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The US Hispanic population has grown rapidly over the last two decades and remains geographically concentrated in nine states. Redistribution away from core states through internal migration has been largely offset by heavy immigration to traditional areas of Hispanic concentration. Geographical patterns of Hispanic miration show broad similarities to overall patterns of population redistribution in the United States. New York and California serve as key spatial redistributors or pivots in the Hispanic migration system.

Prologue: Major changes are occurring in the federal relationship with medical education under the pressure of dwindling resources and the Reagan administrations determined hid to reduce the role of government in American society. These trends, which are forcing greater reliance on financing medical education through state support, students' tuition, research dollars, patient-care fees, and private philanthropy, are affecting the enrollment of minority students in health professional schools. While there may he an emerging surplus of health manpower in many fields, as Ruth Hanft points out in this essay, there is no surplus of minority health manpower. Indeed, wide disparities exist and will continue to exist between the ratio of black manpower to black population and Hispanic manpower to Hispanic population. Hanft's study, undertaken for the Association of Minority Health Professions Schools, points out that black Americans accounted for 11.7 percent of the total population in 1980. In that same year, bl...

The vast majority of Hispanic-Americans, or people of mixed Spanish-Indian or Mexican descent, reside in an area of the southwestern United States which has come to be known as the “borderlands.”The literature concerning this sizable minority nowhere contains a satisfactory attempt to define the extent of the borderlands. Presented here is such an attempt. Based on population data, the borderland (used here in the singular) here delimited is considered to be the region of greatest Hispanic population concentration. The borderland is more than a population region. It is a culture region because of the intensity of a distinctive subculture, the longtime existence of Hispanic settlements, a rich Hispanic legacy, and the presence of Anglo-Americans who have been “Hispanicized.”

Depression among older minority groups, including Hispanics, has not been well studied. Little is known of the true rates of depression, it correlates or how well it is treated. This research is part of a series examining health status of older Hispanics using the Comprehensive Assessment and Referral Evaluation (CARE). Seven hundred older Hispanics living in Los Angeles County were studied using an area-probability sampling method. The CARE items were regrouped to reflect Diagnostic and Statistical Manual III criteria for depression and dysphoria. More than 26% were found to have a major depression or dysphoria. These affective disorders were strongly correlated with physical health status. Without physical health complications, the rate was 5.5%. A number of socioeconomic, health behavior, and family variables were related to affective state. Treatment for affective disorder appeared to be very poor for this population.

This article is based on the premise that culture-specific needs assessment methodologies are necessary to obtain accurate, valid, and reliable results when studies are conducted in culturally different groups. Accordingly, the literature on needs assessment and on Hispanic psychology is reviewed, creating a synthesis prescriptive of the best strategies for the assessment of mental health needs of Hispanic populations. Traditional needs assessment methods are discussed in the context of the types of changes that must be made to render them culturally acceptable and useful with Hispanics. Conceptually, the important issue is that of being sensitive to the interplay between the effectiveness of the methodology and its impact within a given cultural setting.

The 1982–1984 Hispanic Health and Nutrition Examination Survey used ultrasonography to investigate the epidemiology of gallstone disease. Mexican American, Cuban American, and Puerto Rican men and women, aged 20–74 yr, were selected from household samples in Texas, New Mexico, Arizona, Colorado, California, Connecticut, New Jersey, New York, and Florida. Ultrasonography was performed on 2299 persons. The age-adjusted prevalence of gallstone disease (gallstones + cholecystectomy) among Mexican American men (7.2%) was 1.7 times that of Cuban American men and 1.8 times that of Puerto Rican men. The prevalence for Mexican American women (23.2%) was 1.5 times that of Cuban American women and 1.7 times that of Puerto Rican women. Rates were about three times higher among women than men and increased with age in both sexes and all ethnic groups except older Puerto Rican women. Among Mexican American women aged 60–74 yr, the prevalence of gallstone disease reached 44.1%. These results support the hypothesis that Mexican Americans are at increased risk of gallstone disease.

Contents: Demographic Information on General Hispanic Population; Political Participation of General Hispanic Population; Occupational Patterns of General Hispanic Population; Educational Background of General Hispanic Population; Hispanic Personality and Cognitive Studies; History of Hispanic Participation in the Armed Forces; Hispanic Recruitment; Hispanic Recruits: Characteristics and Testing; Hispanics in the Military; Future Hispanic Participation in the Armed Forces; Hispanic Veterans; Social/Cultural Descriptions of Hispanics and Hispanic Subgroups in the General Population.

Suicide and suicide related behavior represent one of the most intriguing and important subjects in the field of psychiatry. Despite the fact that suicide is one of the leading causes of death in the United States, this type of behavior is still little understood by most mental health practitioners. Further, if one tries to explore the parameters of suicide behavior along ethnic lines, the data which currently exists in the medical literature is found to be not only scarce, but offering very little insofar as the understanding of its determinants is concerned. In this study, we decided to review the subject of suicide behavior from an ethno-cultural point of view, thus attempting to shed some light on this complex issue, as well as stimulating further research in this subject. Within this context, we will proceed with reviewing some aspects of the suicide behavior among Puerto Ricans and Mexican Americans. It should, however, be well understood that while Puerto Ricans and Mexican Americans are good examples of the Hispanic ethnic subgroup, one must not generalize and apply concepts pertaining to them to the entire Hispanic population. Nevertheless, some commonalities do exist among all Hispanic ethnic subgroups, and thus, some applicability could be found from the data discussed here which could be used with the entire Hispanic population.

Sudden infant death syndrome occurs with increased frequency in low birth weight infants and in black infants. The degree to which the higher LBW rate among blacks might explain this higher SIDS rate is unknown. To address this question, we analyzed the 1233 SIDS deaths that occurred among 252,376 neonatal survivors in Cook County from 1975 to 1980, using computer-coded matched infant birth and death records. Birth weight and ethnic group were identified. The overall SIDS rates in blacks, Hispanics, and whites were 5.1, 1.2, and 1.3/1000 neonatal survivors, respectively. Within each ethnic group, the SIDS rates increased progressively with decreasing birth weight. Within the less than or equal to 1500 gm birth weight groups, the SIDS rates were 16.4, 3.9, and 5.5/1000 neonatal survivors in blacks, Hispanics, and whites. Using direct standardization, we found that 27% of the SIDS rate disparity between blacks and whites could be explained by the higher LBW rate in blacks (14% vs 6% in whites). The good outcomes in both LBW and SIDS rates for the Hispanic population were unexpected because, like blacks, Hispanics are socioeconomically disadvantaged. Findings for this group suggest that the remaining 73% of the increased SIDS rate in blacks cannot be attributed in a straightforward manner to differences in income or educational attainment.

Drug addiction has assumed major proportions in the Hispanic population. This paper questions whether treatment programs in Puerto Rican communities adequately relate their rehabilitative services to the realities of Hispanic culture. The experience of a clinic in the South Bronx is reviewed, and it is suggested that programs need to be aware of cultural differences, provide Hispanic staff to treat Hispanic patients, and build up acknowledged strengths, values, and folkways.

The lack of adequate vital and health statistics for the Hispanic population of the United States is discussed and recommendations are made for improving the quality and quantity of these data. (ANNOTATION)

An investigation of the mating structure of the rural Hispanic population of the village of abiquiu in northern New Mexico was carried out using village marriage registers. Marital movement and departure from random mating were analyzed by the distribution of birth places of marriage partners and by surname isonymy. The time periods studied were 1882 to 1910 and 1947 to 1977. The results of these analyses show marked marital isolation (median marital distances by birthplace of 11.5 and 20.0 miles, respectively) and a significant departure from random mating (F = 0.0556 and F = 0.0495, respectively). In each case the non-random component of the isonymy coeffient (Fn) greatly exceeds the random, or expected, component. Assortative mating for culture and proximity governed by the historical settlement pattern is indicated as the process producing these results. Isolation has begun to break down in recent years but as yet has had no great effect on the genetic structure of the Abiquiu population.

As we examine the health of Hispanics in the U.S., one key point is that Hispanic people are not a homogeneous group in this country but present a number of areas of diversity—different countries of origin, different cultural experiences, different numbers of years in the United States, different socioeconomic backgrounds, different experiences in dealing with the health care systems, different reasons for being in the United States, and different reasons for wanting to stay. Thus, we must bear these complexities in mind when we talk about health issues in relation to Hispanic populations.

Cardiovascular disease (CVD) is the leading cause of death among the largest and fastest growing ethnic minority in the United States, Latinos/Hispanics. CVD risk factors such as metabolic syndrome, obesity, and diabetes are prevalent in Latinos/Hispanics at alarming rates. It is therefore imperative to understand this population's risk of CVD and the most effective and culturally sensitive treatment methods.To review recent findings on the prevalence of CVD, CVD risk factors, and related illnesses in the US Latino/Hispanic population, and discuss gaps in the current knowledge. To summon a call for greater action on the part of governmental agencies, pharmaceutical companies, academia, industry media, professional and community organizations to address the escalating health problem of CVD and related illnesses, such as diabetes, in the Latino/Hispanic population.An extensive PubMed and Internet literature search for studies published from January 1995 to July 2005 was conducted, using a combination of search terms (cardiovascular disease, CVD, Latino, Hispanic, prevention, guidelines, clinical trials, interventions).Studies meeting initial search criteria were distilled using the date of publication, study population size, and specific relevance to the topic being reviewed.Data validity was assessed based on the quality of the source (large sample size, government agencies, major publications) and a consensus of the authors on perceived validity.The review found limitations in current research as well as treatment methods and options for Latinos/Hispanics at risk for developing CVD and related illnesses.Due to limitations in current data and trials and public health concern, additional research needs to be conducted to fully determine the best predictors of CVD and diabetes in Latino/Hispanic patients. A combined effort on the part of health-influencing and health-governing bodies is needed on all levels in order to address the CVD problem in the Latino/Hispanic population.

Historically, forensic STR panels have been unsuccessful for population assignment due to the limited ancestry information that can be derived from the non-coding STR loci and the low number of loci included in the panel. However, given the recent adoption of expanded (16+ loci) and ‘mega-plex’ (23+ loci) STR panels, the ability to identify source population groups may be improved. This study assessed the impact of increasing locus number on population assignment under different analysis conditions using a published US population dataset comprised of individuals from the African American, Caucasian, Hispanic and Asian populations. The Bayesian clustering programme STRUCTURE was used to assess first, whether increasing the number of loci and the inclusion of known sample population data enabled greater resolution between the four populations in the dataset, and second, the utility for population assignment using criteria based on inferred ancestry scores. Results suggest that increasing the number of loci and including population of origin data allowed the identification of more distinct populations, with three primary populations being observed; African American, Asian, and Caucasian/Hispanic. The close grouping of the Caucasian and Hispanic populations is supported by their recently common ancestry from Western Europe. The ability of the programme to support population assignment to each of the four existing populations was assessed through the application of population and panel specific assignment thresholds based on the inferred ancestry scores obtained from the analysis programme. Predictive accuracy based on a training dataset of 984 individuals suggest that assignment accuracy is > 96% across the four populations and can reach 100% under some test conditions. The accuracy was > 90% when blind testing was performed on 40 ‘unknown’ individuals. As such, the approach described is considered within the acceptable range for a presumptive test and can be performed using data already collected as part of routine forensic investigations.

The latest population statistics show the Hispanic population in the US to be fast-growing, young and very diverse in nature. While the Hispanic group lags behind the general population in average education and employment rates, many gains have been made in the past decade. The growing numbers and attainments of Hispanics will mean an increased demand for better education, employment and training programs, housing and family services.

AMERICA'S new minority group is coming of age: the Hispanic. Surges in Hispanic birth rates and legal and illegal immigration make this growing component of American society a population to be reckoned with. Hispanics totaled 21 million Americans in 1987 (7.9% of the US population). 1 The Hispanic population is expected to increase 40% by the year 2000 (to almost 30 million people). Birth rates for Hispanics are three to four times that of the non-Hispanic white population. Most of us in health care see a lot of this new "poor" American in our clinics and emergency departments, sick and Spanish speaking. Hispanics, with a median age of 23 years, are younger than the US population as a whole. Hispanics (on average) are poor. About 30% of all Hispanic families are living below the poverty level compared with 15% of the total US population. One of every five Hispanic adults

Hispanic adults represent a significant proportion of the lowliterate population in the United States and are thus a group of great potential concern to educators. Attempts to increase the English literacy levels of this group are limited by lack of empirical data regarding variables that affect Hispanics' participation in educational programs. The purpose of the study reported in this article was to gather information about barriers to participation in ESL programs for these adults. Data were obtained from 200 Hispanic ESL students with the Deterrents to Participation Scale-Form LLS (adapted from Hayes & Darkenwald, 1988). Four orthogonal factors were identified through principal components analysis of the data: Self/School Incongruence, Low Self-Confidence, Lack of Access to Classes, and Situational Constraints. Through disjoint cluster analysis, five types of low-literate Hispanic adults were identified according to their scores on the four deterrent factors. These findings provide information that can be used as the basis for developing strategies and programs to meet the ESL needs of specific subgroups of the adult Hispanic population.

CAUSE OF DEATH IN VERY LOW BIRTH WEIGHT PREDOMINANTLY HISPANIC POPULATION: RELATIONSHIP TO BIRTH WEIGHT AND GESTATIONAL AGE

rT _HIS ARTICLE examines the changing nature of Hispanic employment in Southwestern municipalities during 1973-78. Despite the size and importance of the Hispanic population especially in the Southwest there has been scant research on the rates of Hispanic public employment. Previous research has shown that minority public employees black, Hispanic, women, or others are overrepresented at the bottom rungs of the occupational ladder in local, state, and federal employment, and are underrepresented in management and higher-level posts (cf. Sigelman 1976; Hall and Saltzstein 1975, 1977; Meier 1978; Cayer and Sigelman 1980; Rose and Chia 1978; Herbert 1974; Hutchins and Sigelman 1981; see also Krofcheck and Jackson 1974). Cayer and Sigelman (1980) found some improvement in the status of minorities and women in the total state and local workforce between 1973

To the Editor. —The article entitled "A Physician's Guide to Adoption"1 in the Dec 25, 1987, issue ofJAMAignores many aspects of adoption. Although there were good discussions of infertile childless couples adopting babies and toddlers and of black couples adopting black children, there was no mention of other types of adoptive parents or children. For example, there was no discussion of adoption by Hispanics or Native Americans, which was surprising in view of the fact that two of the authors live in areas with large Hispanic populations. Single-parent adoption, which is not uncommon, was not addressed. There was no attention given to families with children (by adoption or by birth) who decide to expand their families through adoption or to foster families who adopt the children they care for. There was no mention of men who adopt. This is especially important because the most common type of adoption

At present, Hispanics rank second in number among minority populations, and demographers are projecting a not very distant time when Hispanics will be the largest minority in the United States. Since this group is sociologically, ethnically, and culturally heterogeneous, presenting very complex and challenging social and health issues, a reference source such as the present volume is most welcome. The editors of this work had as a goal to provide practical information as well as theoretical formulations concerning the Hispanic patient, and they have succeeded admirably. Careful editing of a well-organized wealth of material is evident throughout the volume. The book is divided into four sections, on sociocultural issues, major syndromes, special concerns, and provision of services. Each subject is examined from a general knowledge perspective and is then discussed and applied to the Hispanic population. There is a well-balanced review of the pertinent literature. Some chapters are more research

• The New Mexico Melanoma Registry and New Mexico Tumor Registry identified 81 cases of melanoma involving the skin and mucous membranes of Hispanics. The clinical and pathologic characteristics of these tumors were compared with those observed in whites. The frequency of melanoma in Hispanics appears to be no more than a sixth of that observed in whites. Female patients were more prevalent within the Hispanic population. The median patient age at diagnosis was similar in Hispanics and whites. A much larger proportion of melanomas in Hispanics occurred on the palms, soles, and in subungual regions. Acral lentiginous melanomas were correspondingly more frequent among Hispanics, as was mucous membrane melanoma. Melanomas arising from the palms, soles, subungual regions, and mucous membranes tended to be advanced in stage, to occur in older individuals, and to metastasize. These cases explain the generally poorer prognosis for Hispanic patients compared with whites. The epidemiology of melanoma relevant to these findings is discussed. ( Arch Dermatol 1987;123:1331-1334)

This paper considers the meaning of minority group status for the Hispanic population of the United States regarding access to medical care. A review of the relevant literature raises a number of questions concerning determinants of medical care utilization for Hispanics. They are explored using data from a national survey of health care utilization that oversampled the Hispanic population of the southwestern United States. Some indicators suggest that limited access to medical care for Hispanics in this region is associated with low levels of income, education, and health insurance coverage. Some implications of the findings for future research on Hispanics' access to medical care are presented.

To examine ethnic trends in neonatal mortality rates (NMR) and to find reasons for the trends, we analyzed several maternal and infant variables (based on our perinatal data monitoring system Winegar, Am. J. Ob. Gyn, 1983) in 4659 Hispanic, 6350 black and 12679 white mothers and their children in our network. Epidemiological standardization to account for differences in birthweight distribution (B.Wt. Dist) and weight-specific (Wt. Sp.) death rates were applied to evaluate their influence on outcome trends. (Table. Late PCN= prenatal care after 32 weeks of pregnancy). Although Hispanic NMR was better than blacks, it was entirely due to a better B.Wt. Dist. If Hispanics did have black B.Wt. Dist. their NMR would have been worse than the observed black rate 14.6 Vs 11.9). If Hispanics did have Wt. Sp. death rate as either whites or blacks of our network, their NMR should have been 5.16 and 4.52, which are 17% and 33% better than the observed NMR of 6.05. These trends suggest that although maternal factors and crude NMR seem to be better in Hispanics, their outcome is not as good as it should have been, considering their better B. Wt. Distribution. Late entry into prenatal care and high incidence of diabetes may be in part, responsible for these trends.

Marital disruption among the three largest Hispanic populations in the United States is analyzed. The focus of the study is a comparison between the low levels of marital disruption observed among Mexican Americans and indicators for other Hispanic populations. The results indicate substantial diversity among the Hispanic populations observed with regard to marital stability and instability. The importance of socioeconomic factors is emphasized. (ANNOTATION)

Hemoglobin (Hb) S and C prevalence was determined for several ethnic groups that comprised the population born at our hospital in 1985 by review of data obtained by cord blood screening. The infant's race and nationality were designated as that listed for the mother and prevalence calculated using data available for all births. The rates of FAS and FAC in all White children were higher than previous reports possibly because of the considerable proportion of Hispanics comprising this population. FAS and FAC were more frequently found in H than in BA (p

The largest minority group in the United States may soon become the Hispanic population, which currently is estimated to comprise about 12 million persons. People of Mexican ancestry make up about 60% of this group, and no major US city has a greater proportion of persons of Mexican origin than San Antonio, Tex. Recognizing this, investigators at the University of Texas Health Science Center, San Antonio, are conducting what they say is "one of the first comprehensive studies of diabetes, high blood pressure, and other cardiovascular risk factors to include a broad cross section of this Mexican origin population." Michael P. Stern, MD, director of the study, says the major objective is to learn how socioeconomic, cultural, life-style, and genetic factors affect disease patterns in Mexican- and Anglo-Americans there. The study began in September 1979, and Stern says that preliminary data from the first 251 persons examined indicate that Anglo-Americans