referred for evaluation by their classroom teacher (or parents) because of severe and chronic achievement or behavioral problems. There is evidence that the prevalence of some disabilities varies by age. The high-incidence disabilities such as learning disabilities and speech-language disabilities occur primarily at the mild level. The mild disabilities exist on broad continua in which there are no clear demarcations between those who have and those who do not have the disability, and even "mild" disabilities may constitute formidable barriers to academic progress and significantly limit career opportunities. Problems with the current classification system include stigma to the child, low reliability, poor correlation between categorization and treatment, obsolete assumptions still in use in treatment, and disproportionate representation of minority students. Both African-American and Hispanic students are disproportionately represented in special education but in opposite directions. The disproportionately high number of African Americans in special education reflects the fact that more African-American students than white students are diagnosed with mild mental retardation. Though poverty, cultural bias, and inherent differences have been suggested as reasons for this disproportionate representation, there are no compelling data that fully explain the phenomenon. In most states, classification of a student as disabled leads to increased funding from the state to the school district. This article suggests a revised funding system that weights four factors (number of deficits, degree of discrepancy, complexity of intervention, and intensity of intervention) in a regression equation that would yield a total amount of dollars available to support the special education of a particular student.

Ruiz NT. The social construction of ability and disability: I. Profile types of Latino children identified as language learning disabled. Journal of Learning Disabilities. 1995, 28(8), 476-490. During the course of an ethnographic study of a bilingual special education classroom, three profile types of students emerged, ranging from students with severe language learning disabilities to students with normal abilities. The study points out the inadequacy of a medical model view of student abilities and disabilities --a view that underestimates the communicative and academic competence of bilingual students. Concurrently, the results support a contextual performance view --a view that acknowledges the role of instructional context in revealing the upper or lower range of students' communicative and academic competence. The study further suggests some contextual features of instruction that are associated with students from all profile types showing their best in terms of language and literacy skills. (MEDLINE)

Ruiz, NT. The social construction of ability and disability: II. Optimal and at-risk lessons in a bilingual special education classroom. Journal of Learning Disability, 1995, 28(8), 491-502. Bilingual students' language and literacy skills were compared across three classroom events in a special day classroom for students with language learning disabilities. Events ranged from the teacher-structured, formal class openings to the informal, peer-structured socio-dramatic play. Results showed that certain contextual features were associated with enhanced student performance, whereas others were associated with communicative breakdowns and problems with literacy tasks. This ethnographic study, in conjunction with other naturalistic research on bilingual special education classrooms, undergirds the Optimal Learning Environment (OLE) Project by identifying effective instructional contexts for bilingual students identified as having language learning disabilities.

Sacristan, Jaime R. Mental health in Spanish-speaking mentally retarded people: The state of the art. Australia & New Zealand Journal of Developmental Disabilities. 1988, 14(1), 27-30. Describes the state of the art and the treatment of mentally retarded people with mental health problems in 4 Spanish- speaking populations: Spain, Hispanic groups in the US, Chile, and Mexico. In spite of some differences between them, these populations have cultural similarities and constitute a group with its own identity. (PsycINFO)

Shapiro, J. Simonsen, D. Educational Support Group for Latino Families of Children with Down Syndrome. Mental Retardation. 1994, 32(6), 403-415. Experiences and observations based on an ongoing parent education-support group for Mexican-origin Latino parents of children with Down syndrome were described. Culturally mediated concepts were discussed in terms of their relevance to specific aspects of group functioning, including group structure, membership, and leadership. Problems of particular concern to this population that might adversely affect maintenance and growth of the group were also examined. Finally, the potential value of such support groups for this parent population were considered as were guidelines for enhancing the group experience.

Sluzki, CE. The sounds of silence: Two cases of elective mutism in bilingual families. Family Therapy Collections. 1983, 6, 68-77. Compares the case histories of 2 families, each presenting with elective mutism in a 9-yr-old girl. One family was Mexican- American, and the other was Salvadorian and living in the San Francisco area. Both families practiced bilingualism. It is proposed that in a bilingual family, a choice of language activates allegiances, and there are settings and contingencies in which a choice between allegiances becomes untenable: The individual has neither the power or the ability to disobey the injunction to choose a language, nor the luxury of insight. Under those double-binding circumstances and constrictions, the way out is generally a symptomatic solution, as in these 2 cases. It is concluded that elective mutism constitutes just one of a vast number of language-related problems and symptoms--including learning disabilities, school underachievement, and many other disturbances--that can be found with alarming frequency in bilingual families. (PsycINFO)

Sontag, JC. Schacht, R. An Ethnic Comparison of Parent Participation and Information Needs in Early Intervention. Exceptional Children. 1994, 60(5), 422-433. This study investigated ethnic differences in (a) parent perceptions of their information needs and their sources of information, and (b) the nature of parent participation in early intervention and participation preferences. Interviews were conducted with 536 families with infants and toddlers who had developmental problems. Comparative analyses were conducted on white, Hispanic, and American Indian groups. Results suggested the need to provide more and better information to all parents and the importance of medical doctors as a source of information, individualizing the type and source of information to different ethnic groups, and identifying unique strategies to support the participation of parents from different ethnic groups.

Stein, RC. Hispanic parents' perspectives and participation in their children's special education program: Comparisons by program and race. Learning Disability Quarterly. 1983, l 6(4), 432-439. Interviewed 62 Hispanic families with children receiving special education (SE) services in kindergarten to Grade 12. Results, which were compared to previous findings by E. W. Lynch and the present author, suggest few differences between Hispanic parents of learning handicapped and other program children in terms of attitudes, satisfaction, or participation in the children's educational programs. However, Ss were significantly less actively involved than White parents in their children's SE. Possible cultural/ethnic reasons for this are discussed. (PsycINFO)

Valentin, S. Motivation in second language learning in Hispanic learning-disabled students. Dissertation Abstracts International. 1993, 54(6-A), 2049.

Vaughn, S. Hogan, A. Kouzekanani, K. Shapiro, S. Peer acceptance, self-perceptions, and social skills of learning disabled students prior to identification. Journal of Educational Psychology. 1990, 82(1), 101-106. This study addressed how learning disabled students prior to identification (LDPI), low-

achieving (LA), average-achieving (AA), and high-achieving (HA) students compare on peer, teacher, and self assessments of social status and social skills in the fall and spring of kindergarten. Two hundred thirty-nine Black, Hispanic, and White students, 78% of a kindergarten population, participated. Controlling for age, sex, and achievement levels, four groups were identified: LDPI, LA, AA, and HA. In fall and spring of kindergarten all students were administered measures of peers' perceptions of social status, teacher's assessment of behavior problems and social skills, and self-perception. MANOVA and a stepwise discriminant function analysis revealed that as early as 8 weeks after entering kindergarten, LDPI students differed significantly from their peers on social variables and attention problems. Results suggest that later social difficulties of LD students are not solely a function of a history of low achievement and low teacher acceptance. (PsycINFO) [Assessment.]

Westby, CE. Rouse, GR. Culture in education and the instruction of language learning-disabled students. Topics in Language Disorders. 1985, 5(4) 15-28. Describes the organization of activities in an elementary classroom of eight 6-9 yr old language- learning-disabled Hispanic children and demonstrates how the use of ethnographic research methods can contribute to understanding the culture of the school. An ethnographic paradigm developed by E.T. Hall is used to describe the way in which cultures vary along a continuum in the degree to which their communication messages are contextualized. In high-context (HC) cultures most of the communicative information is either in the physical context or internalized in the person while very little is contained in the verbally transmitted part of the message. Low-context cultures, however, are highly individualized with relatively little mutual involvement among people. Cultural conflicts that arise in schools from the different values that HC and LC cultures place on the role of their members (the group vs the individual, language structure and function, and use of time) are discussed. Activity characteristics and teacher-child interactions designed to facilitate either HC or LC cultures within the learning program are presented. The program allowed the Ss to acquire, then maintain and use, aspects of HC culture in the LC environment of the school. It is suggested that such programs should not be evaluated solely on quantitative data regarding the students' performance on selected variables. (PsycINFO)

Wheeler, DS. Simultaneous-sequential processing in the analysis of limited English proficient learning disabled students. Dissertation Abstracts International. 1993, 54(4-A), 1299.

Whitworth, RH. Comparison of Anglo and Mexican American male high school students classified as learning disabilities. Hispanic Journal of Behavioral Sciences. 1988, 10(2), 127-137. Two groups of 80 Mexican American and Anglo male high school students were administered the Wechsler Adult Intelligence Scale (WAIS) and the Wide Range Achievement Test. Half of each group was classified as learning disabled (LD), and half attended regular classes and were included as normal controls. Analyses revealed significant ethnic differences for WAIS Verbal and Full-Scale IQS for both the LD and normal Ss. No significant differences in either Performance IQ or academic performance between Anglo and Mexican-American LD Ss were noted, suggesting that differences are due to limited-English proficiency or sociocultural factors rather than true learning disabilities. (PsycINFO)

Widaman, KF. MacMillan, DL. Hemsley, RE. Little, TD. et al. Differences in adolescents' self-concept as a function of academic level, ethnicity, and gender. Special Issue: Social skills. American Journal on Mental Retardation. 1992, 96(4), 387-403. A self-concept inventory assessing 11 aspects of self-concept was administered to 680 male and 454 female 8th graders stratified with regard to academic level (regular class, educationally marginal, learning handicapped), ethnicity (White, Black, and Hispanic), and gender. Regular class students had significantly higher levels of self-concept on most scales than did students who were educationally marginal or learning handicapped. The 190 Black students had significantly higher self-concept ratings than did the 803 White and the 341 Hispanic students on most scales. Gender did not moderate the effects of academic level on self-concept scores. Whites who were educationally marginal had the lowest level of academic and verbal self-concept. (PsycINFO)

Worthington, GB. Bening, ME. Use of the Kaufman Assessment Battery for Children in predicting achievement among students referred for special education services. Journal of Learning Disabilities. 1988, 21(6), 370-374. 21 male and 12 female White children, 23 male and 10 female Black children, and 17 male and 16 female Hispanic children (aged 8-12 yrs) referred for special education services were administered the Kaufman Assessment Battery for Children (K-ABC). Mean K-ABC mental processing composite scores for each group and for males and females were evaluated as predictors of reading, mathematics, and written language achievement on the Woodcock-Johnson Psycho-Educational Battery. Analyses confirmed the K-ABC's validity in predicting achievement for each ethnic group and for males in all areas. However, K-ABC scores were not valid predictors of written language achievement among females. (PsycINFO)

Wright, P. Santa-Cruz, R. Ethnic composition of special education programs in California. Learning Disability Quarterly. 1983, 6(4), 387-394. Obtained data from 2 documents prepared by the California State Department of Education: The Report of Special Education Local Planning Areas Handicapping Conditions by Ethnicity (1982) and the California Public Schools' Ethnicity by District, 1981-1982 CBEDS Database (1982). Findings indicate that Hispanic and Black students continue to be overrepresented in special education classes, primarily in mentally retarded and specific learning disability classes. (PsycINFO)

Zavala, J. Mims, J. Identification of learning disabled bilingual Hispanic students. Learning Disability Quarterly. 1983, 6(4), 479-488. Compared 10 limited-English proficient (LEP) bilingual Hispanic students in Grades 1-6 who had been identified as learning disabled (LD) with 10 age-, sex-, and SES-matched LEP bilingual students who were not identified as LD (NLD) based on standardized measures of achievement and potential. Behavioral surveys of both groups were conducted. The following tests predicted learning disabilities: Prueba de Lectura y Lenguaje Escrito, Test of Nonverbal Intelligence, Test of Reading Comprehension, Prueba de Desarrollo Inicial de Lenguaje, Test of Early Language Development, and the Perfil de Evaluacion del Comportamiento/Teacher Survey. Significant differences were found between the LD and NLD groups in 75% of the measures administered. Additional results indicate that the LD Ss scored poorly on the nonverbal IQ test and the language achievement tests, suggesting that the LD Ss would have been identified as LD based on the instruments used in the present study. (PsycINFO)

Zetlin, AG. Everyday stressors in the lives of Anglo and Hispanic learning handicapped adolescents. Journal of Youth & Adolescence, 1993, 22(3), 327-335. The sociocultural context of the lives of 10 learning handicapped adolescents (aged 16-18 yrs) was closely monitored over an entire school year using participant observation techniques. Everyday stressors and coping strategies of 5 Hispanic and 5 Anglo adolescents matched on age, sex, SES, class placement, and family intactness were documented in lengthy field notes. In addition to concerns typical of all adolescents (i.e., family, work, recreation, appearance), cross pressure from cultural conflicts and the learning handicapped status were major sources of stress for these adolescent subgroups. (PsycINFO)

3. Disability Among Working Age Latinos 

This section focuses on disability issues of working age Latinos. The conditions emerging in the age group can be largely attributed to behaviorally-related issues such as mental health, alcohol, tobacco, and other drug abuse, injury related to violence, motor vehicle crashes, and work. In the past 15 years, the most important emerging condition for this age group is AIDS or HIV-related disease (AIDS). HIV disease is now the fourth leading cause of death among all Latinos, and the leading cause of death among Latinos aged 25 to 44 years. As better strategies emerge for controlling HIV emerge, life expectancy will increase. However, certain disabling conditions also are emerging, including blindness and dementia, etc.


Angel, RJ. The costs of disability for Hispanic males. Social Science Quarterly. 1984, 65(June), 426-43. [Physically handicapped: Employment.]

Avolio, BJ. Waldman, DA. Variations in cognitive, perceptual, and psychomotor abilities across the working life span: Examining the effects of race, sex, experience, education, and occupational type. Psychology & Aging. 1994, 9(3), 430-442. Cognitive, perceptual, and psychomotor abilities were examined across the working life span for different racial groups, taking into consideration sex, job experience, education, and occupational type. Data included scores on all subtests of the General Aptitude Test Battery for White, Black, and Hispanic employees. Age and sex generally accounted for a relatively small percentage of the variance in ability test scores when experience, education, and occupational type were controlled. Race accounted for a substantial amount of variance in test performance, even after controlling for education, experience, occupational type, and age. Findings are discussed in terms of the potential for specific experiences and continuing education to affect the maintenance of abilities at later points in the life span for all racial groups. (PsycINFO).

Centers for Disease Control. Firearm-related deaths--Louisiana and Texas, 1970-1990. Morbidity & Mortality Weekly Report, 1992, 41(13): 213-5, 221. In 1990, firearm-related injuries surpassed motor-vehicle crashes as the leading cause of death from injuries in both Louisiana and Texas, and from 1979 through 1987, these states ranked third and fifth, respectively, for age-adjusted firearm-related death rates. Because firearm-related injuries are a major cause of death in Louisiana and Texas, the Louisiana Disability Prevention Program, Louisiana Office of Public Health, and the Injury Control Program, Epidemiology Division, Texas Department of Health, used death certificates to examine patterns in firearm-related mortality. This report summarizes the analysis of death certificate data for firearm-related mortality in these two states.

Fifield, J. Reisine, S. Sheehan, TJ. McQuillan, J. Gender, Paid Work, and Symptoms of Emotional Distress in Rheumatoid Arthritis Patients. Arthritis and Rheumatism. 1996, 39(3), 427-435. Objective. To evaluate the relative contribution of gender-related work conditions, gender-related socialization practices, and disease characteristics to the explanation of emotional distress in men and women with rheumatoid arthritis (RA). Methods. Three hundred sixty-nine RA patients who were employed outside the home were recruited from a national randomized sample of rheumatology practices. Data on paid work and disease characteristics were obtained by telephone interview. Emotional distress was measured by the Center for Epidemiological Studies Depression (CES-D) scale. Hierarchical ordinary least-squares regression was used to assess the relationship of sex, class, work characteristics, and disease characteristics to both the CES-D summary scale and the CES-D factor structure. Results. Differences in emotional distress were explained best by functional ability and pain and secondarily by the characteristics of paid work, with no independent effect for sex. Distress increased with decreasing functional ability, increasing pain, and exposure to such work characteristics as low autonomy, low income, and high demands. No sex differences in any of the CES-D subscales remained after controlling for disease and work variables. Conclusion. Among employed RA patients with high levels of functional disability and exposure to stressful work characteristics, men and women are at equal risk of experiencing emotional distress.

Garcia, JGN. Dresser, KSM. Zerr, AD. Respiratory Health of Hispanic Migrant Farm Workers in Indiana. American Journal of Industrial Medicine. 1996, 29(1), 23-32. The prevalence of respiratory disease in a Midwest Hispanic (mostly Mexican) migrant from worker population was investigated. Chronic respiratory symptoms (cough, wheezing, sputum production) in adult workers (n = 354) were elevated (8.5%, 6.2%, 6.5%, respectively) and were accompanied by physiologic abnormalities as determined by pulmonary function testing. Over 15% of the adult cohort exhibited a FEV(1)/FVC < 75, and over 14% had FEF (25-75) values which were less than 60% of predicted. The observed airflow obstruction of both large and small airways was not explained by cigarette usage (43%) in the adult cohort (current/past smokers). Tuberculin skin tests (TST) were positive (greater than or equal to 10 mm) in 55/195 melt and 35/123 women for a total prevalence of 28.3%. No case of active tuberculosis (TB) was identified by either chest X-ray (CXR) or sputum cultures (in selected cases). In contrast to adult farm workers, who were predominantly born in Mexico (70%), only 36% of adolescent workers (age 11-28 years, n = 107) were born in Mexico with only 7.5% exhibiting TST positivity. Airflow obstruction of large airways (5.8%) and small airways (12.9%) were also less common in adolescents than adults. In summary, these studies document respiratory dysfunction in Hispanic migrant farm workers in Indiana and highlight the need to closely monitor the respiratory health of this high-risk population. © Wiley-Liss, Inc.

Inancsi, W. Guidotti TL. Occupation-related burns: five-year experience of an urban burn center. Journal of Occupational Medicine, 1987, 29(9): 730-3. Mortality from burns in the United States has not improved appreciably since 1955 among men, and the rate of decline among women appears to be slowing. Although one-quarter of all serious burns result from occupational accidents, few systematic epidemiologic studies of occupational burns have been conducted. We reviewed 232 cases of occupational burns among the 1,076 civilians seen as outpatients or admitted to the Regional Burn Treatment Center of the University of California Medical Center in San Diego from 1977 to 1982. Scalds were the most common type of burn overall and in women, but flame-related burns resulted in the highest average percent body surface area burned and were more common in men; tar-related, flame-related, chemical, and electrical burns affected men almost exclusively. Electrical burns were disproportionately severe, as measured by time lost from work, fatalities, and permanent disability, in relation to their frequency and amount of body surface area involved. Contact burns were more frequent in younger persons. Hispanics were overrepresented compared with their representation in the general population. Occupational associations included scalds due to hot grease among restaurant workers, tar burns among roofing workers, electrical burns among farm workers, and injuries reflecting hazards to firefighters and electricians. The number of days off work after hospitalization correlated closely with the number of days hospitalized, which in turn correlated significantly with percentage of body surface area burned. (Abridged)

Lee, DJ. Gomez Marin, O. Lee, HM. Sociodemographic Correlates of Hearing Loss and Hearing Aid Use in Hispanic Adults. Epidemiology. 1996, 7(4), 443-446. We examined sociodemographic correlates of hearing loss and hearing aid use in adult Hispanics using data from the Hispanic Health and Nutrition Examination Survey. After adjustment for age and gender, odds ratios (ORs) of hearing impairment for nonmarried vs married participants were 1.6 `95% confidence interval (Cl) = 1.0-2.5_ for Mexican-Americans and 2.2 (95% Cl=1.2-4.2) for Puerto Ricans. ORs ranged from 1.6 to 3.2 for unemployed us employed, and from 1.7 to 2.1 for uninsured us insured Hispanics. For Mexican-Americans, the OR of hearing aid use for those living below us above the poverty line was 9.1 (95% CI = 1.1-100.0). These results are consistent with those reported for other ethnic groups. [Hearing Impairment.]

Mobed, K. Gold, EB. Schenker, MB. Occupational Health Problems Among Migrant and Seasonal Farm Workers. Western Journal of Medicine, 1992, 157, 367-373.

Santiago, AM. Provision of vocational rehabilitation services to blind and visually impaired Hispanics: The case of New Jersey. Journal of Applied Rehabilitation Counseling, 1988, 19(4, Spec. Issue), 11-15. Examined the participation of 231 blind and visually impaired Hispanics (compared with 771 Black and 2,030 White blind or visually impaired Ss) in vocational rehabilitation programs from 1985 to 1987.Results reveal that Hispanics had lower than expected levels of participation in vocational rehabilitation programs. Few Hispanic clients were being closed as rehabilitated; when Hispanics were successfully rehabilitated, 57% became wage earners. (PsycINFO)

Santiago, AM. Muschkin, CG. Disentangling the effects of disability status and gender on the labor supply of Anglo, black, and Latino older workers. Gerontologist, 1996, 36(3), 299-310. Utilizing data from the 1991 Health and Retirement Study Early Release File, this article examines the effects of disability status on labor force participation and earnings of preretirement workers aged 50 to 64. Results from our hierarchical regression models suggest that poor health and the presence of a work disability significantly reduced the labor force participation and earnings of older men and women. These analyses also suggest that economic well-being was constrained by the costs associated with additional "minority statuses." For example, the odds of being employed were reduced by approximately 46% for black men with disabilities. Further, the earnings of black men were 17% lower than the earnings of their nondisabled counterparts.

Santiago, AM. Villaruel, FA. Leahy, MJ. Latino Access to Rehabilitation Services: Evidence from Michigan. American Rehabilitation, 1996, Spring, 10-17. Authors examine factors associated with access to rehabilitation services by Latinos with disabilities. Data for this analysis were obtained from a 1990-91 pilot survey of 124 working-age Latino adults with disabilities residing in three metropolitan areas in Michigan, At the time of the interview, only 36 percent of the respondents reported receiving services from other agencies, primarily income support from Social Security or General Assistance.

Satz, P. Morgenstern, H. Miller, EN., et al. Low Education as a Possible Risk Factor for Cognitive Abnormalities in HIV-1 - Findings from the Multicenter AIDS Cohort Study (MACS). Journal of Acquired Immune Deficiency Syndromes. 1993, May, V6, N5, 503-511. The present study reports new and unexpected results of cognitive abnormalities among human immuno-deficiency virus type 1 (HIV-1) asymptomatic subjects in the Multicenter AIDS Cohort Study. The major purpose of our analyses is to estimate the separate and combined effects of serostatus and education level on the prevalence of cognitive abnormality. Cognitive "abnormality" was defined as performance that deviated greater-than-or-equal-to 2 SDs below the mean of the total seronegative group on at least one of the five neuropsychological screening tests (Grooved Pegboard, Verbal Fluency, Digit Span, Symbol Digit Modalities, Rey Auditory Verbal Learning). The predicted prevalence of cognitive abnormality was 38% in seropositive individuals with no more than 12 years of education, compared with <17% in the other education-serostatus groups. This interaction between education level and serostatus remained after controlling for the possible confounding effects of age, ethnicity, CD4 level, depression, prior drug history, and learning disability using logistic regression. To account for these findings, we suggest that low education might reflect an indirect index of lower reserve capacity (i.e., a risk factor) that lowers the threshold for neuropsychological abnormalities in cases of early HIV-1 infection. [Measurement, Cognitive Disabilities.]

Seelman, KD. Physical Rehabilitation and Violence - Initiatives of the National Institute on Disability and Rehabilitation Research. Journal of Health Care for the Poor and Underserved. 1995, 6(2), 217-232. The paper presents an analysis of violence-related data from the National Spinal Cord Injury Database within the context of violence-related projects of the U.S. Department of Education's Office of Special Education and Rehabilitative Services. The National Spinal Cord Injury Database is managed by the Spain Rehabilitation Center at the University of Alabama at Birmingham, which is one of 13 Model Spinal Cord Injury Care System centers funded under a grant from the U.S. Department of Education's Institute on Disability and Rehabilitation Research. There are 1,732 cases of spinal cord injury (SCI) due to violence enrolled in the database. This enrollment provides a longitudinal sample, an analysis of which shows that African American individuals and persons of Hispanic origin represent an increasing percentage of new cases, and that an increasing percentage of individuals within, these populations is incurring SCI as a result of violence.

Weinbaum, Z. Schenker, MB. O'Malley, MA. Gold, EB. Samuels, SJ. Determinants of Disability in Illnesses Related to Agricultural Use of Organophosphates (Ops) in California. American Journal of Industrial Medicine, 1995, 28(2), 257-274. Organophosphate (OP)-related illness data reported to the Worker Health and Safety Branch (WH&S) at the California Department of Food and Agriculture (CDFA, now Cal-EPA) in the years 1984-1988 were examined. Eight hundred and seventy-eight cases with systemic illness and 199 cases of skin disease or eye injury were identified. Systemic cases were divided into two outcome groups: (1) "severe," disability and/or hospitalization days (n= 361), and (2) "mild," no disability or hospitalization days (n=372). For the remainder (n=145) or 16.5% of the cases, illness severity could not be determined. Using multiple logistic regression, independent predictors of "severe" illness were identified among the systemic cases. Workers coming in contact with OP residue on commodities or in the field ("exposed to residue" or ER) (OR = 4.6, 95% CI = 3.03-7.07) and mixer/loaders/applicators (MLA) (OR=4.1, 95% CI=2.72-6.07) were at significantly increased risk of severe illness when compared with cases exposed to OP application drift. Cases with a Spanish surname were also at increased risk of severe illness (OR=1.8, 95% CI=1.25-2.73). Increased numbers of OPs per exposure were also associated with severe illness (p < 0.001). Among cases who were exposed to only one OP, severe systemic cases were more likely than mild systemic cases to be associated with exposure to diethyl than dimethyl compounds (OR=1.6, 95% CI = 1.09-2.38). Severe systemic cases were also more likely than severe skin/eye cases to be associated with exposure to OPs with high toxicity (OR = 5.5, 95% CI = 2.42-12.60) and with exposure to diethyl groups (OR=4.8, 95% CI=1.90-12.00). These findings suggest that reducing exposure to OP residues, to OPs with diethyl groups, and to multiple OPs, and exposure during mixer/loader/ applicator activities would reduce the risk of OP-related illness.

Wilson, PG. O'Reilly, MF. Rusch, FR. Analysis of minority-status supported employees in relation to placement approach and selected outcomes. Mental Retardation, 1991, 29(6), 329-333. Employment outcomes of 696 nonminority and 344 minority- status supported employees in the state of Illinois were examined. The most frequent primary diagnosis was mental retardation. Results indicate that minority-status supported employees were younger, had higher IQs, and earned more wages per month than did nonminority supported employees. Few differences between minority subgroups were identified. (PsycINFO)

Young, ME. Alfred, WG. Rintala, DH. Hart, KA. Fuhrer, MJ. Vocational Status of Persons with Spinal Cord Injury Living in the Community. Rehabilitation Counseling Bulletin, 1994, 37(3), 229-243. A sample of 140 persons was drawn randomly from a community-based sampling frame of 640 persons with spinal cord injury (SCI) to examine the vocational status of persons with SCI living in the community. Individual differences in vocational status and productivity were explored in terms of (a) demographic variables such as sex and age and (b) variables associated with the concepts of impairment and disability as defined by the World Health Organization. Data were derived from questionnaires, a home interview, and a comprehensive physical examination conducted at a rehabilitation hospital. Of the participants, 27% were employed, with 35% in unpaid productive activities, and 38% unemployed. Sex, ethnicity, education, and disability were statistically significant correlates of vocational status. (Houston)


MENTAL DISORDERS

Dassori, AM. Neff, JA. Hoppe, SK. Ethnic and Gender Differences in the Diagnostic Profiles of Substance Abusers. Hispanic Journal of Behavioral Sciences, 1993, 15(3), 382-390. The aim of the study was to evaluate ethnic and gender differences in the diagnostic profiles of patients first admitted to the alcohol/drug rehabilitation unit of a state hospital. The majority of the patients (66%) had more than one diagnosis. African- American patients were significantly more likely to have a single diagnosis. However, in terms of primary diagnosis, Mexican Americans were more likely to have an alcohol-related disorder while African-Americans were more likely to have a drug related disorder. Drug-related disorders also complicate the diagnostic profile of African-American patients who had a primary diagnosis of an alcohol-related disorder. Ethnic differences in type of drug abused were observed African Americans were more likely to use stimulants/hallucinogens, and Mexican Americans were more likely to use depressants. A drug-related disorder was the most common diagnosis among females across all ethnic groups. Findings point to the need of developing gender/ethnic-sensitive treatment programs. Potential ethnic and gender biases in the diagnostic evaluation of substance abuse patients are discussed.

Escobar, JI. Rubio-Stipec, M. Canino, G. Karno, M. Somatic Symptom Index (SSI): A new and abridged somatization construct: Prevalence and epidemiological correlates in two large community samples. Journal of Nervous & Mental Disease. 1989, 177(3), 140-146. An abridged somatization construct (the SSI) derived from the Diagnostic Interview Schedule's somatization disorder items was tested on community epidemio-logical samples to examine its prevalence, risk factors, and predictive value. Data from Puerto Rican, Mexican-American, and non-Hispanic White household respondents (aged 18+ yrs) revealed that the construct had a high prevalence and was related to low socioeconomic status (SES), female gender, older chronological age, and Hispanic ethnic background. The presence of this construct determined preferential use of medical services and predicted high indices of disability. The SSI may have practical utility for clinical and community studies of somatoform phenomena. (PsycINFO)

Escobar, JI. Golding, JM. Hough, RL. Karno, M., and others. Somatization in the community: relationship to disability and use of services. American Journal of Public Health, 1987, 77(7), 837-40. We tested the hypotheses that an abridged somatization construct that we had developed would be associated with use of health services, preferential use of medical over mental health services, and an index of disability. These hypotheses were tested using structured interview data from 3,132 randomly selected community respondents. We found that: respondents meeting criteria for somatization reported a heavier use of health services than non-somatizers; of those respondents meeting criteria for a psychiatric diagnosis, somatizers preferentially used medical over mental health services whereas non-somatizers reported the opposite trend; and somatizers were more likely than non-somatizers to report recent sick leave or restricted activity.

Flynn, PM. Craddock, SG. Luckey, JW. Hubbard, RL. Dunteman, GH. Comorbidity of Antisocial Personality and Mood Disorders among Psychoactive Substance-Dependent Treatment Clients. Journal of Personality Disorders. 1996, 10(1), 56-67. Substance users have high prevalence rates of disorders that encompass multiple comorbidities, as well as varied substance use and dependence patterns. Prevalence rates of DSM-III-R antisocial personality (ASP) and other comorbid disorders were investigated among a large sample of substance-dependent treatment clients participating in a national, multisite, prospective study of substance users admitted to treatment. Subjects included 7402 substance-dependent clients with an approximate demo-graphic makeup of 66% male, 47% African American, 12% Hispanic, and average age of 32.6 years. Subjects were assessed with modules for substance dependence and for ASP, depressive, and anxiety disorders from the Composite International Diagnostic Interview and the Diagnostic Interview Schedule. Prevalence rates for substance-dependent subjects were 39.3% ASP and 13.9% lifetime Axis I disorders, and these rates differed according to drug-dependency patterns. Logistic regression was used to assess differences among seven drug-dependency groups while controlling for differences in age, gender, and race/ethnicity. Interrelationships among ASP, other comorbid disorders, and drug-dependency patterns were evident and indicative of the need for multivariate models to better understand the consequences of these comorbid impairments.

Reich, J. Factors related to psychiatric disability. Social Psychiatry, 1986, 21(1), 15-16. Analyzed information obtained from the evaluation of 55 applicants for Supplemental Security Income psychiatric disability in order to evaluate the relationship between psychiatric diagnosis and disability. The Global Assessment Scale was used as an outcome variable. Significant associations were found with psychiatric diagnosis, marital status, and race. The lowest mean scores for diagnosis were organic brain syndrome and schizophrenia; for marital status, never married; and for race, Hispanic. It appears the Hispanic low scores were due to a lack of ability to speak English. No significant associations were found with sex, age, or education. (PsycINFO)

Williams, JW. Kerber, CA. Mulrow, CD. Medina, A. Aguilar, C. Depressive Disorders in Primary Care - Prevalence, Functional Disability, and Identification. Journal of General Internal Medicine. 1995, 10(1), 7-12. Objectives: To assess the relative prevalence of subsyndromal depression (SubD) and major depression (MDD) in primary care patients and describe their associated functional impairments, and to define the operating characteristics of a short depression screen (SDS). Setting: Three primary care clinics: a university-affiliated Veterans Affairs clinic, a county general internal medicine clinic, and a community health center. Subjects: Randomly selected adult patients (n = 221), aged greater-than-or-equal-to 30 years, with no history of psychiatric comorbidity, current substance abuse, major depressive disorder, chronic pain disorder, or dementia. Measurements: The SDS and the Medical Outcomes Study Short Form 36 (SF-36) were interviewer-administered by an experienced bilingual research assistant to all subjects in the language of their choice. A physician administered independently the Structured Clinical Interview for DSM-III diagnosis (SCID) and the Hamilton Depression Rating Scale (HDRS) to all patients who exceeded a minimum threshold on the SDS and to a randomly selected sample of patients who had subthreshold scores. MDD was defined by DSM-III criteria and SubD was defined as two to four DSM-III criteria, of which one had to be depressed mood or anhedonia. Results: Demographic and clinical characteristics of the patients were: Mexican American (53%), non-Hispanic white (38%), and African American 9%; men 68%; mean age 60 +/- 12.7 years; mean level of education 9.5 +/- 4.4 years; and hypertension 57%, diabetes mellitus 51%, and arthritis 45%. The prevalences of MDD and SubD (adjusted for sampling strategy) were 4% and 16%, respectively. For the patients who had MDD, the median HDRS score was 17 (interquartile range, 10-18), and for those who had SubD, the median HDRS score was 9 (interquartile range, 8-14). Compared with the patients who did not have depressive symptoms, those who had either MDD or SubD were significantly impaired in multiple domains of self-reported function. The sensitivity and specificity of the SDS for MDD were 100% (95% CI 57-100) and 72% (95% CI 63-81), respectively. For depressive disorders (MDD or SubD), the sensitivity was 66% (95% CI 49-83) and the specificity was 79% (95% CI 69-89). Conclusions: SubD was more prevalent than MD in these primary care settings. Both MDD and SubD were associated with significant functional impairment. The sensitivity of the SDS was lower for identifying depressive disorders (MDD or SubD) than it was for identifying MD.

Velligan, DI. True, JE. Lefton, RS. Moore, TC. Flores, CV. Validity of the Allen Cognitive Levels Assessment - A Tri-ethnic Comparison. Psychiatry Research. 1995, 56(2), 101-109. Schizophrenia is a mental illness which is characterized by severe cognitive deficits and impairments in adaptive functioning. The Allen Cognitive Levels (ACL) Assessment is a screening instrument designed to assess cognitive functioning and to aid clinicians in making judgments about how a patient will be able to perform basic activities of daily living. While the ACL has been widely used, the validity of ACL scores for predicting concurrent adaptive functioning has not been established empirically. The present study examined ACL scores in 110 schizophrenic patients. Scores on the ACL were found to be highly related to scores on the Functional Needs Assessment (r= 0.66), which measures a patient's ability to perform basic activities of daily living. Findings provided some of the first strong evidence that ACL scores reflect adaptive functioning. Correlations between the ACL and the Functional Needs Assessment were equally strong in non-Hispanic whites (n=31, r= 0.67), Mexican-Americans (n=58,r=0.60), and African- Americans (n=21, r = 0.46), Mean scores did not differ between patients from different ethnic groups. In addition, there was no relationship between ACL scores and level of acculturation within the Mexican-American group. Our data strongly support the hypothesis that the ACL provides a valid and culturally unbiased measure of cognitive functioning that can be helpful in determining how a patient is likely to perform activities of daily living. [Measurement]


POST-TRAUMATIC STRESS DISORDER

Fontana, A. Rosenheck, R. Post Traumatic Stress Disorder among Vietnam Theater Veterans - A Causal Model of Etiology in a Community Sample. Journal of Nervous and Mental Disease. 1994, 182(12), 677-684. Data from the National Vietnam Veterans Readjustment Study, conducted from 1986 td 1988, were used to develop and cross-validate a model of the etiology of posttraumatic stress disorder (PTSD) among a community sample of 1198 male Vietnam theater veterans. The initial model specified causal paths among ve sets of variables, ordered according to their historical occurrence: a) premilitary risk factors and traumas, b) war-related and non-war related traumas during the military, c) homecoming reception, d) postmilitary traumas, and e) PTSD. The initial model was refined and then cross-validated, leading to the specification of a final model with highly satisfactory fit and parsimony. In terms of the magnitude of their contribution to the development of PTSD, lack of support from family and friends at the time of the homecoming and exposure to combat were the two most influential contributors. Other contributing factors, in order of importance, were Hispanic ethnicity, societal rejection at the time of homecoming, childhood abuse, participation in abusive violence, and family instability. Exposure to war-related and non-war- related traumas occurred largely independently of each other, with war-related traumas contributing substantially more than non-war related traumas to the development of PTSD. Limitations to interpretation of the results are noted due to the retrospective nature of the data and the inevitable omission of other etiological factors. (PTSD)

Singer, MI. Anglin, TM. Song, LY. Lunghofer, L. Adolescents Exposure to Violence and Associated Symptoms of Psychological Trauma. Journal of the American Medical Association. 1995, 273(6), 477-482. Objective: To examine the extent to which adolescents are exposed to various types of violence as either victims or witnesses, and the association of such exposure with trauma symptoms; specifically, the hypotheses that exposure to violence will have a positive and significant association with depression, anger, anxiety, dissociation, posttraumatic stress, and total trauma symptoms. Design and Setting: The study employed a survey design using an anonymous self-report questionnaire administered to students (grades 9 through 12) in six public high schools during the 1992-1993 school year. Participants: Sixty-eight percent of the students attending the participating schools during the survey participated in the study (N=3735). Ages ranged from 14 to 19 years; 52% were female; and 35% were African American, 33% white, and 23% Hispanic. Results: All hypotheses were supported. Multiple regression analyses of the total sample revealed that violence exposure variables (and to a lesser extent, demographic variables) explained a significant portion of variance in all trauma symptom scores, including depression (R(2)=.31), anger (R(2)=.30), anxiety (R(2)=.30), dissociation (R(2)=.23), posttraumatic stress (R(2)=.31), and total trauma (R(2)=.37). Conclusions: A significant and consistent association was demonstrated linking violence exposure to trauma symptoms within a diverse sample of high school students. Our findings give evidence of the need to identify and provide trauma-related services for adolescents who have been exposed to violence.

4. Chronic Conditions and Aging 

Angel, RJ. Age at migration, social connections, and well-being among elderly Hispanics. Journal of Aging and Health. 1992, 4(4), 480-99. This study employs data from the 1988 National Survey of Hispanic Elderly People to examine the impact of age at migration and social contacts on the self-assessed health, functional disability, and life satisfaction of elderly Cuban Americans, Mexican Americans, and Puerto Ricans in the United States. The results indicate that the difficulties associated with immigration late in life undermine an older person's morale and interfere with the ability to perform basic activities of daily living. Although children are important sources of social support for all Hispanic groups, our findings also reveal important group differences in the use of other community social resources and their impact on health. Older Cuban Americans, in particular, appear to benefit from residence in ethnic enclaves in which they have largely duplicated their culture of origin.

Angel, RJ. Angel, JL. Himes, CL. Minority group status, health transitions, and community living arrangements among the elderly. Research on Aging. 1992, 14(4), 496-521. Patterns of change in functional capacity were examined among 138 Latinos, 55 non-Latino Black and 4,402 non-Latino White persons over 70 yrs old, over a 4-yr period using the 1988 Longitudinal Study of Aging (National Center for Health Statistics, 1990). Results reveal that among all 3 groups, improvements in functional capacity often follow declines, but that Blacks are more likely than non-Latino Whites to suffer protracted declines in functional capacity, ultimately resulting in more serious incapacity. A conceptual model was developed to identify factors accounting for racial and ethnic group differences in health and functional capacity as well as the propensity of Black and Latino elderly to rely on informal sources of support in the community instead of formal long-term care. (PsycINFO).

Aranda, MP. Knight, BG. The Influence of Ethnicity and Culture on the Caregiver Stress and Coping Process - A Sociocultural Review and Analysis. Gerontologist. 1997, 37(3), 342-354. The authors review the literature an ethnic minority caregivers and suggest that ethnicity and culture play a significant role in the stress and coping process for Latino caregivers. Caregivers of older Latinos face special challenges in the caregiving for individuals at higher risk for specific chronic diseases, who are disabled at earlier ages, and who have more functional disabilities. Ethnicity and culture can also influence the appraisal of stress events, the perception and use of family support, and coping behaviors. Socioeconomic class and minority group status are discussed as additional sources of variation in the caregiver stress and coping model.

Atkin, K. Age, Race and Ethnicity - A Comparative Approach - Blakemore, K, Boneham, M. Disability & Society, 1995, 10(3), 376-377. [Book Review.]

Bohnstedt, M. Fox, PJ. Kohatsu, D. Correlates of mini-mental status examination scores among elderly demented patients - the influence of race-ethnicity. Journal of Clinical Epidemiology. 1994. 47(12): 1381-1387. Data on 1888 patients seen at Alzheimer's Disease Diagnostic and Treatment Centers in California were used to examine possible differences in Mini-Mental State Examination (MMSE) results for different racial-ethnic groups. White patients had scores less indicative of dementia than Black and Hispanic patients using the standard 23 cutting point on the MMSE. However, there were no differences among these groups in the percentages clinically diagnosed as demented. The difference in the percentage of Whites vs Blacks and Hispanics categorized as demented by the MMSE was not accounted for by education, occupation, age, sex, or other variables tested, even though these variables were correlated with MMSE scores. Our data suggest that clinicians should consider MMSE scores for Black and Hispanic patients an underestimate of their cognitive capabilities relative to that of White patients.

Chiodo, LK. Kanten, DN. Gerety, MB. Functional status of Mexican American nursing home residents. Journal of the American Geriatrics Society. 1994, 42(Mar.), 293-296. A study was conducted to compare sociodemographic characteristics, physical function, and cognition of Mexican American and non-Hispanic white nursing home residents. A cross-sectional survey of residents in eight proprietary nursing homes and one Veterans Affairs nursing home in San Antonio, Texas, was undertaken. Participants in the study were 261 Mexican Americans and 899 non-Hispanic whites who had lengths of stay in the nursing homes of 90 days or more. Medical records provided data on sociodemographic characteristics, residence prior to admission, and dependency in activities of daily living. The Folstein Mini-Mental State Examination was administered to a subset of residents. The findings provide the strongest evidence to date that Mexican American nursing home residents are more cognitively and functionally impaired than non-Hispanic white residents.

Clark, DO. Mungai, SM. Stump, TE. Wolinsky, FD. Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. Journal of Gerontology A, 1997, 52(2): M97-105. Background: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites. Methods: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha=.80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups. Results: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group. Conclusions: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.

Commonwealth Fund, The. A Survey of Elderly Hispanics. Rockville, MD: Westat, Inc., January 1989. In 1988, a random sample national telephone survey was conducted, resulting in a sample 2,299 Hispanic elderly, disaggregated by Mexican-Americans (937), Cuban (714), Puerto Rican (368), and other Hispanics (280). The Hispanic Elderly Survey presents sample demographics and results for economic status, health care utilization indicators and perceived health status, difficulties facing the Hispanic elderly, needing and obtaining help (including ADLs and IADLs), and attitudes towards reduction of Social Security assistance. Survey methods and the questionnaire are included in the Appendix. (Compiler's Abstract)

Coulton, CJ. Milligan, S. Chow, J. Haug, M. Ethnicity, self-care, and use of medical care among the elderly with joint symptoms. Arthritis Care and Research. 1990, 3(1), 19-28. Elderly individuals in Ohio with self-reported joint symptoms representing three ethnic groups (i.e., blacks [n=105], Hispanics [n=100], and whites of Eastern European origin [n=112]) answered questions about their use of self-care and medical care for these symptoms. Ethnic groups differed in both self-care practices and their use of medical care for joint symptoms. Multiple regression analyses demonstrated that arthritis-specific and general health status were better predictors than ethnicity of the tendency to rely on self-care and medical care. There was no evidence that self-care served as a substitute for medical care.

Cox, C. Monk, A. Minority caregivers of dementia victims: A comparison of Black and Hispanic families. Journal of Applied Gerontology. 1990, 9(3), 340-354. Examined experiences of 31 Black and 19 Hispanic caregivers for dementia patients at home through 2 interviews 6 mo apart. Caregivers' health status, mental well-being, attitudes toward caregiving, and use of informal and formal supports were measured. Data were collected on the patient's degree of mental and physical impairment. Blacks and Hispanics maintained strong feelings of filial support for the aged and had actively involved informal support networks. For both groups, increased use of formal services at 2nd interview was related to a decrease in informal supports. Health of the caregivers was not affected, although Hispanics showed evidence of depression. (PsycINFO)

Dickerson, AE. Fisher, AG. Culture-Relevant Functional Performance Assessment of the Hispanic Elderly. Occupational Therapy Journal of Research. 1995. 15(1), 50-68. Because the Hispanic population is growing, there is a need for a reliable and valid functional assessment that is not culturally biased for white North Americans and that incorporates culture-relevant tasks for this large minority group. The Assessment for Motor and Process Skills (AMPS) (Fisher, 1993) is a unique evaluation tool that appears to meet that need. The AMPS consists of two scales (motor and process) that are assumed to be universal taxonomies that are free from cultural bias. This study was designed to investigate whether four Hispanic culture-relevant tasks could be added to the AMPS as task choices and whether the AMPS could be used as a sensitive cross-cultural assessment for Hispanic elderly. Hispanic older adults performed two Hispanic culture-relevant tasks and two culture-free tasks. Both goodness-of-fit among tasks and the performance of Hispanic subjects compared with North American subjects who had performed the same culture-free tasks were evaluated. The results indicated that (a) the Hispanic subjects' response patterns were consistent with response patterns of the North American subjects, and (b) the four Hispanic-culture-relevant tasks showed the same psychometric characteristics as previously established AMPS tasks. These findings support the potential to further develop the AMPS as a sensitive cross-cultural assessment for the Hispanic elderly.(PsycINFO). [Measurement]

Emulrow, CD. Chiodo, LK. Gerety, MB. Lee, S. Basu, S. Nelson, D. Function and Medical Comorbidity in South Texas Nursing Home Residents - Variations by Ethnic Group. Journal of the American Geriatrics Society. 1996, 44(3), 279-284. Objective: To evaluate differences in functional status and burdens of medical conditions in Mexican American and non-Hispanic white nursing home residents. Design and Setting: Cross-sectional survey of 17 nursing homes in south Texas. Participants: A total of 617 older nursing home residents, of whom 366 were Mexican American and 251 were non-Hispanic white. Measures: Activities of Daily Living (ADL) status abstracted from standard nurses notes and Burden of Disease abstracted from medical Records. Results: Mexican American residents had greater numbers of ADL dependencies and poorer overall ADL scores than non-Hispanic white residents. This poor functioning was not explained by age, gender, or marital or educational status. The average number of medical conditions was greater, and specific conditions, such as cerebrovascular disease, recent acute infections, diabetes, hypertension, and anemia, were more common in Mexican American residents compared with non-Hispanic white residents. In models relating function with medical conditions and ethnic group, ADL scores and dependencies were significantly related to bowel and bladder incontinence, cerebrovascular disease, dementia, recent infections, and skin decubiti, but not to ethnic group. Conclusion: Mexican American nursing home residents are more functionally dependent than non-Hispanic white residents. The difference in function is explained by a greater burden of medical conditions in the Mexican American residents.

Espino, DV. Parra, EO. Kriehbiel, R. Mortality Differences Between Elderly Mexican Americans and Non-Hispanic Whites in San Antonio, Texas. Journal of the American Geriatrics Society. 1994, 42(6), 604-608. Objective: To identify differences in causes of death between elderly Mexican Americans (MA) and non-Hispanic whites (NHW). Design: Retrospective death certificate review. Subjects: Elderly Mexican Americans and non-Hispanic Whites age 65 and over who died in Bexar County, Texas during 1989. Measures: Data obtained from chart review included age, sex, race/ethnicity, and cause of death. Age-adjusted and cause-specific mortality rates, odds ratios (OR), and 95% confidence intervals (CI) were calculated. Results: Mexican Americans were at greater risk of dying in nine of the thirty causes of death examined. The mortality rates of MA subjects were higher than those of NHW from death caused by diabetes (OR = 3.19, CI = 2.27-4.49), renal failure (OR = 2.06, CI =1.44-2.94), congestive heart failure (OR = 1.50, CI = 1.44-2.94), and multiple systemic diseases (OR = 2.59, CI = 1.89-3.57). Among the male subjects, MA had a greater risk than NHW of dying from myocardial infarction (OR = 1.83, CI = 1.15-2.90), coronary disease (OR = 1.37, CI = 1.07-1.75) and septicemia/pyuria (OR = 2.12, CI =1.09-4.10). Among female subjects, MA had a greater likelihood of dying from cirrhosis (OR = 3.03, CI = 1.009.29). For only one of the causes of death was the risk lower among MA than NHW: MA female subjects had a lesser chance of dying from the chronic obstructive pulmonary disease (COPD) than NHW females (OR = 0.36, CI = 0.180.72). Conclusion: Mexican American elders have a greater risk of dying from non-insulin dependent diabetes mellitus and renal failure than their NHW counterparts. Elderly MA men have a greater risk of dying from cardiovascular disease than their NHW counterparts. Mexican American women may have a greater risk of dying from cirrhosis, but a lower risk of dying from complications of COPD. Finally, death from ill defined causes, such as multiple systemic diseases, may be a major under-acknowledged cause of death among older Mexican Americans.

Ezzati, TM. Hoffman. K. Judkins, DR. Massey, JT. Moore, TF. A Dual Frame Design for Sampling Elderly Minorities and Persons with Disabilities. Statistics in Medicine. 1995, 14(5-7), 571-583. Multiple data sources are sometimes available as potential sampling frames for population surveys, and in some situations the use of a multiple frame sample design is more advantageous than using a single sampling frame. The use of multiple sampling frames, however, has variance and bias implications, as well as sampling, data collection, and logistical considerations, These issues are addressed for a proposed dual frame sampling approach in the National Health Interview Survey (NHIS). The results of an investigation of the sampling efficiencies and operational issues in supplementing the NHIS area frame sample with a sample of elderly African and Hispanic Americans and persons with disabilities selected from Social Security Administration files are presented. [Databases, Measurement]

Gurland, B. Wilder, D. Cross, P. Lantigua, R. Teresi, J. Barrett, V. Stern, Y. Mayeux, R. Relative Rates of Dementia by Multiple Case Definitions, over 2 Prevalence Periods, in 3 Sociocultural Groups. American Journal of Geriatric Psychiatry. 1995, 3(1), 6-20. The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a "clinical core," and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age. The following findings were robust across case definitions: sociocultural membership was not associated, but lower education was associated, with increased rates of recorded dementia; however, the patterns of the association with education varied across sociocultural groups.

Haan, MN. Weldon, M. The Influence of Diabetes, Hyper-tension, and Stroke on Ethnic Differences in Physical and Cognitive Functioning in an Ethnically Diverse Older Population. Annals of Epidemiology. 1996, 6(5), 392-398. Prevention of decline in cognitive and physical functioning In the elderly has become an important focus in geriatric medicine. Hispanics are among the fastest-growing group of elderly in the United States, yet few data are available on functional impairments in this group. We examined the association between ethnicity (non-Hispanic whites [NHW], English- speaking Hispanics `EH_, and Spanish- speaking Hispanics [SH]) and cognitive status, self-assessed functional status, and physical performance in a community- dwelling sample of 589 people aged greater than or equal to 60 years. The purpose of this study was to examine the association between ethnicity and these measures of functional status and to evaluate the influence of comorbid stroke, diabetes, and hypertension on this association. We found that EH and SH had significantly lower scores on the MiniMental State Exam than NHW, but that this difference was almost entirely due to educational level. When SH whose educational attainment was grade 8 or higher were compared to NHWs, there were no differences in cognitive functioning. Those with diabetes and stroke had poorer cognitive functioning. Among those with stroke, EH and SH women had more self-assessed functional limitations (IADLs and ADLs) than NHW. Male SH and EH with diabetes also had more self-assessed functional limitations than NHW. SH with two or three of these conditions had more IADL limitations. Our results suggest that elderly community- dwelling Hispanics experience greater levels of disability and that this is due, in part, to lower socioeconomic status and higher prevalence of disabling conditions. Our results suggest that elderly community-dwelling Hispanics experience greater levels of disability and that this is due, in part, to lower socioeconomic status and higher prevalence of disabling conditions.

Jette, AM. Crawford, SL. Tennstedt, SL. Toward Understanding Ethnic Differences in Late-Life Disability. Research on Aging. 1996, 18(3), 292-309. The authors hypothesized that ethnic differences in late-life disability would be observed and that ethnic differentials would be attributed to differences in physical capacity versus measurement error or cultural response to disabling disease. This study employed performance-based and self-report disability measures in a probability sample of 156 older African American, White, and Puerto Rican adults living in Springfield, Massachusetts. Analyses revealed that Puerto Rican and African American older adults reported significantly more disability than did Whites and that observed ethnic differences in disability were attributed to functional limitations. The current cohort of Puerto Rican and African American older adults clearly is at higher risk of needing long-term health and social services related to their increased levels of disability.

Lawrence, RH. Tennstedt, SL. Almy, SL. Subject-caregiver response comparability on global health and functional status measures for African American, Puerto Rican, and Caucasian elders and their primary caregivers. Journal of Gerontology B, 1997, 52(2), S103-11. Ethnic differences in response compara-bility and bias were evaluated for elderly African American, Puerto Rican, and non-Hispanic Caucasian elderly subjects with some degree of disability and their caregivers. Responses were compared for items assessing basic and instrumental activities of daily living, memory problems, confusion, and global health status. In general, for all ethnic groups, response comparability, based on kappa, was only poor to fair, with the lowest agreement found for items assessing memory problems and confusion. When disagreements occurred, caregivers tended to overestimate impairment relative to the elderly subjects, regardless of ethnicity. However, there were very few significant differences between the response patterns of the caregivers of these different ethnic groups. Thus, although three may be bias in the responses of caregivers relative to elderly persons, in general further bias is not introduced by ethnic differences in comparability of caregiver responses for elders with some degree of disability. [Measurement, Bias.]

Linn, MW. Hunter, KI. Linn, BS. Self-assessed health, impairment and disability in anglo, black and Cuban elderly. Medical Care, 1980, 18(3), 282-288. Self-assessed health and physician-rated impairment were compared for 174 Anglo, black, and Cuban elderly medical outpatients. Level of disability was also recorded by the interviewer. A minimal correlation was found between patient and physician-rated health. Self-assessed health and level of functioning were associated significantly in each of the 3 cultures. The way patients perceived their health and functioned differed by culture, but impairment ratings of the physician did not discriminate among cultures. It seems likely that nonmedical factors may explain cultural differences in perception of health as well as how these perceptions influence ability to perform everyday activities of living. The patients' estimates of health appear to be an important factor in their overall health status, which physicians could use to augment their assessments of impairment. Since self-assessed health relates to level of functioning and to the way the elderly react to an illness, it can be seen as a useful component in evaluating health and predicting patient behavior.

Lopez-Aqueres, W. et al. Health needs of the Hispanic elderly. Journal of the American Geriatrics Society. 1984. 32(3) 191-198. Examined the health care needs of the Hispanic elderly population of Los Angeles County, using the Comprehensive Assessment and Referral Evaluation (CARE) instrument. Data from 404 females and 299 males, aged between 60 and 75+ yrs, were employed to compute the scores for 22 Likert-type scales measuring the prevalence of numerous psychiatric, medical, and social problems. Results indicate that older Hispanics were affected by cognitive impairment (13.8%), depression/ demoralization (30.8%), heart disorders (12.8%), stroke effects (11.5%), arthritis (28.3%), hypertension (23.7%), financial hardship (28%), fear of crime (38.4%), ambulation problems (17.2%), or activity limitation (24.7%); they also needed assistance (19.3%) or used social services (22%). Further analysis revealed that the prevalence of many of these problems varied significantly according to the Ss' age, sex, language, and income. The indicators of health care needs used in the present study differed substantially from the more traditional measures based on the person's own perception of his/her health. (PsycINFO).

Macheledt, JE. Vernon SW. Diabetes and disability among Mexican Americans: the effect of different measures of diabetes on its association with disability. Journal of Clinical Epidemiology, 1992, 45(5), 519-28. The association of non-insulin-dependent diabetes mellitus and disability was evaluated in a population of Mexican Americans from the southwest U.S. using data from the Hispanic Health and Nutrition Examination Survey. Among the total sample of persons who completed a clinical examination, 14.6% reported a limitation of job performance, the inability to complete housework, or the inability to perform activities of daily living. Among the subsample who completed the clinical examination and reported having diabetes, 31.6% claimed similar disability. In those respondents who also completed an oral glucose tolerance test (OGTT) or who were currently receiving insulin, the prevalence of disability was 25% in persons with an abnormal OGTT and 40.2% in those who were receiving insulin compared with 14.9% in those with a normal OGTT. Self-reported diabetes was positively associated with functional impairment in the examined population after adjusting for demographic variables and comorbidity; however, diabetes confirmed by OGTT was not significantly associated with disability after adjustment for other factors. Differences in pre-existing health status between persons who completed the OGTT and those who did not are discussed in relation to these results.

Mahurin, RK. Espino, DV. Holifield, EB. Mental Status Testing in Elderly Hispanic Populations - Special Concerns. Psycho-pharmacology Bulletin. 1992, 28(4): 391-399. The rapid growth of the older Hispanic population highlights the importance of accurately assessing the mental status of these individuals. Although several community surveys have reported relatively higher rates of cognitive impairment among older Hispanics, closer analysis has revealed excessive false positives and the underestimation of cognitive functioning. Problems inherent in the mental status testing of this group include the lack of appropriately translated and culturally sensitive instrumentation, the diversity of the population, differences in their educational experiences, and bias in the test-taking situation. Commonly used neuropsychological test batteries have generally been neither translated nor normed for Hispanic subjects. To minimize cultural differences, cross-cultural tests have used nonverbal content; however, nonverbal testing does not, in itself, remove cultural bias. Alternative methods of testing that may reduce bias include performance-based assessment of everyday living skills and measurement of basic psychophysiological responses. [Measurement]

Mangum, WP. Garcia, JL. Kosberg, JI. Mullins, LC., et al. Racial/ethnic variations in informal caregiving. Special Issue: Caregiving: A classroom resource. Educational Gerontology. 1994, 20(7), 715-731. Documents and discusses variations in informal caregiving among members of racial ethnic minority groups in American society. Family members are the main providers of informal care for older persons, furnishing approximately 80% of in-home care for persons aged 75 yrs or older and suffering chronic disabilities. Specifically, the article summarizes the literature regarding attitudes, norms, practices, expectations, and stereotypes in informal caregiving among Blacks, Hispanics, American Indians, Asians, and Pacific Islanders. Although informal caregiving is the predominant mode of care provided for most older persons, demographic and cultural changes in all groups in the US should lead to a greater balance between informal and formal care. (PsycINFO)

Markides, KS. Consequences of gender differentials in life expectancy for Black and Hispanic Americans. International Journal of Aging & Human Development. 1989, 29(2), 95-102. Discusses the increased survival by Blacks and Hispanics that is causing a widening of the sex imbalance of the elderly population much like what is observed in the general population. These demographic trends point toward greater widowhood among minority women and continuing high rates of poverty. In addition, increased rates of disability in minority elderly women, increased dependency, worsening intergenerational relationships, and higher rates of institutionalization are expected. (PsycINFO)

Markides, KS. Stroup-Benham, CA. Goodwin, JS. Perkowski, LC. Lichtenstein, M. Ray, LA. The Effect of Medical Conditions on the Functional Limitations of Mexican-American Elderly. Annals of Epidemiology. 1996, 6(5), 386-391. We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitution-alized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n=177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for earing to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican- American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly. (C) Elsevier Science Inc.

Markides, KS. Timbers, DM. Osberg, JS. Aging and health: A longitudinal study. Archives of Gerontology & Geriatrics. 1984, 3(1), 33-49. Tested a set of double-jeopardy hypotheses predicting a double health disadvantage in growing old and being a member of an ethnic minority, female, of lower SES, and unmarried, using data from a 4-yr longitudinal study of older Mexican-Americans (MAs) and Anglos. 510 individuals aged 60+ yrs were interviewed in 1976. 70% were MAS and 61% were women. The MAS were of lower SES, while most Anglos were from blue- and white-collar backgrounds. 338 Ss were reinterviewed in 1980. Of the remaining 172 Ss, 59 were deceased. Two measures of health were used in the analysis: a global self-rating and a measure that combined the presence of health conditions with bed disability days and hospital nights. With the exception of SES, little support was found for the double-jeopardy predictions in a multivariate analysis of change in health. When Ss who died during the study interval were included in the analysis by assigning them the lowest score on health, the results changed somewhat: The relationship between age and decline in health was strengthened and the effect of sex changed from a direction suggesting that women show greater declines in health with age to one suggesting that men experience greater declines in health with age. Implications of the effect of deceased dropouts for studies on aging and health are discussed. (PsycINFO)

Medina, RA. Pugh, JA. Monterrosa, A. Cornell, J. Minority Advantage in Diabetic End-Stage Renal Disease Survival on Hemodialysis - Due to Different Proportions of Diabetic Type. American Journal of Kidney Diseases. 1996, 28(2), 226-234. The objectives of this study were to identify predictors of survival on hemodialysis in patients with diabetic end-stage renal disease (ESRD) and to explain ethnic differences in survival among non-Hispanic whites, African-Americans, and Mexican- Americans. The study design was a survival analysis of an inception cohort and was conducted in dialysis centers in two urban counties in Texas. A population-based, tri-ethnic cohort of 638 adult patients with diabetic ESRD were studied. Follow-up was completed in 96% of the cohort, with a median length of follow-up of 3.8 years. Survival length on center hemodialysis was the main outcome measure. In a combined model of types I and II diabetes, Mexican-Americans (relative hazard `RH_, 0.666; 95% confidence interval `CI_, 0.457 to 0.944) and African-Americans (RH, 0.598; 95% CI, 0.414 to 0.864) showed a better survival than non-Hispanic whites. Other predictors independently associated with survival were age (RH, 1.015 per 10 years of age; 95% CI, 1.001 to 1.028), high self-reported physical disability (RH, 1.770; 95% CI, 1.213 to 2.583), coronary artery disease (RH, 1.445; 95% CI, 1.044 to 2.012), lower extremity amputations (RH, 2.049; 95% CI, 1.438 to 2.920), and average blood glucose levels prior to ESRD (RH, 1.002 per 1 mg/dL increment; 95% OI, 1.003 to 1.004). Non-Hispanic whites had a significantly higher rate of type I diabetes, but did not have a greater burden of any of the other predictors, In separate type I and II models, ethnicity was still a significant predictor of survival among type I but not among type II. In conclusion, we have reconfirmed the survival advantage on dialysis of African-Americans and Mexican-Americans over non-Hispanic whites with diabetic ESRD. However, among type II patients, this minority survival advantage disappears. Self-reported physical disability is an important predictor of survival among both diabetes types. Functional status at baseline is an important predictor of survival and should be assessed as an adjunct to measurement of co-morbidities. Macrovascular disease is important for type II, while educational status is important for type I. While amputation may be a marker for the severity of systemic illness, it could be a marker for quality of primary care provided to diabetic patients, since a majority of diabetic lower extremity amputations are thought to be preventable. (C) National Kidney Foundation, Inc.

Escalante, A. Galarza-Delgado, D. Beardmore, TD. Baethge, BA; Esquivel-Valerio, J. Marines, AL. Mingrone, M. Cross- cultural adaptation of a brief outcome questionnaire for Spanish-speaking arthritis patients. Arthritis & Rheumatism, 1996, 39(1), 93-100. Objective: To cross-culturally adapt a brief self-assessment questionnaire to measure outcome among English- or Spanish-speaking patients with arthritis. Methods. A questionnaire containing the following items was translated to Spanish: the 8 activities of daily living (ADL) question of the Modified Health Assessment Questionnaire; a question about the duration of morning stiffness; and a 10-point pain scale. Equivalence to the original English, test-retest reliability, and construct, criterion, and discriminant validity were determined on a population of patients with 4 clinical centers. Results. English-Spanish equivalence and test-retest reliability of the questionnaire were almost perfect (intra-class correlation coefficients [ri] > or = 0.90 for each). Construct validity, measured by comparing questionnaire scores with an occupational therapist's evaluation, was also near-perfect in both languages (ri = 0.93 for English and 0.89 for Spanish). Both versions of the questionnaire correlated well with the physician-determined Steinbrocker functional class, as well as with the amount of pain, grip strength, and walking velocity. Patients with systemic lupus erythematosus, rheumatoid arthritis, osteoarthritis, and fibromyalgia differed significantly in their pain: ADL ratios, in both languages. Conclusions: The items of the Spanish questionnaire that we have adapted are equivalent to the original English versions. This questionnaire is suitable for studying Spanish-speaking subjects with arthritis in the US and elsewhere.

Escalante, A. Lichtenstein, MJ. White, K. Rios, N. Hazuda, HP. A Method for Scoring the Pain Map of the McGill Pain Questionnaire for Use in Epidemiologic Studies. Aging Clinical and Experimental Research. 1995, 7(5), 358-366. Identifying and quantifying the location of pain may be important for understanding specific functional impairments in elderly populations. The purpose of the present analysis was two-fold: first, to describe the reliability of a scoring method for the McGill Pain Map (MPM), and second, to validate the method of scoring the MPM as a tool for assessing areas of body pain in an epidemiologic study. In interviews performed at the subjects' homes, 411 community dwelling Mexican-American and non-Hispanic white subjects aged 65-74 from the San Antonio Longitudinal Study of Aging (SALSA) were asked to describe the location of their pain on the map of the human body included in the McGill Pain Questionnaire. The location of pain was scored by overlaying the survey figures with a MPM template divided into 36 anatomical areas. Inter- and intra-rater agreement among three raters was measured by calculating a kappa statistic for each of the body areas, and an intraclass correlation coefficient for the total number of painful areas (NPA). Internal validity was measured by Spearman's rho between the NPA and the Present Pain Index (PPI) and Pain Rating Index (PRI) of the McGill Pain Questionnaire, and external validity by correlation between NPA and the Perceived Health (PH), Amount of Bodily Pain (APE), and Pain Interference with Work (PIW) items of the Medical Outcomes Study, and the Perceived Physical Health (PPH) question of the San Antonio Heart Study. Average inter-rater agreement for individual MPM areas was 0.92 +/- 0.01, and average agreement for NPA was 0.96 +/- 0.01. Intra-rater agreement for individual areas averaged 0.94 +/- 0.01, and for NPA = 0.99 +/- 0.001. Pain in one or more areas was present in 47.7% of the subjects. For the whole sample, correlations between NPA and the validation indices were: PPI (0.91), PRI (0.89), PH (0.25), ABP (0.64), PIW (0.49), and PPH (0.20). Among the 196 subjects with pain, correlations were: PPI (0.34), PRI (0.34), PH (O.19), ABP (0.21), PIW (0.38), and PPH (O.19) - p < 0.01 for all correlations. In conclusion, we have developed a reliable method of scoring the MPM and have shown evidence of its validity in a community-based sample of elderly subjects. Patterns of painful body areas may be associated with specific diseases and functional impairments. [Measurement, Pain.]

Gonzalez, VM. Stewart, A. Ritter, PL. Lorig, K. Translation and validation of arthritis outcome measures into Spanish. Arthritis and Rheumatism, 1995, 38(10), 1429-1446. Objective: To produce Spanish versions of common arthritis outcome measures: the Health Assessment Questionnaire (HAQ) Disability Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) Pain Severity Scale, the Arthritis Self-Efficacy Scale for Pain and Other Symptoms (with the addition of 2 new items), the Visual Analogue Pain Scale, the MOS Self-Rated Health Item, and a Physical Activities Scale that would be usable by most Hispanics living in the US. We tested these translated measures for reliability and, where appropriate, validity. Methods: Instruments were translated and back translated by bilingual persons from 5 different countries of origin. Translators met to resolve variations in translation. The instruments were then administered to Hispanic arthritis patients in 6 geographic locations (5 in the United States and 1 in Latin America). All instruments underwent standard psychometric testing. As appropriate, the sample was stratified by level of acculturation, nation of origin, and geographic location. Results: The translated instruments, with slight modification, met acceptable levels of reliability and validity. They are understood and easily usable by diverse Spanish-speaking populations. Conclusion: The availability of these translated outcome measures should enable investigators to include monolingual Spanish- speakers into their studies, and should facilitate study of cross- cultural differences with respect to these specific outcomes.

Meyer, M. Harrington. Gender, race, and the distribution of social assistance: Medicaid use among the frail elderly. Gender & Society. 1994, 8(Mar.), 8-28. The writer explores the distribution of Medicaid benefits to the frail elderly in order to examine class-based and feminist theories of the welfare state. Class-based theories claim that poverty-based benefits stratify society by social class. By contrast, feminist theories suggest that universal and poverty-based benefits stratify on the basis of gender and race, in addition to class. An analysis of data from the National Long Term Care Survey on the distribution of Medicaid benefits to the frail elderly revealed that class, gender, and race are significant predictors of Medicaid use even when differences in income, education, age, marital status, and nursing home use are accounted for. Women, blacks, and Hispanics have the greatest need for long-term care and the fewest resources with which to meet those needs. For this reason, they are more likely than white men to depend on Medicaid and to face the differential treatment that accompanies poverty-based benefits. (WSSI)

Miller, B. Campbell, RT. Davis, L. et al. Minority use of community long-term care services: a comparative analysis. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 1996, 51B, S70-S81: 1079-5014. A series of national surveys since 1982 have examined health needs of elders. Small proportions of minority elders in each sample have limited our understanding of service use by minorities. This research sought to determine (1) the extent to which minorities have restricted use of community long-term care services as a result of socioeconomic status, family structure, and health status, and (2) the replicability and validity of results across three national surveys: Supplement on Aging, National Long-Term Care, and National Medical Expenditure. Results indicate no bivariate or multivariate differences between African American, Hispanic, or White frail older persons in use of community long-term services. Living arrangements, Medicaid use, and overall health and functional status were primary predictors of service use. Taking methodological limitations into account, the results suggest similarity in processes influencing use of community long-term care services for African American and White older persons.

Mui, AC. Burnette, D. Long-Term Care Service Use by Frail Elders - Is Ethnicity a Factor. Gerontologist, 1994, 34(2): 190-198. Using data from the 1982-84 National Long-Term Care Channeling Demonstration, this study examines factors associated with long-term care service use by African American, Hispanic, and white frail elders living in the community. Findings indicate that in addition to predisposing, enabling, and need factors, race/ethnicity is a significant predictor of each type of service use.

Mulrow, CD. Chiodo, LK. Gerety, MB. Lee, S. Basu, S. Nelson, D. Function and Medical Comorbidity in South Texas Nursing Home Residents - Variations by Ethnic Group. Journal of the American Geriatrics Society. 1996, 44(3), 279-284. Objective: To evaluate differences in functional status and burdens of medical conditions in Mexican American and non-Hispanic white nursing home residents. Design and Setting: Cross-sectional survey of 17 nursing homes in south Texas. Participants: A total of 617 older nursing home residents, of whom 366 were Mexican American and 251 were non-Hispanic white. Measures: Activities of Daily Living (ADL) status abstracted from standard nurses notes and Burden of Disease abstracted from medical records. Results: Mexican American residents had greater numbers of ADL dependencies and poorer overall ADL scores than non-Hispanic white residents. This poor functioning was not explained by age, gender, or marital or educational status. The average number of medical conditions was greater, and specific conditions, such as cerebrovascular disease, recent acute infections, diabetes, hypertension, and anemia, were more common in Mexican American residents compared with non-Hispanic white residents. In models relating function with medical conditions and ethnic group, ADL scores and dependencies were significantly related to bowel and bladder incontinence, cerebrovascular disease, dementia, recent infections, and skin decubiti, but not to ethnic group. Conclusion: Mexican American nursing home residents are more functionally dependent than non-Hispanic white residents. The difference in function is explained by a greater burden of medical conditions in the Mexican American residents.

Mungas, D. Marshall, SC. Weldon, M. Haan, M. Reed, BR. Age and Education Correction of Mini-Mental State Examination for English and Spanish-speaking Elderly. Neurology. 1996, 46(3), 700-706. Previous research has shown that the Mini-Mental State Examination (MMSE) is biased as a measure of cognitive impairment in minority and low-education patients. The purpose of this study was to (1) develop a statistical correction for effects of age and education and (2) test the efficacy of the statistically adjusted MMSE (MMSAdj) as a screening test for dementia using different ethnic groups and education levels, We used a population-based community survey sample (n = 590) composed of 46.6% Hispanics and 53.4% non-Hispanics to derive the statistical correction, defined as: MMSAdj = Raw MMSE - (0.471 x `Education-12_) + (0.131 x `Age-70_). Ethnicity and language of test administration were not significantly related to MMSAdj in the community survey sample, but the raw MMSE was strongly influenced by these factors. We used an independent sample (n =2,983) of patients evaluated through the California Alzheimer's Disease Diagnostic and Treatment Centers to test the diagnostic accuracy of the MMSE and the MMSAdj across low- and high-education groups and across whites, Hispanics, and blacks. Results showed greater stability of sensitivity and specificity across education levels and ethnic groups for the MMSAdj than for the raw MMSE and suggest that the MMSAdj is a preferable measure of cognitive impairment for low-education and minority individuals. (Measurement)

O'Donnell, RM. Functional disability among the Puerto Rican elderly. Journal of Aging & Health. 1989. 1(2), 244-264. Compared data on the functional status of 515 elderly Puerto Ricans (aged 65+ yrs) living in the US with national data on 205 Black and 515 White age-matched Ss. Puerto Ricans were significantly more disabled than either Blacks or Whites. When the demographic factors and the English language disadvantage that distinguish Puerto Ricans from both Blacks and Whites were taken into account, the estimate of the effect of race/ethnicity on disability was reduced, but a considerable effect remained. Older Puerto Ricans were at high risk for dependency, particularly those whose lack of English severely limited their capacity to interact with the environment. (PsycINFO).

Ponchillia, SV. The effect of cultural beliefs on the treatment of native peoples with diabetes and visual impairment. Special Issue: Diabetes. Journal of Visual Impairment & Blindness. 1993, 87(9), 333-335. An increase in the incidence of diabetes among Native Americans, Mexican Americans, and Pacific Islanders as they adopt western diets and lifestyles is leading to a modern epidemic of diabetes and its complications. Traditional cultural beliefs can affect the success of services to native peoples who are experiencing vision loss. These cultural beliefs, including the circle of life, identification of persons with disabilities, natural causes of illness and disability, the value of silence, and the healing role played by the blindness professional are illustrated here by examples from Native American culture. Sensitivity toward traditional beliefs can increase the success rates of rehabilitation services. (PsycINFO) [Diabetes]

Ramirez de Arellano, Annette B. The Elderly. Ch. 7 in: Molina, CW. & M. Aguirre-Molina, Eds. Latino Health in the US: A Growing Challenge. Washington, DC: American Public Health Association, 1994. This review article begins with a demo-graphic description of Latino elders (who comprise 5% of Latinos), and then presents the 5 "D's" of health conditions: death, disease, disability, discomfort, and dissatisfaction. She then reviews health care use, barriers to care (lack of insurance, language), and then presents four trends in Latino aging: feminization, increase of the old-old population, return migration, and the decrease of family members potentially available to care for the aged. (JOA).

Scox, EO. Dooley, AC. Care-Receivers Perception of Their Role in the Care Process. Journal of Gerontological Social Work. 1996, 26(1-2), 133-152. Ninety-one elderly black, Hispanic and white care-receivers were interviewed in-depth regarding their role and their perceptions of the caregiving/care-receiving process. In-depth structured interviews were also conducted with 79 caregivers. Respondents identified a number of common strategies used to assist their caregivers and/or provide self-care. The importance of education, mutual support between caregiver and care-receiver, assumption of responsibility for acceptance of disabilities, and learning new ways of coping were identified as key factors in the care process. The critical importance of care-receivers' roles in maintaining mental health, positive attitudes, and learning new patterns of behavior in the care process is described and the importance of further exploration of care-receiver issues to social work practice is suggested.

Strawbridge, WJ. Camacho, TC. Cohen, RD. Kaplan, GA. Gender Differences in Factors Associated with Change in Physical Functioning in Old Age - A 6-Year Longitudinal Study. Gerontologist. 1993, 33(5), 603-609. We compared 356 older men and women and found that income, education, and marital status had significantly stronger associations with 6-year change in functioning for men; internal health locus of control was stronger for women. Large but not significant differences occurred for age, perceived health, and days going out per week (stronger for women) plus exercise and smoking (stronger for Men). We found no difference for ethnicity, chronic conditions, and social contacts. Gender specific models incorporating factors amenable to change predicted significantly higher follow-up functioning for those with positive health behaviors. Supporting the value of preventive interventions.

Tang, MX. Maestre, G. Tsai, WY. et al. Relative Risk of Alzheimer Disease and Age - At- Onset Distributions, Based on Apoe Genotypes among Elderly African Americans, Caucasians, and Hispanics in New York City. American Journal of Human Genetics. 1996, 58(3), 574-584. Apolipoprotein-E epsilon 4 (APOE-epsilon 4) has been consistently associated with Alzheimer disease (AD) and may be responsible for an earlier age at onset. We have previously reported a diminished association between APOE-epsilon 4 and AD in African Americans. Using a new method, which allows inclusion of censored information, we compared relative risks by APOE genotypes in an expanded collection of cases and controls from three ethnic groups in a New York community. The relative risk for AD associated with APOE-epsilon 4 homozygosity was increased in all ethnic groups (African American relative risk `RRï = 3.0; 95% confidence interval `CIï = 1.5-5.9; Caucasian RR = 7.3, 95% CI = 2.5-21.6; and Hispanic RR = 2.5, 95% CI = 1.1-5.7), compared with those with APOE-epsilon 3/epsilon 3 genotypes. The risk was also increased for APOE- epsilon 4 heterozygous Caucasians (RR = 2.9, 35% CI = 1.7-5.1) and Hispanics (RR=1.6, 95% CI=1.1-2.3), but not for African Americans (RR=0.6, 95% CI=0.4-0.9). The age distribution of the proportion of Caucasians and Hispanics without AD was consistently lower for APOE-epsilon 4 homozygous and APOE-epsilon 4 heterozygous individuals than for those with other APOE genotypes. In African Americans this relationship was observed only in APOE-epsilon 4 homozygotes. These results confirm that APOE genotypes influence the RR of AD in Caucasians and Hispanics. Differences in risk among APOE-epsilon 4 heterozygote African Americans suggest that other genetic or environmental factors may modify the effect of APOE-epsilon 4 in some populations.

Teresi, JA. Golden, RR. Cross, P. Gurland, B. Kleinman, M. Wilder, D. Item Bias in Cognitive Screening Measures - Comparisons of Elderly White, Afro-American, Hispanic and High and Low Education Subgroups. Journal of Clinical Epidemiology. 1995. 48(4), 473-483. A study of item bias in standard cognitive screening measures was conducted in a sample of Afro-American, Hispanic and non-Hispanic white elderly respondents who were part of a dementia case registry study. The methods of item-response theory were applied to identify biased items. Both cross-cultural and high and low education groups were examined to determine which items were biased. Out of 50 cognitive items examined from six widely used cognitive screening measures, 16 were identified as biased for either high and low education groups or ethnic/racial group membership. (Measurement)

Wallace, SP. Lew-Ting, C. Getting by at home. Community- based long-term care of Latino elders. Western Journal of Medicine, 1992, 157(3), 337-44. Although evidence suggests that the morbidity and mortality of Latino elders (of any Hispanic ancestry) are similar to those of non-Latino whites, Latinos have higher rates of disability. Little is known about influences on the use of in-home health services designed to assist disabled Latino elders. We examine the effects of various cultural and structural factors on the use of visiting nurse, home health aide, and homemaker services. Data are from the Commonwealth Fund Commission's 1988 national survey of 2,299 Latinos aged 65 and older. Mexican-American elders are less likely than the average Latino to use in-home health services despite similar levels of need. Structural factors including insurance status are important reasons, but acculturation is not pertinent. Physicians should not assume that Latino families are taking care of their disabled elders simply because of a cultural preference. They should provide information and advice on the use of in-home health services when an older Latino patient is physically disabled.

Wallace, SP. Levystorms, L. Ferguson, LR Access to paid in-home assistance among disabled elderly people - Do latinos differ from non-latino whites? American Journal of Public Health. 1995, 85(7), 970-975. Objectives. The purpose of this study was to compare the national prevalences and predictors of paid in-home functional assistance among disabled Latino and non-Latino elderly people who receive such assistance. Methods. Data were derived from the 1988 wave of the National Center for Health Statistics Longitudinal Study on Aging and the 1988 Commonwealth Fund Commission Survey of Elderly Hispanics. Logistic regression was used to model paid care use and to calculate estimated probabilities of such use. Results. Among Latino and non-latino Whites 74 years of age and older who received functional assistance, similar proportions used paid assistance. Predictors of paid care coincided with established models for non-Latino Whites only. Disabled Latinos had a lower estimated probability of using paid assistance when they were highly disabled and socially isolated but had a higher estimated probability when their children lived nearby. Conclusions. The effects of disability and social support differ among non-Latino White and Latino elderly people. Latino elderly people with high anticipated needs obtain less paid assistance than similar non-Latino Whites. In addition to a reduction in financial barriers, improving access to long-term care services requires addressing this diversity in service use patterns.

Walston, J. Silver, K. Bogardus, C. et al. Time of Onset of Non-Insulin-Dependent Diabetes Mellitus and Genetic Variation in the Beta(3)-Adrenergic-receptor Gene. New England Journal of Medicine, 1995, 333(6), 343-347. Background: The beta(3)- adrenergic receptor is expressed in visceral adipose tissue and is thought to contribute to the regulation of the resting metabolic rate and lipolysis. Methods: To investigate whether mutations in the gene for the beta(3)-adrenergic receptor predispose patients to obesity and non-insulin-dependent diabetes mellitus (NIDDM), we studied this gene in 10 Pima Indians by analysis of single-stranded conformational polymorphisms and dideoxy sequence analysis. Association studies were performed in 642 Pima subjects (390 with NIDDM and 252 without NIDDM). Results. A missense mutation was identified in the gene for the beta(3)-adrenergic receptor that results in the replacement of tryptophan by arginine (Trp64Arg) in the first intracellular loop of the receptor. This mutation was detected with allelic frequencies of 0.31 in Pima Indians, 0.13 in 62 Mexican Americans, 0.12 in 49 blacks, and 0.08 in 48 whites in the United States. Among Pimas, the frequency of the Trp64Arg mutation was similar in nondiabetic and diabetic subjects. However, in subjects homozygous for the mutation the mean (+/-SD) age at the onset of NIDDM was significantly lower (36+/-10 years) than in Trp64Arg heterozygotes (40+/-10 years) or normal homozygotes (41 +/- 11 years; P = 0.02). Furthermore, subjects with the mutation tended to have a lower adjusted resting metabolic rate (P = 0.14 by analysis of covariance). Conclusions. Pima subjects homozygous for the Trp64Arg beta(3)-adrenergic-receptor mutation have an earlier onset of NIDDM and tend to have a lower resting metabolic rate. This mutation may accelerate the onset of NIDDM by altering the balance of energy metabolism invisceral adipose tissue. [Genetic Risk factors.]

Warner, DC. McCandless, RR. Denino, LA. Cornell, JE. Pugh, JA. Marsh, GM. Costs of Diabetes in Texas, 1992. Diabetes Care. 1996, 19(12), 1416-1419. Objective: To estimate direct and indirect costs of diabetes in Texas in 1992. Research Design and Methods: For most direct medical costs, we relied on third party and provider billing databases, including Medicare, Medic-aid, VA facilities, public hospitals, and others. The researchers identified people with diabetes in the respective databases, located all records of their care, and sorted records as clearly probably, or probably not attributable to diabetes on the basis of principal diagnoses. In most cases, costs were valued as allowable or paid charges. Some medical costs, such as private insurance, were estimated from national data and state surveys. Indirect costs included current short- and long-term disability costs and the discounted present value of future costs of mortality. Disability estimates relied on National Health Interview Survey (NHIS) data and U.S. Department of Labor wage data applied to Texas. Mortality estimates were based on death certificates. Results: Total costs clearly or probably attributable to diabetes among Texans in 1992 were estimated at $4.0 billion. Direct medical costs were similar to $1.6 billion. Indirect costs were estimated at $2.4 billion. The largest direct costs were paid by Medicare. Most indirect costs were from long-term Disability. Conclusions: This study demonstrates methods for conducting cost of illness studies at the state level. In a state like Texas, with a large and growing Mexican-American population, estimation of current and future economic costs of diabetes is vital for development of strategies to minimize social and economic consequences of diabetes.

Wray, LA. Health policy and ethnic diversity in older Americans. Dissonance or harmony? Western Journal of Medicine, 1992, 157(3), 357-61. The rapid growth and diversity of the older population have long-term implications for health care policies in the United States. Current policies designed for a homogeneous population are increasingly obsolete. To ameliorate obstacles that handicap many ethnic minority elders and to provide equal access to adequate and acceptable health care, several factors need to be considered. Enhanced data collection and analytic techniques are needed. The effects of race or ethnicity must be separated from other biologic, environmental, socioeconomic, cultural, and temporal factors on health status and behavior. Health care professionals and organizations serving minority elders must continue to expand their advocacy efforts to articulate the findings and their concerns to policymakers. Policymakers must understand and acknowledge the implications of an increasingly diverse society and determine what will constitute adequate, accessible, and acceptable health care within continuing fiscal constrains. Program planning, implementation, and evaluation methods must be revised to meet future health care needs effectively and efficiently.

Yaniz, Manuel J. Geriatric assessment: Risks of functional disability, dementia and depression among Hispanic elderly living at home with caregivers support. Dissertation Abstracts Inter-national. 1991, 51(9-B), 4612. [Measurement]

Zsembik, BA. Ethnic and Sociodemographic Correlates of the Use of Proxy Respondents - The National Survey of Hispanic Elderly People, 1988. Research on Aging. 1994 Dec; 16(4): 401-414. The goal of this research is to examine the ethnic and socio-demographic correlates of older Latino adults who report for themselves in survey research, and those who use a spouse, child, or other adult as a proxy respondent. Multivariate analysis of the National Survey of Hispanic Elderly People identifies specific ethnic and sociodemographic factors that are significant correlates to sources of information. Researchers collecting data on an older, immigrant population might consider use of a proxy respondent to reduce nonresponse rates. [Measurement, Methodology, Data Collection.]

5. Service Delivery and Rehabilitation Issues 

This section is divided into four parts. The first addresses issues of access to health care, lack of insurance, and service utilization by the Latino (and other minority) persons with disabilities. The second part presents different models and strategies for culturally competent service delivery and practice, including assessment, counseling, and language services. Attention has been paid to diversity issues and perceptions of the disabled. The third part includes work on work and vocational rehabilitation. The fourth part presents additional resources in the area of service delivery.


SERVICES ACCESS AND UTILIZATION

Akin, BV. Rucker, L. Hubbell, FA. Cygan, RW. Waitzkin, H. Access to medical care in a medically indigent population. Journal of General Internal Medicine, 1989, 4(3), 216-20. Objective: To study nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers. Design: Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated. Setting: A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population. Patients: 200 patients who presented to eligibility workers seeking financial assistance. Measurements and Results: Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find Care. Conclusions: Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care. (Access to Care)

Berkanovic, E. Telesky, C. Mexican-American, black-American and white-American differences in reporting illnesses, disability and physician visits for illnesses. Social Science & Medicine, 1985; 20(6): 567-77. This paper presents data on the reporting of illnesses, disability due to illnesses and the decision to seek medical attention for illnesses among a representative sample of Mexican-Americans, Black-Americans and White-Americans in Los Angeles. Few differences were observed among these groups with respect to the reporting of illnesses, disability due to illnesses or in the frequency with which illnesses were brought to medical attention. Hierarchical stepwise multiple regressions were run for each of these variables within each of these subgroups. Some differences were found among these groups in the variables that predicted illness reporting, disability and the use of physician services for illnesses. These differences indicate that ethnicity affects health behavior through its interaction with other variables. Speculations are offered regarding the meaning and historical sources of the differences observed. [Health services, Access]

Butler, JA. Singer, JD. Palfrey, JS. Walker, DK. Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas. Pediatrics, 1987, 79 (1): 89-98. The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05). Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care. [Children, Insurance Coverage.]

Cornelius, LJ. Altman, BM. Have We Succeeded in Reducing Barriers to Medical Care for African and Hispanic Americans with Disabilities? Social Work in Health Care, 1995, 22(2), 1-17. There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities disproportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed. [Access to Care.]

Marcus, AC. Stone, JD. Racial/ethnic differences in access to health care: further comments on the use-disability ratio. Medical Care, 1982, 20(9): 892-900. Indicators of access to health care generally fall into one of two broad groups. The first group of indicators focuses on factors responsible for differential rates of use and often are assessed through reports of patient satisfaction. The second group of indicators focuses more specifically on actual rates of use, and therefore represents a more objective measure of access. One of the most widely used objective indicators of access is the use-disability ratio. This article illustrates some problems in using this ratio in health services research and some strategies one might adopt to minimize these problems. The data reported below were obtained from an analysis of racial/ethnic differences in use of services that was conducted as part of the 1979 Los Angeles Health Survey (N=1003). Our findings suggest that 1) blacks had greater access to health care than either white/Anglos or Hispanics, particularly for respiratory and musculo-skeletal problems, and 2) the use-disability ratio should be used cautiously, since it is sensitive to subgroup differences in the chronicity and cause of the disability. (Access to Care)

McManus, MA. Newacheck, PW. Greaney, AM. Young adults with special health care needs: prevalence, severity, and access to health services. Pediatrics, 1990, 86 (5), 674-82. Health care needs of disabled young adults and access to care are analyzed using the 1984 National Health Interview Survey, a nationally representative sample of 10,394 randomly selected noninstitutionalized young adults aged 19 to 24. In 1984, 1.4 million young adults (almost 6%) suffered from disabilities. The leading cause of disability was diseases of the musculoskeletal system and connective tissue. Young adults living in poverty, in households where the family reference person had less than a high school education, and who were male were at elevated risk of disability. Disabled young adults made almost three times as many physician contacts and were hospitalized for close to six times as many days as nondisabled young adults. One of every 5 disabled young adults was uninsured in 1984. Forty-one percent of disabled Hispanic 19- to 24-year-olds and 51% of disabled young adults of other races were uninsured compared with 19% of whites and blacks. Research and financing policy implications are discussed.

Aranda, MP. Knight, BG. The Influence of Ethnicity and Culture on the Caregiver Stress and Coping Process - A Sociocultural Review and Analysis. Gerontologist. 1997, 37(3), 342-354. The authors review the literature an ethnic minority caregivers and suggest that ethnicity and culture play a significant role in the stress and coping process for Latino caregivers. Caregivers of older Latinos face special challenges in the caregiving for individuals at higher risk for specific chronic diseases, who are disabled at earlier ages, and who have more functional disabilities. Ethnicity and culture can also influence the appraisal of stress events, the perception and use of family support, and coping behaviors. Socioeconomic class and minority group status are discussed as additional sources of variation in the caregiver stress and coping model.

Santiago, AM. Villaruel, FA. Leahy, MJ. Latino Access to Rehabilitation Services: Evidence from Michigan. American Rehabilitation, 1996, Spring, 10-17. [No abstract.]

Weller, B. Unmet needs for developmental disabilities services. Population & Environment: A Journal of Interdisciplinary Studies. 1994, 15(4), 279-302. Data were collected in face-to-face interviews from 312 persons who are developmentally disabled to determine the number of services these persons receive, the extent to which they do not receive services they need, the reasons these services are not received, and the factors that are related to satisfaction with services. A battery of 90 services that can be grouped into 8 general categories was used. Results show that unmet need for developmental services exists. One-third of the services reported as needed by the Ss were not currently being received. Unmet need is most pronounced for residential, education, and employment/vocational rehabilitation services. Predictors of a relatively high level of unmet need include physical impairments, Hispanic ethnicity, being a teenager, living in a family setting, and receiving relatively few services. (PsycINFO)

 

DIVERSITY/CULTURAL SENSITIVITY AND COMPETENCE

Andrews, JF. Jordan, DL. Minority and Minority - Deaf Professionals - How Many and Where Are They. American Annals of the Deaf. 1993, 138(5), 388-396. A survey of 6,043 professionals in 349 deaf education programs showed that 10.4% are from nonwhite or minority ethnic/cultural backgrounds. Of these minority professionals, 11.7% are deaf. Only 8 minority deaf administrators were found. Chi-square analyses showed that ethnic/cultural background and hearing loss were strongly associated with the type of program where the professionals were employed. More than half of the minority professionals worked in public schools. The District of Columbia, New York, and Maryland lead the country in the number of deaf professionals employed. More than half of all black deaf professionals work in either D.C. or New York. Texas leads the country in numbers of Hispanic professionals employed, and New Mexico has more Hispanic professionals than does California, New York, or Florida. [Human Resources, Professionals.]

Arnold, BR. Attitudinal research and the Hispanic handicapped: a review of selected needs. Journal of Rehabilitation. 1983, 49, (Oct./Dec.), 36-38. [Attitudes toward the physically handicapped. Rehabilitation services.]

Blanche, EI. Alma: coping with culture, poverty, and disability. American Journal of Occupational Therapy, 1996, 50(4), 265-76. This article raises questions about the ways culture affects the nature of health care services. By examining the life story of Alma, a Central American woman who has a daughter with disabilities; her interactions with health care providers; and my own assumptions about cultural differences, I note the impact of cultural differences on coping and adaptation in Alma and in the health care system when working with poor, non-English-speaking clients.

Hays, PA. Culturally responsive assessment with diverse older clients. Professional Psychology: Research & Practice. 1996, 27(2), 188-193. Clinical research in the field of geropsychology has focused primarily on older people of dominant cultural identities. The purpose of this article is to help psychologists conduct assessments that are more responsive to older people of diverse minority cultures. The ADRESSING framework (which represents age and generation-specific influences, disability, religion, ethnicity, social status, sexual orientation, indigenous heritage, national origin, and gender) is used to organize and consider diverse cultural influences and identities affecting older clients. Suggestions are offered for establishing rapport with older people of minority groups, understanding their cultural identities and heritage, and obtaining clients' histories with attention to generational and culture-specific contexts. (PsycINFO)

Middleton, RA, Flowers, C. Zawaiza, T. Multiculturalism, Affirmative Action, and Section 21 of the 1992 Rehabilitation Act Amendments: Fact or Fiction? Rehabilitation Counseling Bulletin, September 1996, 40(1), 11-30. (ABSTRACT AVAILABLE.)

Pape, DA. Walker, GR. Quinn, FH. Ethnicity and disability: Two minority statuses. Journal of Applied Rehabilitation Counseling. 1983, 14(4) 18-23. Discusses various problems associated with each stage of the rehabilitation process of disabled individuals of various ethnic minorities. It is asserted that the knowledge and understanding of cultural diversity factors as they relate to accurate problem identification, rehabilitation planning, and service provision is an important aspect of the rehabilitation of this population. Counselors must be aware of how cultural considerations affect the functional limitations of the disabled person, but they must also recognize that person as an individual who deserves individualized treatment planning. Concerns pertaining to job placement are also reviewed. (PsycINFO)

Presidents Committee on Employment of People with Disabilities. Operation People First: Toward a national disability policy. Journal of Disability Policy Studies. 1994, 5(2), 81-106. Describes 11 issues identified by the President's Committee on employment of People With Disabilities that constitute the principal remaining barriers to employment for people with disabilities. Three initiatives were given top priority: health care, Americans With Disabilities Act implementation and enforcement, and empowerment. Project findings in these areas are discussed as well as findings in the areas of personal assistance services, removal of work barriers from social services and creation of employment opportunities, mental health, education and the schools, attitudinal change, and minority issues. Special initiatives need to be developed to ensure that minority groups, including Blacks, Asian-Americans, Hispanics, and Native Americans, receive equal access to information, treatment, and services for people with disabilities. (PsycINFO)

Smart, JF. Smart, DW. The Rehabilitation of Hispanics Experiencing Acculturative Stress - Implications for Practice. Journal of Rehabilitation. 1994, 60(4), 8-12. This article defines the unique characteristics of acculturative stress encountered by Hispanic immigrants and documents the need for rehabilitative services for this group. Implications for rehabilitation practice are identified, including the need for (a) family, group, and community-based interventions; (b) good client counselor relationships; and (c) attention to language needs.

Smart, JF. Smart, DW. The rehabilitation of Hispanics with disabilities: Sociocultural constraints. Rehabilitation Education. 1993, 7(3), 167-184. Identifies 11 sociocultural problems that work against the job placement specialist as an attempt is made to place Hispanic persons with disabilities. These problems are (1) lack of culturally sensitive career development theories, (2) issues of ethnic density, (3) effects of 'tokenism,' (4) effects of social problems, (5) work disincentives, (6) learning without earning, (7) lack of technological skills, (8) low placement expectations, (9) job placement discrimination, (10) problems with standardized tests, and (11) limitation of job placement of private employers. It is argued that these problems are embedded in the cultural and social practices of the dominant society. (PsycINFO)

Smart, JF. Smart, DW. Acculturation, biculturalism, and the rehabilitation of Mexican Americans. Journal of Applied Rehabilitation Counseling. 1993, 24(2), 46-51. Reviews the literature on the acculturation and biculturalism processes of Mexican-Americans, the measurement and assessment of acculturalism and biculturalism, and possible relationships between acculturation of Mexican- Americans and rehabilitation practice. Acculturation can be behavioral, psychological, and/or sociocultural and is generally thought of as the acquisition of a second culture. Possible relationships may exist between level of acculturation and (1) disability, (2) psychometric evaluation, and (3) acceptance of disability. Implications for rehabilitation practice are given. (PsycINFO)

Smart, JF. Smart, D. The Use of Translators Interpreters in Rehabilitation. Journal of Rehabilitation. 1995, 61(2), 14-20. A marked change which faces the rehabilitation profession is the extension of services to individuals who are not fluent in English. Thus, the services of interpreters/translators are necessary. This article, which is based upon a review of rehabilitation literature and the authors' experience in bilingual practice, advocates the use of trained and supervised interpreters/translators in order to provide ethical and successful services. Problems and cautions in the use of translators are outlined as well as recommendations to assist the rehabilitation worker in the use of translators/interpreters.

Swensen, JG. Counseling the forgotten neighbor: Implications in the rehabilitation of migrant and seasonal farmworkers. Journal of Applied Rehabilitation Counseling. 1994, 25(2), 7-10. Compares migrant and seasonal farm workers with disabilities to static neighbors. The article addresses effective cross-cultural counseling variables. Concepts such as migration, cultural disadvantages, Hispanic traits that demonstrate ethnicity, and barriers that impede the disabled worker are discussed. The process of rehabilitation and cultural sensitivity in counseling are examined, from referral and eligibility to plan formulation and closure. Effective counselor-client relationships facilitate service delivery and overcome cultural barriers. Education of rehabilitation counselors working with Hispanic populations is called for. (PsycINFO)

Zea, MC. Belgrave, FZ. Townsend, TG. Jarama, SL. Banks, SR. The influence of social support and active coping on depression among African Americans and Latinos with disabilities. Rehabilitation Psychology. 1996, 41(3), 225-242. Examined relationships among depression, active coping, and social support in a sample of 109 African American and 57 Latinos with disabilities. Measures included Beck and Beck (1972) short version of the Depression Inventory, Brandt and Weinert's (1981, 1987) Personal Resources Questionnaire (PRQ), and the condensed version of Tyler's (1978) Behavioral Attributes of Psychosocial Competence Scale (Zea, Reisen, & Tyler, 1996). Findings indicated that active coping, satisfaction with social support, and type of disability were significant predictors of depression for African Americans, whereas active coping, perception of severity of disability, and social support were significant predictors of depression for Latinos. These findings underscore the importance of testing separate models for African Americans and Latinos.

Zea, MC. Quezada, T. Belgrave, FZ. Latino cultural values: Their role in adjustment to disability. Special Issue: Psychosocial perspectives on disability. Journal of Social Behavior & Personality. 1994, 9(5), 185-200. Reviews Latino cultural values and their impact on adjustment and the rehabilitation process. Allocentrism, familialism, and interdependence may enlist family help in rehabilitation. Well-defined gender roles may contribute to denial of the disability in the case of men, but to 'aguante' or endurance for women. A present-time orientation may make long-term planning of treatment difficult. 'Simpatia,' power distance, and 'respeto' may be reflected by the imbalance in relationships with health care providers and rehabilitation specialists, and emphasis on the traditional past orientation of Latino culture may impact long-term rehabilitation planning. Spirituality may influence the beliefs of clients regarding the explanation of disability as determined by supernatural forces. It is concluded that an understanding of culture and the role it plays in adjustment to disability and rehabilitation is essential for specialists and professionals. (PsycINFO) [Rehabilitation]

 

WORK, EMPLOYMENT, AND VOCATIONAL REHABILITATION

Meier, KN. (1993). Culture-Specific Variables That May Affect Employment Outcomes for Mexican-American Youth with Disabilities. In: Dais, Teresa, et al (Eds.). Selected Readings in Transition: Cultural Differences, Chronic Illness, and Job Matching. Volume 2; see ERIC-EC303150. This paper reviews variables specific to the Mexican-American culture that might influence work-related behavior and outcomes for youths with disabilities from this population. Areas covered include: parental/family network; cultural view of disability; religious influences; acculturation levels; language issues; education and employment relationships; substance abuse; folk illnesses; and cultural concepts such as "machismo," marianismo," and "familism". The paper then examines the limited (and possibly inconsistent) research on outcomes in supported employment and youth work programs for Latino youths with disabilities. These studies appear to show that these youths do as well as or better than their counterparts from other ethnicities. Recommendations for improvement in service delivery are offered, such as encouraging involvement from local minority business, developing cultural pride and awareness programming, and locating service programs in non-intimidating buildings accessible by public transportation. (ERIC).

Smart, JF. Smart, DW. Vocational evaluation of Hispanics with disabilities: Issues and implications. Vocational Evaluation & Work Adjustment Bulletin. 1993, 26(3), 111-122. Discusses issues that influence the vocational evaluation of Hispanics with disabilities. These issues include defining Hispanic populations; historical and ongoing racial bias in testing and evaluation; inequitable employee selection; inappropriate test content, standardization samples, test instructions, motivational sets, and response sets; culture- and language-biased test items; lack of cultural sensitivity of vocational evaluators; clients' lack of test-taking strategies; and controversy over 'equal outcome' vs 'equal treatment' of evaluation results. Implications for improved quality of vocational counseling are drawn. (PsycINFO)

Trevino, B. Mora Szymanski, E. A Qualitative Study of the Career Development of Hispanics with Disabilities. Journal of Rehabilitation, 1996, July-Sept., 5-13. Career development of Hispanics with disabilities was the focal problem of this study. Participants were 7 Hispanic women and 3 Hispanic men. 20 interviews were conducted and recorded. Additional data were collected through in-depth questionnaires. A grounded theory approach was used to identify, categorize, and connect themes. Two overriding themes emerged. First, career motivation was defined by experiences relating to developmental work motivation, the meaning of work, and the hierarchy of work needs. The second, vocational behavior, related to personal attributes, disability and work, and barriers and supports.

 

OTHER RESOURCES

Walker, S. (Ed.) (1991). Future Frontiers in the Employment of Minority Persons with Disabilities. Proceedings of the National Conference (March 28-30, 1990). Washington, DC.: Howard Univ. Research and Training Center for Access to Rehabilitation and Economic Opportunity; President's Committee on Employment of People with Disabilities, Washington, DC. This proceedings reports on a national conference which explored means of eliminating and reducing barriers to employment, educational opportunities, and rehabilitative services for minority individuals with disabilities. Section I, titled "Policy Implications and Future Forecasts,": "Future Frontiers in the Employment of Minority Persons with Disabilities: NIDDR's Role" (William H. Graves); "Status of Minority Persons with Disabilities: Where Do We Go from Here"? (Howard Moses); "Prevalence, Distribution and Impact of Disability among Ethnic Minorities" (Sylvia Walker et al); "Differences in Rehabilitation Service Utilization Patterns of African Americans and White Americans with Disabilities" (Faye Z. Belgrave and Sylvia Walker); and "Substance Abuse among Physically Disabled Patients in a Hospital Serving Urban Minorities" (Herbert L. Thornhill). Section II, "New Frontiers in Multicultural Approaches," includes: "Enhancing Diversity: A Multicultural Employment Perspective" (Lynda R. Campbell); "Hispanics with Disabilities in the Work Force: A Window of Opportunity" (Antonio Suazo); "Vocational Rehabilitation and the American Indian: Where Is the Innovation"? (Jennie R. Joe); "The Employment of Asian/Pacific Minority Persons with Disabilities" (Alan H. Woo). Section III, "Frontiers in Assistive Technology?": "Future Frontiers in the Access to Technology" (Robert W. Nicholls); "Hearing To Read: The Kurzweil Reading Machines" (Grace J. Lyons); "What Is Appropriate Technology"? (Jan Galvin and Betsy Phillips); "The Computer: A Vehicle for Access for People with Disabilities" (Susan Boaz); and "Information Technology Program for Persons with Disabilities" (Patrick Sheehan). The final section, "Advancing Frontiers through Collaboration," contains "Bridges to Leadership 2000: Howard University Youth Leadership Training Program" (Sylvia Walker and Satwant Kaur); "Maximizing Potential: The Parents' Role" (Shirley Poindexter Dyer); "America's Mean Streets: A Challenge to Youth" (Isaac W. Hopkins); "Collaborative Models: Partnerships for Success" (Joyce Keener); and "Empowering Minority Persons with Disabilities through Collaboration" (Toni Killings). (ERIC).

6. Latino Health Status: Risk Factors for Chronic Conditions, and  
    Disability

This section presents selected abstracts of a wide variety of work in this area. It is our observation that much work has been done in this area, but that much of the work that has been done is of limited quality. While much effort has addressed inclusion of Latinos, there is little specification or segmentation by Latino subgroups, gender, or age groups. While part of this problem may be due to parsimonious instrument designs, a greater proportion is due to a failure to include appropriate population measures (see Section VIII) such as place of birth, acculturation, etc.


Mendoza, FS. Ventura, SJ. Valdez, RB. Castillo, RO. Saldivar, LE. Baisden, K. Martorell, R. Selected Measures of Health Status for Mexican-American, Mainland Puerto Rican, and Cuban-American Children. Journal of the American Medical Association, 1991, 265(2), 227-232. The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of "Hispanic" children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Rican having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic groups than among non-Hispanic whites. Mexican-American and Cuban-American children has a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.

Molina, CW. & M. Aguirre-Molina (Eds.) Latino Health in the US: A Growing Challenge. Washington, DC: American Public Health Association, 1994.

Paneth, NS. The Problem of Low Birth Weight. Future of Children. 1995, 5, 19-34. Low birth weight is a major public health problem in the United States, contributing substantially both to infant mortality and to childhood handicap. The principal determinant of low birth weight in the United States is preterm delivery, a phenomenon of largely unknown etiology. Preterm delivery is more common in the United States than in many other industrialized nations, and is the factor most responsible for the relatively high infant mortality rate in the United States. Within the United States, Asian populations experience the lowest preterm delivery rates, while Hispanic and Native American populations experience slightly higher preterm delivery rates than the white population. African Americans, however, have much higher rates of preterm delivery than any of the other major ethnic groups. Poverty is strongly and consistently associated with low birth weight, but the precise social and environmental conditions that produce preterm delivery have not been elucidated. Although it is popular to link illicit drug use to low birth weight, a high low birth weight rate was characteristic of the United States for decades before the cocaine epidemic of the 1980s. Neither the low birth weight rate nor the preterm delivery rate has improved in the United States in the past quarter century. Most efforts to prevent prematurity or low birth weight, when carefully evaluated, have not proven effective. A major goal of biomedical research ought to be better understanding of the causes of this important public health problem.

@Plepys, C. Klein, R. Health Status Indicators: Differentials by Race and Hispanic Origin. Statistical Notes, Number 10, September 1995. Hyattsville, MD: National Center for Health Statistics.

Reveille, JD. Moulds, JM. Arnett, FC. Major Histocompatibility Complex Class II and C4 Alleles in Mexican Americans with Systemic Lupus Erythematosus. Tissue Antigens, 1995, 45(2), 91-97. Few data exist on associations of class II and class III alleles of the major histocompatibility complex (MHC) and susceptibility to systemic lupus erythematosus (SLE) in Mexican Americans, a group of predominantly mixed Spanish and Native American ancestry. Therefore, MHC class II alleles (HLA-DRB1, DQA1, DQB1, DPA1 and DPB1 alleles) and C4 allotypes were determined in 52 Mexican American SLE patients and 105 ethnic-matched controls. HLA-DRB1*0301 and C4A* Q0 were each increased in the SLE patients, especially HLA-DRB1*0301 in those with anti-Ro/SSA autoantibodies. C4A*Q0 was associated with HLA-DRB1*0301 only in a minority of patients and controls. Anti-U1-RNP antibodies were significantly associated with the presence of HLA-DQB1*0302, and the risk for the production of anti-Re antibodies was heightened by the presence of at least three (out of four possible) DQA1 chains possessing a glutamine at position 34 and/or DQB1 chains a leucine at position 26 of their outermost domains. Thus the HLA class II and C4 null allele associations that have been noted in other ethnic groups are also found in Mexican Americans, suggesting shared susceptibility factors across ethnic lines in predisposition to SLE. [Systemic Lupus Erythematosus.]

Roberts, RE. Lee, ES. The health of Mexican Americans: evidence from the human population laboratory studies. American Journal of Public Health. 1980, 70(4), 375-84. Data are presented from sample surveys conducted in 1974 (N=3,119) and 1975 (N=657) in Alameda County, California, by the Human Population Laboratory. Mexican Americans are compared to Anglos and Blacks on selected health status indicators; chronic conditions, disability, symptoms and a summary measure, the Physical Health Spectrum. Comparisons of crude percentages indicate that, compared to Anglos, Blacks report having more chronic conditions, more disability and more symptoms, while Chicanos generally report fewer health problems than these two groups. Controlling for the effects of age, sex, education, family income, marital status, and perceived health reduces the Anglo/Black differentials in reported health problems, primarily by reducing the rates for Blacks. However, even after adjustment the prevalence rates for Blacks remain higher. After controlling for the effects of the six covariates, the rates for Chicanos remain essentially unchanged in both samples, e.g., lower than the other groups. Results of binary regression analysis indicate that the two most powerful predictors of health status in both samples are age/sex and perceived health. Ethnicity overall is not a good predictor of health status, accounting for 1 per cent or less of the explained variance. Socioeconomic status, while predicting slightly better than ethnicity, still accounts for less than 2% of the variance in health status.

Stern, MP. Patterson, JK. Haffner, SM. Hazuda, HP. Mitchell, BD. Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey [see comments]. Journal of the American Medical Association, 1989, 262(3), 360-4. (Comments in: JAMA 1989 Jul 21: 262(30): 398-9; JAMA, 1990, 263(17), 2302.) Cardiovascular disease is the leading cause of morbidity, disability, and death among patients with type II (non-insulin-dependent) diabetes mellitus. Moreover, hyperlipidemia is also common among these patients. Despite this, there are virtually no data regarding the level of awareness and treatment of hyperlipidemia among diabetic subjects at the community level. We therefore examined 374 Mexican-Americans and 86 non-Hispanic whites with type II diabetes identified in an epidemiologic survey that involved 3279 Mexican-Americans and 1847 non-Hispanic whites who resided in San Antonio, Tex. More than 40% of the diabetic subjects were hyperlipidemic according to the criteria of the National Cholesterol Education Program, and an additional 23% had hypertriglyceridemia and/or low levels of high-density lipoprotein cholesterol. By contrast, less than one fourth of the nondiabetic subjects were hyperlipidemic. Only approximately 25% of non-Hispanic whites with diabetes were aware of their hyperlipidemia, and less than 10% were receiving treatment. Awareness and treatment were even less frequent among Mexican-Americans with diabetes. Community physicians should be encouraged to give early attention to the management of lipid disorders in their diabetic patients. [Diabetes.]

Valencia, RR. Chapa, J. Special Issue - Latino Population Growth and Demographic Trends - Implications for Education - Introduction. Hispanic Journal of Behavioral Sciences. 1993, 15(2), 163-164. [EDITORIAL. Demographics.]

Vega, WA. Amaro, H. Latino Outlook: Good Health, Uncertain Prognosis. Annual Review of Public Health, 1994, 15: 39-67. This article presents a profile of the health status of Hispanic (Latino) populations in the U.S. This review is issue oriented and identifies those factors that have a continuing influence on Hispanic health. This review provides a demographic comparison of Hispanic ethnic groups, an assessment of health status for the largest groups, a brief summary of health services utilization, and a discussion of health promotion and disease prevention.


A INJURY AND TRAUMA

Agran, PF. Winn, DG. Anderson, CL. Tran, C. Delvalle, CP. The Role of the Physical and Traffic Environment in Child Pedestrian Injuries. Pediatrics. 1997, 98(6), 1096-1103. Objective: To identify environmental risk factors on residential streets for pediatric pedestrian injuries. Method: The sample consisted of 39 Latino children 0 to 14 years of age injured as pedestrians on a street in the same block as their home and 62 randomly selected neighborhood control subjects matched to the case by city, age or year of birth, ethnicity, and gender. The cases were identified from a population- based hospital and coroner's office surveillance system established in north-central Orange County, CA. Neighborhood assessments were performed from 3:45 PM to 5 PM, a fairly active time for young pedestrians. The cases were compared with the controls using conditional logistic regressions; in this study design, the odds ratios were interpreted as estimates of the incidence rate ratios. Results: Children living in a multifamily residence had an incidence of injury greater than that of children living in single-family residence on a single lot (odds ratio `ORï 3.1, 95%confidence interval `CIï 1.3-7.6). The ORs in the highest category were several times those in the lowest category for both parked vehicles (OR 9.6, 95% CI 2.6-36) and total number of pedestrians observed (OR 4.7, 95% CI 1.4-16). Vehicle parking, total pedestrians, vehicular traffic volume, and speed were examined in a multivariate model. The association of vehicles parked on the street with pedestrian injury risk remained significant. Unlike the crude results, progressively greater vehicular speed was associated with a marked increase in risk. Progressively higher vehicular traffic volume was associated with a progressively lower adjusted OR. Conclusion: The results of this analysis would indicate that residential streets with a high proportion of multifamily residences, over 50% of the curb occupied with parked vehicles, and a large number of pedestrians observed in unenclosed areas should receive high priority for intervention programs to reduce pediatric pedestrian injuries. The analysis suggests that on these streets, measures to reduce the amount of street parking (thus increasing visibility) and reductions in vehicular speed should he considered to decrease pedestrian injuries.

Agran, PF. Winn, DG. Anderson, CL. Delvalle, CP. Pediatric Injury Hospitalization in Hispanic Children and Non-Hispanic White Children in Southern California. Archives of Pediatrics & Adolescent Medicine. 1996, 150(4), 400-406. Objective: To compare the incidence and causes of injury requiring hospitalization or resulting in death or both between Hispanic children and non-Hispanic white children. Design: Population-based surveillance of children younger than 15 years residing in eight Orange County cities and communities who were hospitalized or died of injuries sustained during 1991 and 1992. Setting: Eight hospitals and the coroner's office in central Orange County, California. Participants: Study population was 213,906 children residing in the study area. Forty-nine percent were Hispanic, 37% were non-Hispanic white, 12% were Asian or Pacific Islander, and 3% were of other racial origin. Results: A total of 1361 severe injuries were identified (crude annual rate was 318 per 100 000 population). The crude incidence rate ratio comparing Hispanics and non-Hispanic whites was 1.82. After adjustment for census block group, Hispanic children had a 60% higher injury rate and incidence rate ratios of more than 2 for pedestrian injuries, asphyxia, aspirations, foreign-body ingestions, and poisonings. Conclusions: Hispanic children had higher injury rates than non-Hispanic white children, even when controlling for census block group. These rate differences may be related to differences in exposure to various causes of injury, injury prevention practices, parenting practices, family size, and language. Injury rate differences by ethnicity that address specific injury hazards must be explored to guide prevention efforts. More culturally and linguistically appropriate interventions are needed to provide injury prevention programs to the Hispanic population.

Agran, PF. Winn, DG. Anderson, CL. Who Carries Passengers in the Back of Pickup Trucks. Accident Analysis and Prevention. 1995, 27(1), 125-130. This study was designed to compare pickup truck drivers who carried passengers in the back with those who did not, with respect to driving behaviors, sociodemographic features, and issues related to use of the pickup truck. A computerized assisted telephone survey was conducted in Riverside County, California. One thousand ten motor vehicle drivers were interviewed with respect to demographics, restraint use, driving behaviors, and variables related to vehicle use. Thirty-six percent (364) of the households had a pickup truck driver. Pickup drivers were grouped into those who stated that they had carried occupants in the back (n= 119) and those who had not (n= 245). A higher proportion of 16- to 24-year-old and 35-to 44-year-old pickup truck drivers carried passengers in the back of pickup trucks. Those who carried occupants in the back were significantly more likely to be Hispanic to be students, and to live in a household that included teenagers. They also had a larger mean household size. They were less likely to own the pickup and less likely to be the principal wage earners. They were more likely to report four high-risk driving behaviors. They also used the pickup truck for multiple purposes, i.e. recreation, work, school transportation, and daily transportation. In the multivariate analysis, the presence of teenagers in the household, three high-risk driving behaviors, and three indicators of pickup truck use were independently related to carrying passengers in the back of a pickup. Those who allowed passengers in the back were significantly less likely to agree with statements suggesting restriction of travel in the back. Finally, only 9% of the respondents who carried passengers in the back of a pickup reported that the pickup truck was the only vehicle available in the household.

Aughan, RD. Mccarthy, JF. Armstrong, B. Walter, HJ. Waterman, PD. Tiezzi, L. Carrying and Using Weapons - A Survey of Minority Junior High School Students in New York City. American Journal of Public Health. 1996, 86(4), 568-572. To explore weapon carrying among young, inner-city adolescents, a survey was administered in fall 1993 to 2005 predominantly Hispanic students (mean age = 12.8 years) in three New York City junior high schools. The survey revealed that 21% of students reported personally carrying a weapon; guns and knives were the weapons most commonly carried. Most of those who carried guns reported that they bought them. Forty-two percent indicated that they had a family member or close friend who had been shot. Boys and older students were more likely to report carrying weapons. Preventive efforts may need to begin before or on entry into junior high school rather than high school. [Violence Risk.]

Baker, RS. Wilson, MR. Flowers, CW. Lee, DA. Wheeler, NC. Demographic Factors in a Population-based Survey of Hospitalized, Work-related, Ocular Injury. American Journal of Ophthalmology. 1996, 122(2), 213-219. Purpose: To obtain population- based estimates of the incidence of severe work-related ocular trauma and to identify demographic factors related to increased risk of this type of injury. Methods: A statewide population-based survey of severe work-related ocular injury was performed using hospital discharge data, These data were derived from all inpatient admissions to nonfederal, acute care hospital facilities in the state of California during 1988. Worker's compensation was used as the principal payor code to establish the work-relatedness of a given ocular injury. Census data for the state of California were used to obtain population denominators. Results: 269 (approximately 14.3%) of all admissions for which ocular trauma was the principal diagnosis (1,876) were work related. Annual incidence for severe work related ocular injury was 1.76 per 100,000 employed persons when ocular trauma was the principal diagnosis and 2.98 per 100,000 employed persons when ocular trauma was a principal or secondary diagnosis. Projected to the working-age United States population (128 million) these annual rates correspond to an estimated 2,165 acute hospitalizations for work-related ocular trauma as the principal diagnosis, and an estimated 3,745 acute hospitalizations for work-related ocular trauma as a principal or secondary diagnosis. Incidence of severe work-related ocular injury was highest among men, Hispanics, and individuals 20 to 24 years of age (5.02, 3.72, and 4.64 per 100,000 employed per year, respectively). Conclusions: The workplace accounts for a substantial proportion of severe ocular injury. Demographic groups at highest risk for this type of injury are men, Hispanics, and young adults. [Risk: Blindness, Sight Impairment.]

Chang, I. Lapham, SC. Barton, KJ. Drinking Environment and Sociodemographic Factors among DWI Offenders. Journal of Studies on Alcohol. 1996, 57(6), 659-669. Objective: This study was designed to identify issues for public health/traffic safety in prevention of DWI and alcohol-related traffic injuries/deaths by investigating the relationships among drinking locations, sociodemographic characteristics and drinking environment- related factors of convicted DWI offenders. Method: Subjects were clients (N = 5,154, 79% male) referred to the Lovelace Comprehensive Screening Program for alcohol-related assessment and were interviewed by counselors using a structured, computer-based questionnaire. Differences among ethnic/racial and gender categories were analyzed by logistic regression. Results: (1) Some groups showed a higher rate of DWI convictions, compared to the adult county population: young, single male; Hispanic and Mexican national; marital status: divorced/separated/widowed (increasing with age); (2) older, educated or employed offenders reported drinking more in bars/lounges, while younger offenders were more likely drinking in private parties; (3) Hispanic and Mexican National men showed equal likelihood of drinking with friends and relatives in bars/lounges, whereas non-Hispanic white males reported drinking more with friends; and (4) Native Americans were associated with higher blood alcohol concentration (BAC) and alcohol-related problems. Conclusions: (1) Young offenders' drinking and social behavior in private parties has implications for traffic safety; (2) divorced/separated offenders suggest a need for attention to underlying emotional problems; (3) strong family ties among Hispanics and Mexican nationals may be a factor in remedial treatment; (4) Native American BAC statistics showed a need for further study; (5) multiple offenders' association with away-from-home drinking locations increased their risk of being involved in fatal crashes; and (6) server intervention programs should be emphasized to minimize intoxication of customers in commercial establishments.

Christoffel, KK. Donovan, M. Schofer, J. Wills, K. Lavigne, JV. Tanz, RR. Barthel, M. Jenq, J. Klinger, C. Mcguire, P. Psychosocial Factors in Childhood Pedestrian Injury - A Matched Case-Control Study. Pediatrics. 1996, 97(1), 33-42. Hypothesis: Psychosocial factors-such as hyperactivity and low family cohesion-contribute to the risk for child pedestrian injury (PI), even after controlling for known demographic risk factors. Participants. Urban PI victims aged 5 to 12 years were recruited from one large, urban pediatric trauma center in a large city. One hundred twenty-eight cases were matched to uninjured children on age, sex, race, location of residence, and parental education. Among matched cases: 70% were male, 41% were black, 33% were Hispanic, and 66% of the mothers had a high school education or less. Research Design and Measurements: Case-control comparisons on 19 psychosocial variables drawn from interviews and standardized tests, using one-tailed matched-pairs t tests and conditional logistic regression analyses. Results: Cases had higher reported physical quotient `PQï (P =.01), self-help quotient (P = .04), and family stress (P = .02), and lower family supportiveness (P = .03). Multivariate analyses confirmed that PQ was higher in cases (10-point increase: odds ratio (OR) = 1.32 `90% confidence interval (CI) 1.01-1.76ï, that stress was higher in cases (1 log increase: OR 2.13, `1.26-3.61ï), and that cases had lower family supportiveness (25-point decrease: OR 1.43, `1.25-1.63ï). It also identified household crowding as a factor for non-black cases (OR for increase of 0.25 people per room: 2.18, `1.31-3.62ï). Conclusion: Even when controlling for demographic risk, several family factors and one child factor place children at risk for PI. Clinicians may choose to use these as indicators for injury prevention counseling. Research on family effects may help clarify means to protect children who are demographically at risk for PI.

Ginsburg, HJ. Mendez, R. Padilla, E. Arocena, M. et al. Perceptual development and early childhood injuries: A prospective pilot study. Perceptual & Motor Skills. 1993, 76(1), 125-126. A prospective pilot study of 172 Hispanic children and their mothers was performed to identify developmental predictors of 9 maternal reports of childhood injuries that required medical attention during the following year. The 1972 McCarthy Scales of Children's Abilities (MSCA) was administered near the children's 3rd birthday, and maternal reports of injuries were obtained 1 year later. The Verbal, Perceptual, Quantitative, Memory, and Motor Subscales of the MSCA accounted for a small but significant proportion of variance. Ss who showed advanced abilities on the Perceptual subscale were more likely to be reported as having an injury requiring medical attention during the subsequent 12 month period. [Injury risk; parent perceptions; measurement.]

Lee, P. Orsay, E. Lumpkin, J. Ramakrishman, V. Callahan, E. Analysis of Hispanic Motor Vehicle Trauma Victims in Illinois, 1991-1992. Academic Emergency Medicine. 1996, 3(3), 221-227. Objective: 1) To develop a profile of Hispanic motor vehicle trauma victims in Illinois, 2) to ascertain whether differences exist between Hispanic and general-Illinois-population motor vehicle trauma victims, and 3) to identify potential target areas for future injury intervention programs. Methods: A retrospective analysis of Illinois motor vehicle trauma patients admitted from July 1991 to June 1992 was made. Participants were motor vehicle trauma victims (drivers and passengers) who presented to one of 73 level I or level II trauma centers throughout Illinois and were entered into the Illinois Trauma Registry (ITR) from July 1, 1991, through June 30, 1992. Results: Of the 12,299 motor vehicle trauma victims in the ITR, 771 (6.3%) were Hispanic, 8,979 (73.0%) were white, 1,115 (9.1%) were black, and 1,434 (11.6%) were other. When compared with the other racial groups, the group of Hispanic victims were younger (25.2 vs 33.2 years), had higher male predominance (72.8% vs 60.9%), and had the lowest rate of safety equipment/occupant restraint use (21.7% vs 34.7%). A high alcohol use rate (30.7%) and high mean serum ethanol levels (44 mmol/L; 0.2 mg%) were noted. When contrasted with other racial/ethnic groups, the Hispanic victims had lower Injury Severity Scale scores (p < 0.001), but mean hospital charges tended to be higher, with fewer alternative sources of payment (p < 0.001). Conclusion: Using age-adjusted data from the ITR, Hispanic motor vehicle trauma victim features differ significantly from those of other racial groups. Effective health maintenance and injury prevention strategies should address the basis for these differences.

Looker, AC. Johnston, CC. Wahner, HW. Dunn, WL. Calvo, MS. Harris, TB. Heyse, SP. Lindsay, RL. Prevalence of Low Femoral Bone Density in Older US Women from NHANES III. Journal of Bone and Mineral Research. 1995, 10(5), 796-802. Data on the number of U.S. women with low femoral bone mineral density (BMD) are currently available only from indirect estimates. We used dual-energy X-ray absorptiometry (DXA) measurements of femoral BMD from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III, 1988-1991) to estimate prevalences of low femoral BMD in women ages 50 years and older using an approach proposed recently by an expert panel of the World Health Organization (WHO). Cutpoints for low BMD were derived from BMD data of 194 non-Hispanic white (NHW) women aged 20-29 years from the NHANES III dataset. The prevalence of older U.S. women with femoral osteopenia (BMD between 1 standard deviation `SDï and 2.5 SD below the mean of young NHW women) ranged from 34-50% in four different femur regions, which corresponds to similar to 12-17 million women. The prevalence with osteoporosis (BMD > 2.5 SD below the mean of young NHW women) ranged from 17-20, or similar to 6-7 million women. Prevalences were 1.3-2.4 times higher in NHW women than non-Hispanic black women (NHB), and 0.8-1.2 times higher in NHW versus Mexican American (MA) women. The estimated numbers of NHW, NHB, and MA women with osteopenia were 10-15 million, 800,000-1.2 million, and 300,000-400,000, respectively; corresponding figures for osteoporosis were 5-6 million, 200,000-300,000, and 100,000 respectively. Thus, the first data on BMD from a nationally representative sample of older women show a substantial number with low femoral BMD. The majority of these women are white, but the number of minority women with low BMD is not trivial. (Comment: Lower rates of osteoporosis may result in lower rates of injury among Mexican-American women.)

Martinez, R. Veloz, RA. A Challenge in Injury Prevention - The Hispanic Population. Academic Emergency Medicine. 1996, 3(3), 194-197.

Matteucci, RM. Holbrook, T. Hoyt, DB. Molgaard, C. Trauma among Hispanic Children - A Population-based Study in a Regionalized System of Trauma Care. American Journal of Public Health. 1995, 85(7), 1005-1008. We studied 1164 injured Hispanic and 2560 injured non-Hispanic White children newborn through 14 years triaged to the San Diego County regionalized Trauma System from 1985 through 1990. Incidence rates did not differ by ethnic group. Hispanic children were more likely to be struck as pedestrians (odds ratio `ORï = 1.5) and less likely to be injured in falls (OR = 0.7) than non-Hispanic White children. For motor vehicle and pedal cycle injuries, Hispanic children were more likely not to have been restrained by seatbelts (OR = 4.0) or car seats (OR = 3.7).

Payne, JE. Berne, TV. Kaufman, RL. Dubrowskij, R. Outcome of Treatment of 686 Gunshot Wounds of the Trunk at Los Angeles County-USC Medical Center - Implications for the Community. Journal of Trauma. 1993, 34(2), 276-281. The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. Their records were coded by trauma nurse reviewers and held in the Trauma Emergency Medical Information System (TEMIS) and Automated Medical Record Abstracting and Reporting System (AMRARS). Diagnoses, procedures, and complications were verified by chart review. An estimate of disability 3 months after discharge was made from the record and reported on a functional activity scale. The total number of patients with GSWs admitted to all of the level I Los Angeles County trauma centers was 2771 during the study period. The total number of patients with major gunshot injuries admitted to LAC-USC Medical Center was 1007. Thoracoabdominal wounds without any head wound component occurred in 686 gunshot patients. Three quarters of the injured patients with truncal gunshot injuries were Hispanic. Total length of stay at the LAC-USC Medical Center for those with truncal wounds was 4666 hospital bed days including 432 ICU bed days, representing a minimum estimated total medical cost of $5,441,334. Annual medical cost of all admissions including rehabilitation, however, could be as great as $12 million for the Medical Center and $53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients. Mortality was 12% overall and 9.5% after truncal GSWs. Major visceral injuries occurred in 245 survivors of truncal wounds, of whom 49% were still disabled 3 months later. Spinal injuries occurred in 35 patients. Gunshot wounds of the trunk are accompanied by monetary costs and health consequences that are extremely high. They should be fully understood by the medical profession, the community, and their legislators. Appropriate taxation of firearms and ammunition to offset these medical costs should be considered. (Note; possibility of Hispanic data.)

Rodriguez, MA. Brindis, CD. Violence and Latino Youth - Prevention and Methodological Issues. Public Health Reports. 1995, 110(3), 260-267. Latino communities bear a disproportionate share of violence-related morbidity and mortality, yet little attention has been given to ethnic-cultural differences and their implications for violence prevention research and health promotion efforts. To date, much of what is known about violence among Latinos is based on regional homicide studies. Little formal data exist that assess and substantiate what is known about Latino cultures and their implications for the study of all aspects of violence, particularly prevention. This paper presents an overview of the scope of homicide and intentional injuries in Latino communities, reviews risk factors for intentional injuries, and discusses the implications of ethnic-specific factors for violence prevention and research efforts. Data collection and methodological issues and their implications for violence prevention research and health promotion efforts among Latino populations are specifically addressed.

Rosenthal, M. Dijkers, M. Harrison Felix, C. Nabors, N. Witol, AD. Young, ME. Englander, JS. Impact of Minority Status on Functional Outcome and Community Integration Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 1996, 11(5), 40-57. Objective: To determine whether minority status affected short-term and 1-year functional outcome and community integration for patients with traumatic brain injury (TBI) in the TBI Model Systems National Data Base. Design: Prospective study, consecutive sample. Setting: Four tertiary care rehabilitation centers. Patients: Five hundred and eighty-six patients with TBI admitted to one of four TBI Model Systems programs from February 1989 through June 1995. Inclusion criteria for the study included evidence of a TBI, admission to the system hospital emergency department within 8 hours of injury, 19 years of age or older, and acute care and inpatient rehabilitation within the system hospitals. Information was collected for demographics such as race, age, gender, education, employment status, marital status, and data related to the injury such as injury severity, etiology of injury, and payer source. Over half of the sample was white (53.4%) with the 46.6% of minorities composed of blacks (37.2%), Hispanics (7.3%), and Asians (2.0%). Main Outcome Measures: Functional outcome was measured with the Functional Independence Measure (FIM). Disability Rating Scale (DRS), and Community Integration Questionnaire (CIQ). The FIM and DRS were measured at inpatient rehabilitation admission, discharge, and 1 year post injury. The CIQ total score and subscale scores for Home Integration, Social integration, and Productivity were obtained at 1-year post injury. It was hypothesized that minority status would not predict functional outcome after acute rehabilitation but would predict functional outcome and community integration at 1 year post injury. Results: There were no significant differences between whites and minorities for DRS and FM scores at acute rehabilitation discharge. There were also no significant differences between whites and minorities on FIM scores 1 year post injury, but there were significant differences between whites and minorities on the Social Integration and Productivity subscales and total score of the CIQ. Multiple regression indicated that minority status predicted functional outcome for CIQ total score (r=-.28) and two subscales, Social Integration (r=-.28) and Productivity (r=-.23) even after controlling for etiology, severity of injury, age, gender, and functional status a rehabilitation discharge. Conclusions: Although minority status does not negatively impact recovery of basic mobility and daily living skills, it may impact long-term outcome related to community integration as measured by productivity and social integration. Greater outreach and access to postdischarge services and support may be needed to optimize community integration outcomes. Further studies are needed to determine how best to serve the needs of this segment of the population with TBI.

Schenker, MB. Lopez, R. Wintemute, G. Farm-Related Fatalities among Children in California, 1980 to 1989. American Journal of Public Health. 1995, 85(1), 89-92. To evaluate farm-related deaths among children in California and to identify specific risk factors, this study used death-certificate tapes to identify 40 farm-related deaths among children under age 15 in California for 1980 to 1989. Mortality rates and odds ratios for cause-specific unintentional farm deaths were calculated. While California's farm- related mortality rate was lower than those in the midwestern states studied, the rate for Hispanic boys was 70% higher than that for non-Hispanics. The odds of death from machinery (81.3), animals (10.1), electricity (5.2), and nontraffic motor vehicles (3.4) were significantly greater than those in nonfarm locations; those from drowning were significantly lower (0.2). Specific factors associated with the lower California mortality rate need to be identified.

Weddle, M. Bissell, R. Shesser, R. Perceptions of Preventability among Acutely Injured Hispanic Patients. Journal of Safety Research. 1996, 27(3), 175-181. Attitudes and belief systems are regarded as major factors affecting the success of injury prevention efforts. It is not known whether cultural belief systems affect the injury rates of Hispanics in the United States, a population that is known to be at high risk for injury. We interviewed Hispanic injury patients requiring emergency treatment, and we asked them to put into words their ideas and beliefs concerning the preventability of their injuries. Male patients and victims of unintentional injuries were more likely to consider their injuries unavoidable. Younger patients were more likely to not know if their injuries could have been avoided, and patients with higher family income were more likely to think that a change in someone else's behavior could have prevented their injury. These findings are in agreement with earlier investigations of attribution theory, a description of how individuals assign causality to events. Attitudes regarding injury prevention were not related to degrees of acculturation for the Hispanic members of our sample.

Waters, RL. Adkins, RH. Firearm Versus Motor Vehicle Related Spinal Cord Injury - Preinjury Factors, Injury Characteristics, and Initial Outcome Comparisons among Ethnically Diverse Groups. Archives of Physical Medicine and Rehabilitation. 1997, 78(2), 150-155. Objective: To determine the extent to which individuals with spinal cord injuries caused by firearms differed from those caused by motor vehicle crash (MVC) in terms of selected preinjury factors, injury characteristics and related treatment, and outcomes at discharge from rehabilitation; and to determine the effect of ethnicity on preinjury factors and outcome. Design: Survey including interview of former rehabilitation inpatients and medical records review. Setting: Model Spinal Cord Injury Care System centered at an urban, public rehabilitation medical center. Participants: Volunteer convenience sample of 164 men who were between the ages of 18 and 35 years at the time of injury and who were injured by firearm or MVC between January 1, 1980 and December 31, 1989. Subjects had completed rehabilitation at a rehabilitation center; they were non-Latino White, African- American, or Latino. Subjects were contacted by mail and telephone. The sample was comprised of 2646 of the potential participants; however, differential follow-up rates were highly consistent with distribution of primary characteristics within the population of potential candidates. Main Outcome Measures: The Functional Independence Measure (FIM) and total and rehabilitation lengths of stay were the outcome measures. Groups and outcomes were also compared in terms of preinjury education, employment, and indicators of antisocial behavior, as well as neurological deficit, associated injuries, and surgical treatment. Results: The firearm and MVC groups were different in terms of ethnic distribution. There were no non-Latino Whites in the firearm group and few African-Americans in the MVC group. With the exception of preinjury education, nonparametric and univariate tests showed differences between the firearm and MVC groups in terms of preinjury employment and indicators of antisocial behavior, associated injuries, surgical treatment, neurological deficit, and lengths of stay. Changes in FIM scores, however, were not different between etiologic or ethnic groups. Multiple regression indicated that injury severity accounted for the largest variance in outcomes and that preinjury factors, etiology, and ethnicity did not contribute significantly to the variance in outcome measures. Conclusions: Although preinjury factors are associated with ethnicity and minorities have higher proportions of SCI caused by firearms, these factors do not significantly influence rehabilitation outcomes at discharge. The primary factors influencing rehabilitation outcomes are related to the deficits, associated physical injuries, and related treatments common to the causes of the injury. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

7. Multicultural and Cross-cultural Perspectives on Disability 

@ Bradsher, JE. Disability among Racial and Ethnic Groups. Disabilities Statistics Abstract, No. 10, October 1995. Disability Statistics Rehabilitation Research and Training Center, University of California, San Francisco. Published by U.S. Department of Education, National Institute on Disability and Rehabilitation Research. [Database: SIPP.]

Dziekan, KI. Okocha, AA. Accessibility of rehabilitation services: Comparison by racial-ethnic status. Rehabilitation Counseling Bulletin, 1993, 36(4), 183-189. Investigated whether there were any differences in the application rates of majority (White) and racial-ethnic minority individuals for public vocational rehabilitation services (VRSs). Access and acceptance rate data were analyzed for 55,540 White and 8,234 racial ethnic minority individuals applying for public VRSs from 1985 though 1989. There was a clear association between membership in a racial-ethnic minority group and acceptance for services. Even though minority applicants applied for services at higher rates than their representation in the population, they were accepted for services at lower rates than majority applicants. (PsycINFO)

Kirchner, C. Peterson, C. Estimate of Race-Ethnic Groups in the U.S.: Visually Impaired and Blind Population. Ch. 10 in: C. Kirchner (Ed.) Data on Blindness and Visual Impairment in the U.S.: A Resource Manual on Social Demographic Chara-cteristics, Education, Employment and Income, and Service Delivery. Second edition. New York: American Foundation for the Blind, 1988.

Kirchner, C. Peterson, C. Ethnicity and Rehabilitation: An Analysis of Blind and Visually Impaired Clients in the Federal/State System. Ch. 11 in: C. Kirchner (Ed.) Data on Blindness and Visual Impairment in the U.S.: A Resource Manual on Social Demographic Characteristics, Education, Employment and Income, and Service Delivery. Second edition. New York: American Foundation for the Blind, 1988. (HV1795.K58d/1988)

Logue, BJ. Race differences in long-term disability: Middle-aged and older American Indians, Blacks and Whites in Oklahoma. Social Science Journal. 1990, 27(3), 253-272. Analyzes long-term disability patterns for American Indians, Blacks, and Whites aged 45+ yrs in Oklahoma in 1980 by considering how minority identification, socioeconomic status (SES), and health influence the quality of life and the aging process. Data were obtained from the 1980 decennial census. The effects of several factors are considered, including educational attainment, family income, and areas of residence. Large within- and between-group differences were found by age, sex, educational attainment, income, marital status, and race. Findings indicate that minorities and less educated Whites suffer disproportionately from long-term disability. (PsycINFO)

Pfeiffer, D. The influence of the socio-economic characteristics of disabled people on their employment status and income. Disability, Handicap & Society. 1991, 6(2), 103-114. Results of a survey of 733 adults with disabilities in Massachusetts, of whom 43% were men, show that the social class structure that enables White males in the US to have access to such things as education, jobs, and higher income rules in the disability community. Disabled White males were more likely to be employed and to receive higher income than disabled women and disabled minorities. (PsycINFO)

Walker, S. Brown, O. The Howard University Research and Training Center: A Unique Resource. American Rehabilitation, 1996, Spring, 27-33. Describes some of the initiatives of this Center in addressing the needs of minorities, particularly relating to vocational rehabilitation.


ASIAN\PACIFIC AMERICANS

Leung, P. Asian Pacific Americans and Section 21 of the Rehabilitation Act Amendments of 1992. American Rehabilitation, 1996, Spring, 2-6. The Rehabilitation Cultural Diversity Initiative includes Asian Pacific Americans as a target group, yet little is known about the incidence and prevalence if disability among these populations and, thus, little is known about their rehabilitation needs. This article provides a brief overview of the many groups which have been included under the rubric of Asian Pacific Americans. In addition, it attempts to dispel some myths, provide some insight into their culture and values, and offer a few suggestions related to their involvement in vocational rehabilitation programs.

Yang, H. Leung, P. Wang, J. Shim, N. Asian Pacific Americans: The Need for Ethnic-Specific Disability and Rehabilitation Data. Journal of Disability Policy Studies, 1996, 7(1): 33-53. The Rehabilitation Act Amendments of 1992 mandate that state and federal public vocational rehabilitation extend efforts to further include "traditionally" underserved" populations. Section 21 specifies the Asian Pacific American population as an "underserved group", and other data indicate that they are the fastest growing population in the United States. Yet, current data related to rehabilitation and disability at the national level are unavailable for Asian Pacific Americans. This article uses data taken from the Hawaii vocational rehabilitation program to illustrate the need for Asian Pacific American data to be reported, not only in an aggregate form, but also for each ethnic group within the aggregate. It proposes a policy change for the way data are gathered and collected for these populations.


AFRICAN-AMERICANS

Alston, RJ. Bell, TJ. Feist-Price, S. Racial Identity and African-Americans with Disabilities: Theoretical and Practical Considerations. Journal of Rehabilitation, 1996, Apr-June, 11-15.

Alston, RJ. Bell, TJ. Cultural Mistrust and the Rehabilitation Enigma for African Americans. Journal of Rehabilitation, 1996, Apr-June, 16-20.

Alston, RJ. McCowan, CJ. Perception of Family Competence and Adaptation to Illness Among African Americans with Disabilities. Journal of Rehabilitation, 1995, Jan.-March, 27-32.

Alston, RJ. Mngadi, S. The interaction between disability status and the African American experience: Implications for rehabilitation counseling. Journal of Applied Rehabilitation Counseling. 1992, 23(2), 12-16. Presents information useful to rehabilitation counselors and human service professionals providing services to African-Americans with disabilities. The potential double bias of being African- American and disabled is examined. There is a special focus on the similarities in stigmas experienced by persons with disabilities and members of the African-American community, and how the interaction between minority race status and disability status affects the delivery of rehabilitation services to African-Americans. The client-centered approach is described and suggested as a theoretical orientation to be adopted by rehabilitation counselors to lessen the impact of a double stigma on this population. (PsycINFO)

Asbury, CA. Walker, S. Belgrave, FZ. Maholmes, V. Green, L. Psychosocial, Cultural, and Accessibility Factors Associated With Participation of African-Americans in Rehabilitation. Rehabilitation Psychology, 1994, 39(2), 113-121.

Atkin, K. Health, illness, disability and Black minorities: A speculative critique of present day discourse. Disability, Handicap & Society. 1991, 6(1), 37-47. Discusses how the construction of Black people's perceptions of health, illness, and disability arises from the nature of the discourse. This discourse defines the nature and source of and the solution to the "problem" and predetermines the areas of relevance rather than those identified as appropriate by the Black communities. To remedy this, the debate needs to shift its focus of attention and become situated in the realities of people who form Black minorities. The debate must be informed by an account of disability and health in terms of Black people's perceptions without these perceptions becoming identified as deviant and pathological. Fundamental to the analysis are the political, social, and economic position of Black minorities and the context of racism. (PsycINFO

Baldwin, CH. Smith, RT. An evaluation of the referral and rehabilitation process among the minority handicapped. International Journal of Rehabilitation Research. 1984, 7(3), 299-315. Using the fiscal year 1978 data from the Rehabilitation Services Administration, two general hypotheses found in the literature were examined: (1) Minority status is likely to be a key determinant in the referral and rehabilitation process in the US; and (2) selected sociodemographic factors, along with social supports and disability condition, are likely to reveal direct influences on the referral and rehabilitation process. Data on 54,182 White and 45,926 Black clients yielded information on referral, rehabilitation, race, educational level, source of support, and family factors. Analysis revealed that the independent variables, for the most part, had either a direct or indirect effect on the outcome of referral and rehabilitation. Results suggest that bias related to age, sources of support, and race existed in the referral and rehabilitation process. (PsycINFO)

Longres, JF. Torrecilha, RS. Race and the diagnosis, placement and exit status of children and youth in a mental health and disability system. Journal of Social Service Research. 1992, 15(3-4), 43-63. Analyzed the relationship between race of child and primary diagnosis, service placement, and exit status in a county mental health and disability system for 1980 (n= 1,779) and 1985 (n= 4,111), using a multivariate logit model. Results indicate that race may be associated with the kinds of problems for which minority and majority children and youth seek help. Results also indicate that race may be related to the likelihood of being treated out-of-home, but that it is only marginally related to the need for further services after treatment in the system has expired. (PsycINFO)

Mendes de Leon, CF. Beckett, LA. Fillenbaum, GG. et al. Black-White Differences in Risk of Becoming Disabled and Recovering from Disability in Old Age: A Longitudinal Analysis of Two EPESE Populations. American Journal of Epidemiology, 1997, 145(6), 486-497.

Rogers Dulan, J. Blacher, J. African American Families, Religion, and Disability - A Conceptual Framework. Mental Retardation. 1995, 33(4), 226-238. In recent years, there has been considerable discussion of the impact of factors such as religion and ethnicity on the adjustment: of families who have a child with disabilities. The role of religion is particularly relevant for African American families because of its historic influence on basic social and cultural values of this ethnic group. In this paper we explored issues of religion, disability, and ethnicity, with emphasis on how these factors relate to adjustment for families, particularly African American families. Findings gathered from diverse literature sources are reflected in a proposed framework to guide future research and policy development.


IMMIGRANTS

Stephen, EH. Foot, K. Hendershott, GE. Schoenborn, CA. Health of the foreign-born population, 1989-90. Advance Data from vital and health statistics, 241. Hyattsville, MD: National Center for Health Statistics, 1994. This report presents selected health statistics from the NHIS for the foreign-born population according to Hispanic-origin, duration of residence, and selected sociodemographic characteristics. Further breakdowns by specific ethnic or national origins were not possible because of the relatively small size of the groups. Data and tables are presented for respondent-assessed health status, limitation in activity, bed days, and physician contacts. Recent immigrants were found to be healthier than those who had live in the US ten years or longer; the latter group was healthier than US-born adults.

O'Brien, AM. Rhoades, GW. Providing Outreach and Rehabilitation Services to Non-English Speaking Persons. American Rehabilitation, 1996. Spring, 7-9.


INTERNATIONAL

Gregory, RJ. Rehabilitation interventions: ideas based on a South Pacific example. Disability and Rehabilitation, 1996, 18(1), 47-51. The South Pacific represents a unique area of the world where people with disabilities do need and want rehabilitation interventions. Cross-cultural work, however, carries inherent misunderstandings. Some ideas and examples illustrate how rehabilitation interventions can take place if and when deeper insight into cultural differences is available.

Pongprapai, S. Tayakkanonta, K. Chongsuvivatwong, V. Underwood, P. (1996) A study on disabled children in a rural community in southern Thailand. Disability and Rehabilitation, 18(1), 42-46.

Stuart, OW. Race and disability: Just a double oppression? Special Issue: Researching disability. Disability, Handicap & Society. 1992, 7(2), 177-188. This articles argues that Black disabled people in Britain experience simultaneous, rather than double, oppression. Three areas where Black disabled people may experience oppression are discussed: limited or no individuality and identity, resource discrimination, and isolation within the Black community and the family. These forms of discrimination isolate Black disabled people and place them at the margins of the ethnic minority and disabled populations. (PsycINFO)

8.  Measurement, Research, and Surveillance Issues 

For persons interested in disability and ethnic\racial populations, there are two critical questions. How do we measure disability in these groups; and how do we measure these groups? The first section presents selections on how we measure and do research with Latino\Hispanic populations. The second part presents work not presented earlier on how different aspects of disability are measured in Latino populations. Where appropriate, we have included other cross-cultural works.


MEASUREMENT OF ETHNICITY

Betancourt, H. Regeser Lopez, S. The Study of Culture, Ethnicity, and Race in American Psychology. American Psychologist. 1993, 48(6), 629-637. The study of culture and related concepts, such as ethnicity and race, in American psychology are examined in this article. First, the conceptual confusion and ways in which culture, ethnicity, and race are used as explanatory factors for intergroup differences in psychological phenomena are discussed. Second, ways in which to study in mainstream psychology and to enhance hypothesis testing and theory in cross-cultural psychology are illustrated. Finally, the importance of examining sociocultural variables and considering theory in ethnic minority research is addressed. In general, it is proposed that by including theory, conceptualizing, and measuring cultural and related variables, mainstream, cross-cultural, and ethnic research can advance the understanding of culture in psychology as well as generality of principles and the cultural sensitivity of applications.

Centers for Disease Control. Use of Race and Ethnicity in Public Health Surveillance: Summary of the CDC/ATSDR Workshop. Morbidity and Mortality Weekly Report, 42/RR-10, June 25, 1993. (Can be downloaded from CDC via Internet.)

Marin, G. VanOss Marin, B. Research with Hispanic Populations. Newbury Park, CA: SAGE Publications, 1991. The Marin's are community psychologists at the University of California San Francisco who work in areas related to public health. This book is divided into six chapters. The first defines Hispanics and discusses their cultural values. Chapter 2 introduces issues in identifying Hispanics, including the appropriate label ('Hispanic', 'Latino', 'Chicano'); the operationalization of Hispanic ethnicity by ancestry, sociocultural characteristics, and self-identification; and addressing Hispanic heterogeneity by generational history, and acculturation level. Chapters 1 and 2 are also useful for non-researchers and can be widely used for teaching about these issues, particularly how to specify and segment Latino populations. Chapter 3 discusses enhancing research participation through community consultation and other sampling-related problems. Chapter 4 addresses the development and adaptation of instruments. Chapter 5 presents issues for translation of data collection instruments. Chapter 6 discusses potential problems in interpreting data, such as extreme response sets, acquiescence response sets, and social desirable responses. The inaccurate reporting of behaviors, incomplete response or missing data, and the level of self-disclosure also are addressed. Throughout the book, the reader will find extremely useful tips and guidelines. (JOA)

Montgomery, LE. Carter-Pokras, O. Health Status by Social Class and or Minority Status - Implications for Environmental Equity Research. Toxicology and Industrial Health. 1993, 9(5), 729-773. Much of the epidemiologic research in the United States has been based only on the categories of age, sex and race; thus, race has often been used in health statistics as a surrogate for social and economic disadvantage. Few multivariate analyses distinguish effects of components of social class (such as economic level)from the relative, joint, and independent effects of sociocultural identifiers such as race or ethnicity. This paper reviews studies of social class and minority status differentials in health, with a particular emphasis on health status outcomes which are known or suspected to be related to environmental quality and conditions which increase susceptibility to environmental pollutants. Sociodemographic data are presented for the U.S. population, including blacks, Asian American, Pacific Islanders, American Indian/Alaska Natives, and Hispanics. Four areas of health status data are addressed: mortality, health of women of reproductive age, infant and child health, and adult morbidity. Conceptual and methodological issues surrounding various measures of position in the system of social strata are discussed, including the multidimensionality of social class, in the context of the importance of these issues to public health research. Whenever possible, multivariate studies that consider the role of socioeconomic status in explaining racial/ethnic disparities are discussed.

Negy, C., & Woods, D.J. The importance of acculturation in understanding research with Hispanic-Americans. Hispanic Journal of Behavioral Sciences. 1992, 14(2), 224-247. Reviews empirical studies addressing the role of acculturation (ACC) in relation to a variety of psychosocial variables (i.e., family socialization, social-support networks, alcoholism, psychosocial adjustment). The primary deficiency in ACC studies is the lack of agreement as to the definition of the construct, a lack of a satisfactory scale to assess ACC, and an overreliance on self-reports. (PsycINFO)

Rogler, L. The Meaning of Culturally Sensitive Research in Mental Health. American Journal of Psychiatry, 1989, 146(3), 296-303.

Rogler, Lloyd H. Cortes, Dharma E. Malgady, & Robert G. Acculturation and mental health status among Hispanics: Convergence and new directions for research. American Psychologist, 1991, 46(6), 585-597. Acculturation, the process whereby immigrants change their behavior and attitudes toward those of the host society, is a fundamental part of migration- induced adaptations to new sociocultural environments. A rapidly expanding research literature on acculturation has accompanied the growth of international migrations. In response to the need to integrate the growing literature on acculturation and mental health status among Hispanics in the US, and to identify points of convergence and new directions for research, 30 publications were examined. Points of convergence are identified, as are problems and limitations. The research needs new directions, proceeding from but not constricted by the assumptions and procedures in the work already done. (PsycINFO)

Saint-Germain, Michelle A. Bassford, Jamsen L. Montano, Gail. (1993). Surveys and focus groups in health research with older Hispanic women. Qualitative Health Research, 3(3), 341-367. Contrasts the findings from 2 studies undertaken on the barriers to health care use in general and to breast cancer screening faced by older Hispanic women. One study conducted a randomly selected population survey of 409 Hispanic women; the other used focus group interviews (FGIs) with 50 Hispanic women. FGIs are considered a culturally appropriate methodology for research with older Hispanic women because they draw on oral traditions, norms of helping, and existing social networks. While the two approaches tended to produce similar findings, the focus group interviews revealed some important differences. The article concludes that the survey interview is more suited to documenting individual levels of knowledge and practice, whereas the focus group interview is more suited to reproducing, community attitudes and patterns of practice and explaining the reasons behind the survey findings. (PsycINFO).

Sasao, T. Sue, S. Toward a Culturally Anchored Ecological Framework of Research in Ethnic-Cultural Communities. American Journal of Community Psychology. 1993, 21(6), 705-727. Proposed a research framework (the "cube" model) in which community psychologists working in ethnic-cultural communities can make appropriate decisions on conceptual and methodological issues from a culturally anchored, ecological- contextualist perspective. The intent of the model is to articulate ethnic-cultural heterogeneity in community research by eluci-dating three metamethodological issues: (a) definition of an ethnic-cultural community, (b) applicability of cross-cultural theories and methods to ethnic-cultural community research, and (c) geographical or ecological stability of an ethnic-cultural community. The model posits that ethnic-cultural community research can be conceptualized as a three-dimensional structure that represents an interaction among research questions, methods, and cultural complexity (referring to the extent to which an ethnic-cultural group is defined in a larger ecological context or community both at the individual and collective levels). Future directions for research were discussed in terms of the utility and the limitations of the proposed research model.

Stanfield, JH. Rutledge, MD. (Eds.) Race and Ethnicity in Research Methods. Newbury Park, CA: SAGE Publications, 1993.

Trimble, JE Ethnic Specification, Validation Prospects, and the Future of Drug Use Research. The International Journal of the Addictions. 1990-91, 25(2A), 149-170. Interest in drug use among America's major ethnic minority groups is increasing. Despite the welcomed interest, researchers tend to use broad ethnic labels to identify their samples. Such labels as "ethnic glosses" provide little information concerning the heterogeneity of each ethnic group and, in most instances, violate the guidelines concerning appropriate description of sample characteristics. Use of broad ethnic descriptors particularly in drug use research creates external validity problems and prevents replications. Researchers are encourages to obtain detailed information on the sociocultural characteristics of their samples by obtaining measures on ethnic identification, situated identity, and acculturative status. Use of ethnic identity and acculturation measures, however, can create problems in defining appropriate sample frames.

Vega, William A. Theoretical and Pragmatic Implications of Cultural Diversity for Community Research. American Journal of Community Psychology. 1992, 20(3), 375-391.

Wagerer, D K. Ethical Considerations in the Design and Execution of the National and Hispanic Health and Nutrition Examination Survey (HHANES). Environmental Health Perspectives, 1995, 103(S3), 75-80. The purpose of this article is to describe some ethical considerations that have arisen during the design and implementation of the health examination surveys conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Three major areas of concern are discussed: sharing information from the study, banking and using banked tissue samples, and obligations for future testing of subjects. Specific concerns of sharing information include: when to inform, whom to inform, maintaining confidentiality, and how to inform individuals. Specific concerns of determining when sera will be banked and using banked samples include: depletion of samples for quality control, obtaining informed consent for unanticipated uses, access by others, and requests for batches of samples. Finally, specific concerns regarding future testing of subjects include: retesting for verification, retesting for interpretation, testing for different risk factors, and follow-up. Although existing surveys can provide experience or even suggest guidelines, the uniqueness of any new survey will generate unique ethical problems, requiring the careful formulation of unique solutions.

Wyatt, Gail E. (1991). Examining Ethnicity Versus Race in AIDS Related Sex Research. Social Science & Medicine, 33 (1), 37-45.

Zambrana, Ruth E. (1991). Cross-Cultural Methodological Strategies in Low Income Racial Ethnic Populations. Pp. 221-228. In: Primary Care Research: Theory and Methods. Rockville, MD: DHHS, PHS, Agency for Health Care Policy and Research.

Zapka, JG. Chasan, TL. Bigelow, C. Hurley, T. Methodological issues for health-related surveys of multicultural older women. Evaluation & the Health Professions. 1994, 17(4), 485-500. Given the concerns about survey nonresponse bias as well as the need to plan resources for subject recruitment, the authors tracked each step of the recruitment process (location, response, consent, and completion) of 767 sociodemographically diverse older women for a survey on mammography experience. Younger, less educated, poor women were likely to be lost due to inability to locate them, while older middle- and upper-economic group women were more likely to be lost due to refusal to participate. Hispanic and Black women were signi-ficantly more likely to respond on successive attempts to recruit them than were White, non- Hispanic women. There was no significant difference in refusal rates by minority women over the successive contacts, as contrasted with White women, who refused at significantly higher rates with each attempt. All subgroups of women need intensive recruitment and follow-up, albeit for different reasons. (PsycINFO) (Aging, Elderly, Women.]


MEASUREMENT OF DISABILITY

Canales, S. Ganz, PA. Coscarelli, CA. Translation and Validation of a Quality of Life Instrument for Hispanic American Cancer Patients - Methodological Considerations. Quality of Life Research. 1995, 4(1), 3-11. The increasing diversity of the US population has drawn attention to the need for the development of quality of life tools that are appropriate for special populations, including Hispanic Americans, Asian Pacific Islanders, and Native Americans. The Hispanics are one of the fastest growing of these special populations, and this group includes persons who have lived in the USA for many generations, as well as recent immigrants. Both language and culture are important to consider when developing a quality of life tool for Hispanics. The initial aims of this study were to develop a Spanish translation of the CAncer Rehabilitation Evaluation System (CARES), perform content and construct validation of the Spanish CARES in Spanish-speaking and bilingual patients with cancer, and provide descriptive data on the rehabilitation needs and quality of life of these patients. However, in performing this study we encountered a number of methodological problems that had not been previously described in the literature, including the need for idiomatic translations, lack of familiarity with questionnaires, low acculturation and low literacy rates among Hispanic cancer patients in the southwestern USA. We suggest a number of practical considerations for future investigators planning to develop quality of life tools for this special population.

Carr, W. Szapiro, N. Heisler, T. Krasner, MI. Sentinel health events as indicators of unmet needs. Social Science & Medicine, 1989, 29(6), 705-14. It is vitally important to be able to assess the impact of the health care system on the populations it serves. This paper explores whether sentinel health events--negative health states, such as death, disability, and disease, that might have been avoided given current medical and public health knowledge and technology--can be used as sociomedical indicators to assess levels of unmet needs and to evaluate health system performance. Using hospital discharge data, the occurrence of sentinel health events in New York State and differences among population subgroups are examined. Among hospitalized residents of New York State in 1983, more than 17,000 deaths occurred that were possibly avoidable. More than 336,000 instances of disease were found that were potentially preventable. Significantly higher rates and ratios for many sentinel events were found among blacks, Medicaid recipients, and users of public hospitals than were found for comparison groups. The sentinel events approach proved to be useful and practical. However, refinements and adaptations of the sentinel events method are needed, including the development of one or more smaller sets of indicators--tracer sentinel events--that can be used to profile aspects of health status and the health system. [Surveillance]

Gonzalez, VM. Stewart, A. Ritter, PL. Lorig, K. Translation and Validation of Arthritis Outcome Measures into Spanish. Arthritis and Rheumatism. 1995, 38(10), 1429-1446. Objective: To produce Spanish versions of common arthritis outcome measures: the Health Assessment Questionnaire (HAQ) Disability Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) Pain Severity Scale, the Arthritis Self-Efficacy Scale for Pain and Other Symptoms (with the addition of 2 new items), the Visual Analogue Pain Scale, the MOS Self-Rated Health Item, and a Physical Activities Scale that would be usable by most Hispanics living in the US. We tested these translated measures for reliability and, where appropriate, validity. Methods. Instruments were translated and back translated by bilingual persons from 5 different countries of origin. Translators met to resolve variations in translation, The instruments were then administered to Hispanic arthritis patients in 6 geographic locations (5 in the United States and 1 in Latin America). All instruments underwent standard psychometric testing. As appropriate, the sample was stratified by level of acculturation, nation of origin, and geographic location. Results: The translated instruments, with slight modification, met acceptable levels of reliability and validity. They are understood and easily usable by diverse Spanish- speaking populations. Conclusion: The availability of these translated outcome measures should enable investigators to include monolingual Spanish-speakers into their studies, and should facilitate study of cross-cultural differences with respect to these specific outcomes.

Guillemin, F. Bombardier, C. Beaton, D. Cross-Cultural Adaptation of Health-Related Quality of Life Measures - Literature Review and Proposed Guidelines. Journal of Clinical Epidemiology. 1993, 46(12), 1417-1432. Clinicians and researchers without a suitable health-related quality of life (HRQOL) measure in their own language have two choices: (1) to develop a new measure, or (2) to modify a measure previously validated in another language, known as a cross-cultural adaptation process. We propose a set of standardized guidelines for this process based on previous research in psychology and sociology and on published methodological frameworks. These guidelines include recommendations for obtaining semantic, idiomatic, experiential and conceptual equivalence in translation by using back-translation techniques and committee review, pre-testing techniques and re-examining the weights of scores. We applied these guidelines to 17 cross-cultural adaptation of HRQOL measures identified through a comprehensive literature review. The reporting standards varied across studies but agreement between raters in their ratings of the studies was substantial to almost perfect (weighted kappa = 0.66-0.93) suggesting that the guidelines are easy to apply. Further research is necessary in order to delineate essential versus optional steps in the adaptation process.

Holbrook, TL. Hoyt, DB. Anderson, JP. Hollingsworth Fridlund, P. Shackford, SR. Functional Limitation after Major Trauma - A More Sensitive Assessment Using the Quality of Well-being Scale the Trauma Recovery Pilot Project. Journal of Trauma. 1994, 36(1), 74-78. Little is known about the degree of disability and quality of life of patients after major trauma. We conducted a prospective study to examine the incidence and predictors of functional limitation (FL). Between January 1, 1990 and March 30, 1990, 61 eligible trauma patients were enrolled in the study (admission GCS score greater-than- or-equal-to 12, LOS > 24 hours). Functional limitation after trauma was measured at discharge and 3 months after discharge using the Quality of Well-being (QWB) scale, a more sensitive index to the well end of the functioning continuum (range, 0 = death to1.000 = optimum functioning). Functional limitation was also measured using a standard ADL scale (range, 17 = full function to 41 = maximum dysfunction). Risk factors measured were injury severity, body region, depression (CES-D) scale, and social support. Follow-up was achieved in 42 patients (70%). The mean age was 30 years, 74% were male, 52% white, 41% hispanic, and 3% other. The mean ISS was 15, with 69% blunt injuries and a mean LOS of 12 days. The QWB scores improved between discharge and follow-up; discharge mean = 0.457 (+/-0.048), follow-up mean = 0.613 (+/-0.118), but the mean QWB score at follow-up still reflected a significant degree of functional limitation. The mean percentage of change in QWB scores was 34.5% (+/-25.5%) with a range of -6.34% to 103.8%. The discharge mean FDS was 29 (+/-6.2) while the follow-up FDS mean was 17 (+/-3.8), reflecting that most patients at follow-up reported near-perfect ADL functioning. Injury severity, body region, and social support were not associated with FL. Depression was significantly associated with FL; discharge rate = 81% and follow-up rate = 43%. The relative risk for depression for the lowest versus highest tertile of QWB% change was 1.9 (p < 0.05). Functional limitation as assessed by the QWB was much greater at follow-up. The ADL scale did not adequately measure FL; the follow-up mean was close to full ADL function. The high incidence of posttrauma depression may be an important predictor of FL. (Measurement) [Editor's Note: While a significant Hispanic sample was included, it is not clear whether data for this population was analyzed.]

Solis, ML. Abidin, RR. The Spanish version Parenting Stress Index: A psychometric study. Special Section: Disadvantaged children and their families. Journal of Clinical Child Psychology, 1991, 20(4), 372-378. Evaluated the psychometric properties of the Spanish version of the Parenting Stress Index (PSI), based on the responses of 223 Hispanic mothers (aged 17-62 yrs). Alpha coefficients were comparable to those for the original PSI. A factor analysis of the 13 PSI subscales indicated that 3 factors rather than the original 2-factor solution more meaningfully described the Hispanic data. This study is consistent with recent research with Anglo-American mothers suggesting that the dimensions of the PSI are better described by 3 factors: child characteristics, parent characteristics, and child-parent interaction. Multivariate analysis of variance (MANOVA) indicated that in a Hispanic sample, mothers of handicapped children reported more parenting stress than did mothers of nonhandicapped children. Findings support the cross-cultural utility of the PSI. (PsycINFO)

Tran, TV. & Williams, LF. Effect of Language of Interview on the Validity and Reliability of Psychological Well-Being Scales. Social Work Research. 1994, 18(1), 17-25. This study tested the hypothesis that the use of different languages in a telephone survey could adversely affect the cross-cultural comparability of standardized research measures. The data used in the analysis were taken from the 1988 National Survey of Hispanic Elderly People (NSHEP) to test this hypothesis. The NSHEP survey contains data on 2,299 Hispanic persons aged 65 and older, and it was designed to study the living arrangements, health status, use of services, and attitudes toward aging problems held by the respondents. A telephone interview was used to collect the data. A majority of the respondents (86.6 percent) were interviewed in Spanish, and 13.4 percent were interviewed in English. LISREL-7 was the method of statistical analysis used to examine the factor equality of the positive affect and negative effect stales between the English and Spanish language respondents. Our findings indicate that there was no significant difference between the factor structure of the negative affect scale between the two groups; however, the factor structure associated with the positive affect scale demonstrated marked factorial differences between the two groups.

9.  Disability Databases 

Where do we find data on disability and Latinos? Some key national databases where one may find data on Hispanics\Latinos, other ethnic-racial groups, and disability data are listed below. Some databases may be accessed from the Internet, and their descriptions are posted on the agency Internet servers and key recent emerging publications. In addition, there are number of privately funded surveys, particularly for the elderly.

Federal Databases

Source/agency

Latino data

Disability

Chronic Conditions

Risk

Current Population Survey (CPS)

U.S. Bureau of the Census

X

X

 

 

 

Survey of Income and Program Participation (SIPP)

U.S. Bureau of the Census

X

X

-

 

National Medical Expenditure Survey (NMES)

Agency for Health Care Policy and Research

*

x

X

 

Behavioral Risk Factor Surveys (BRFS)

Centers for Disease Control (CDC), State health agencies

*

QOL

DM

X

National Health Interview Survey (NHIS)

National Center for Health Statistics (NCHS)

x

1994-95

X

X

National Health and Nutrition Examination Survey (NHANES)

National Center for Health Statistics

X

x

X

x

Natality Statistics (Congenital anomalies, etc,)

National Center for Health Statistics

X

 

X

x

Mortality Statistics (indirect indicator)

National Center for Health Statistics

X

 

X

 

Codes: X=good data; x=limited data; QOL=Health Status/Quality of Life; DM=Diabetes Mellitus *=not published


Burt, VL. Harris, T. The 3rd National Health and Nutrition Examination Survey - Contributing Data on Aging and Health. Gerontologist, 1994, 34(4), 486-490. The third National Health and Nutrition Examination Survey (NHANES III, 1988-94) is the most recent in a series of national examination studies conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. Prior to NHANES III the upper age limit was 74; the upper age limit was removed for NHANES III. Persons 60 years and older in the black and Mexican American populations, and those 60-69, 70-79, and 80 years and older in the white population were oversampled. The NHANES III component for older persons provides a multidimensional overview of physical health status and aspects of functional health status. The key components for older persons are: Osteoporosis, arthritis, nutrition, cardiovascular disease, pulmonary disease, and physical, cognitive, and social function. [Aging, Chronic Diseases]

LaVeist, TA. Data sources for aging research on racial and ethnic groups. The Gerontologist. 1995, 35(June), 328-339. This article reports the results of a survey of recent and ongoing aging-related data sources supported by U.S. federal agencies. The survey sought to obtain data on the sample sizes and topics covered within the data sets maintained and frequently used by the various federal agencies engaged in data collection and/or analysis. The objective of the study was to determine the suitability of these data sets to conduct research on minority elders. Formal tests of the adequacy of data set sample sizes to support analysis on various minority groups were performed. Each data set was found to be large enough to conduct research on white elders, and a majority of the data sets were large enough for research on African American elders. However, Hispanics, American Indians, Alaska Natives, Asian Americans, and Pacific Islander were rarely included in sufficient numbers. [Aging, Measurement]

10.  Disability Statistics and Studies 

This section provides a more abbreviated overview of the work on disability in general. Some items may contain some data on Latinos and other ethnic\racial groups (*). In general, it might be said that the status of Latinos is generally ignored. In other cases, investigators may be reluctant to provide Hispanic\Latino data because of the small sample sizes.


Brandt, EN Jr. Pope, AM. (Eds.) Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington DC: National Academy Press, 1997. (Institute of Medicine)

Ferron, DT. Diagnostic Trends of Disabled Social Security Beneficiaries, 1986-93. Social Security Bulletin, 1995, 58(3), 15-31.

Fitzgerald Storck, I. Thompson-Hoffman, S. Demographic Characteristics of the Disabled Population. In: Thompson-Hoffman, S. Fitzgerald Storck, I. (Eds.) Disability in the United States: A Portrait From National Data. New York: Springer Publishing Company, 1991.*

Guralnik, JM. Fried, LP. Salive, ME. Disability as a Public Health Outcome in the Aging Population. Annual Review of Public Health, 1996, 17, 25-46.

Kirchner, C. (Ed.) Data on Blindness and Visual Impairment in the U.S.: A Resource Manual on Social Demographic Characteristics, Education, Employment and Income, and Service Delivery. Second edition. New York: American Foundation for the Blind, 1988. (HV1795.K58d/1988)*

Kochhar, S. Scott, CG. Disability Patterns Among SSI Recipients. Social Security Bulletin, 1995, 58(1), 3-14. Describes changes in disability patterns among SSI recipients.

@ Kraus, LE. Chartbook on Disability in the United States, 1996. Prepared for: U.S. Department of Education, National Institute on Disability and Rehabilitation Research. Berkeley, CA: InfoUse. Provides a useful overview of disability statistics based on analysis of a number of databases including the National Health Interview Survey, with about five charts relating to minority group in their broadest aggregations.*

Pope, AM. Tarlov, AR. (Eds.). Disability in America: Toward a National Agenda for Prevention. Washington, DC: National Academy Press, 1991 (Institute of Medicine).

Songer, TJ. Disability in Diabetes. Ch. 12 in: National Diabetes Data Group (Eds.) Diabetes in America, 2nd Ed.

Washington DC: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Thompson-Hoffman, S. Fitzgerald Storck, I. (Eds.) Disability in the United States: A Portrait From National Data. New York: Springer Publishing Company, 1991. [Book.]

@ Winger, BL. Kaye, HS. LaPlante, MP. Disabilities Among Children. Disabilities Statistics Abstract, No. 15, March 1996. Disability Statistics Rehabilitation Research and Training Center, University of California, San Francisco. Published by US .Department of Education, National Institute on Disability and Rehabilitation Research. (Database: NHIS, 1992)