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Proyecto de Salud Para Latinos:
Understanding the Sexual and
Reproductive Health Needs of Young
Latino Men and Women Residing in
Rural Oregon
Moderator: Marie Harvey
OPHA Panel Presentation: October 18, 2010
Latino Health Project
Why??
• Latinos disproportionately high rates of unintended
pregnancy and STIs
• Sexual health disparities only have the potential to grow
• Non-traditional settlement areas experienced rapid and
dramatic increases in the number of Latino residents
with large numbers migrating to rural areas
• Oregon has experienced a striking 52.7% growth in
Latino population between the years 2000-2008
• Relatively little known about sexual risk profile of Latino
men and women who live in rural Oregon.
Latino Health Project
Proyecto de Salud Para Latinos
5-year funded CDC study that examined the
relational and contextual determinants of
contraceptive use and sexual risk behavior
among young adult Latinos in rural Oregon
Project Period: 9/30/2007 – 9/29/2011
Latino Health Project for Men
Proyecto de Salud Para Hombres Latinos
3-year DHHS Office of Population Affairs
funded study designed to improve delivery of
sexual and reproductive health services to
heterosexual Latino men in rural areas.
Project Period: 9/30/2007 – 9/29/2011
It Takes a Village…
Research Team
S. Marie Harvey, DrPH, MPH – Principal Investigator
Ann P. Zukoski, DrPH, MPH - Co-Investigator
Donna Champeau, PhD – Co-Investigator
Jocelyn Warren, PhD, MPH – Post Doctoral Fellow
Liana Winett – DrPH, MPH – Research Associate
Meredith R. Branch, MPH - Project Coordinator
Deanne Hudson, RN, MPH - Project Coordinator
Marit Bovbjerg, MS – Research Assistant
Antonio Torres, B.A. - Field Coordinator/Interviewer
Leslie Salas Karnes - Graduate Research Assistant
Doris Cancel-Tirado – Graduate Research Assistant
Brennan Beauchesne - Undergraduate Student Intern
It Takes a Village…
Field Staff Recruiter/Interviewers/Translators
Yazmin Brambila
Victor Elias
Javier Fernandez Salvador
Jazmin Gonzalez
Mario Rosales
Elio Cacerras
Jasmin Guerra
Alonso Oliveros
Patricia Robleto
Community Partners
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Tuality Salud
Virginia Garcia Clinics
Radio Movimiento
Planned Parenthood
Benton County Health Department
Centro Latino
Farmworker Housing Development Corporation
Linn-Benton Hispanic Advisory Committee
Woodburn Public Library
Chemeketa Community College
Proyecto de Salud Para Hombres Latinos:
Immigrant Latino Men Residing in Rural
Communities in the Northwest: Exploring
Physical and Social Environments
Antonio Torres, Marie Harvey, Liana Winett, Deanne
Hudson, & Meredith Branch
OPHA Panel Presentation: October 18, 2010
Goals
Of the study:
• to increase understanding of sexual and
reproductive health needs of heterosexual
immigrant Latino men residing in rural areas of
Oregon
Today:
• to provide a snapshot of the lives of Latino men
working and living in rural Oregon
• to describe how contextual factors might interact
to increase men’s risk for HIV/STIs
Latinos in Rural Communities
• Largest & fastest growing minority group in US,
particularly in “new settlement areas”
• Face unique challenges that may influence sexual
behavior and health service utilization that increase
risk of exposure to HIV/STIs, unintended pregnancy
• Migration disrupts social, familial, sexual
relationships
• The percent increase in Latino population over the
last decades has been dramatic in Oregon,
Washington and Idaho.
% Increase Hispanic Population 1980-2000
[US Census 2000]
268%
81%
318%
178%
29%
Disparities Facing
the Latino Community
• High rates of unintended pregnancy, STIS &
HIV/AIDS among U.S. Latinos
• 2007 AIDS case rate among Latinos was 3.3
times higher than for Whites
• In 2008, Latinos had highest syphilis rate and
second highest chlamydia and gonorrhea rates
among minority populations in OR
Contextual Determinants
• Amaro and Raj (2000) called for including
individually-based factors within the context of
the larger social dynamics of gender,
race/ethnicity and class oppression
• Our focus: how individual and interpersonal
risk factors interact with sociostructural
variables that place Latino men at increased
risk
Target population
• Heterosexual men who self-identify as Latino
• Immigrated to the U.S. in past 10 years
• 18-30 years old
• Live in rural Oregon
• Report intercourse within past 3 months
• Not seeking to get partner pregnant
• Not HIV +
Challenges
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Trust
Immigration Issues
Legitimacy of Project
Building a Presence
Finding Participants
Cultural Norms-Talking about Sexual Issues
Perceived Discrimination Issues
Recruitment and
Networking Strategies
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Building community presence
Outreach locations
Marketing
Face to face/Engaging participants
Community Partners
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Tuality Salud
Virginia Garcia Clinics
Radio Movimiento
Planned Parenthood
Benton County Health Department
Centro Latino
Farmworker Housing Development Corporation
Linn-Benton Hispanic Advisory Committee
Woodburn Public Library
Chemeketa Community College
Study Methods
• Individual, semi-structured interviews
• 60-90 minutes long
• Bilingual, bicultural staff members
conducted interviews in English or
Spanish
Analysis
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Interviewed 49 Latino men
Audio-recorded, translated & transcribed
NVIVO 8 qualitative data analysis software
Ethnographic content analysis
SPSS 17.0 to create frequency distributions
of structured survey responses
• Content analysis using NVIVO8
RESULTS…
Participant Characteristics
• Average age 24 years
• 92% from Mexico
• Average 6 years living in the US; 4.3 years in
OR
• 57% unemployed
• Mean household income $13,621
• Mean 9.1 years of education completed
Sexual Risk Profile
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Average age first intercourse 16 years
Mean of 8.2 lifetime sexual partners
10% tested for STIs in past month
49% ever tested for HIV
45% ever had sex with prostitute
29% never used condoms during sex
46% report binge drinking
Social and Physical
Environment
Living in Oregon
• Came to Oregon for increased opportunity
• Came to Oregon because of friends/family
• Cultural differences
Working in Oregon
• Employment/unemployment
• Workplace conditions
Social Relationships
• Family and sexual partners
• Social support
• Committed relationships
Sexual Relationships
• Sex outside of committed relationship
• Loneliness
• Sexual experimentation
• Sexual needs
• Engaging with prostitutes
• Cultural differences
Implications
• Risky environments + migration-driven
factors = increased prevalence of
HIV/STIs
• Social network dynamics, social isolation
• Address substance use
• Source, availability & social economy of
prostitution
Proyecto de Salud Para Latinos:
Para Hombres
Perceived Structural Barriers to Sexual and Reproductive
Health Services
Deanne Hudson, Marie Harvey, Antonio Torres, Meredith Branch
OPHA 2010 Annual Meeting
October 18, 2010
Corvallis, Oregon
Purpose of the Presentation
• Characterize structural and service delivery
factors that affect utilization of services
• Explore the preferred context for services and
strategies to promote access and utilization of
services
• Discuss implications of findings
Greatest Concerns about
Health and Sexual Health
• Overall Health:
– Sexual health was fourth
• Sexual Health:
– Over half had no concerns
– About two fifths were concerned about STIs
Utilization of Services
• Almost half had ever used services - US
– Community/Public Clinic: 52%
– Emergency Department: 17%
– HMO: 13%
– Private Doctor: 9%
• Utilization of SRH services - Oregon
– Used STD Services: 31%
– Received HIV Testing: 37%
• A few used Family Planning services - US
Health Insurance
• 88% Lacked health insurance
– Few had employer-provided coverage
Structural Factors Affect
Access & Use of SRH Services
• Lack of knowledge
• Cost
• Time
• Clinic Staff Characteristics - Language
• Privacy – Confidentiality - Trust
Factors Affect Access/Use
of Family Planning Services
• Few men ever used US family planning services
• Self and Cohort: lack of knowledge
• Cohort
– Lack of interest and services not valued
• Self
– No need for FP services
– Not ready for a family
Factors Affect His Ability to Get
Birth Control Now
Too much waiting time at clinics
It is hard for me to get time off work or school
76%
53%
I have transportation problems getting to a clinic
45%
Takes too long to get an appointment
41%
I have no one to watch my kids
33%
No clinic close to where I live
30%
Clinic hours are not convenient for me
30%
Experiences with
Discrimination in Oregon
• Over half reported ever having been
discriminated against or made to feel
unwelcome in Oregon.
Perceived Discrimination in
US Health Care Services
About half who received health care in the US perceived:
– Been treated with less courtesy than others
– Been treated with less respect than others
– Received poorer service than others
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Scale adapted from Bird ST, Bogart LM, 2001.
Preferred Context: How
Men Want to Be Treated
• About three fourths described the importance of
having trust in your provider.
• About two thirds wanted to be treated
respectfully.
• About half wanted equality and fair treatment.
Preferred Delivery Setting
for SRH Services
• Prefer to receive services at Community/Public
Health Clinics
• Prefer to see a private doctor or clinic
• Preferred Involvement in Decisions to
Prevent Pregnancy
– Talk with my partner and me together
Strategies to Increase Use of SRH
Services: What Can Clinics Do?
• Increase Awareness and Knowledge
• Reduce Cost
• Efficient use of Time
• Clinic Staff Characteristics - Language
• Promote Privacy - Confidentiality - Trust
Discussion
• Results are consistent with the literature
• Informs practice, policy and research
Factors Influencing Effective Contraceptive Use Among a
Sample of Latinos Residing in Rural Communities in the
Northwest
Jocelyn T. Warren, S. Marie Harvey & Marit Bovbjerg
Oregon Public Health Association 2010 Annual Meeting
Corvallis, Oregon
Background
• Unintended pregnancy high among Latinos
• Use of contraception low
– Inconsistent use
– Reliance on less effective methods
Previous Research
• Individual factors identified
– self-efficacy, perceived vulnerability, etc.
• Cultural factors explored
– machismo, familismo, marianismo
– acculturation
• Partner and relationship factors?
– women’s pregnancy intention varies depending on
partner
– men often not included in contraceptive research
• Include individual factors in larger context
Study Purpose
• Describe effective contraceptive use
• Determine whether contextual factors are
related to effective contraceptive use
• Discuss significance of findings for
reproductive and sexual health programs
Latino Health Project
Proyecto de Salud para Latinos
• Multi-method study to increase understanding of social,
cultural factors that influence condom use, sexual risk
behavior, HIV/STI prevention among Latinos living in
rural Oregon
• Participants included young Latino heterosexual men
and women and health care providers who serve
Latinos in rural areas
• Young adult participants recruited from clinics and
community locations
Methods
• Eligibility criteria for study:
– Ages18-25
– Current sexual partner
– Not planning pregnancy
– No sterilization within couple
• Data derived from computer-assisted quantitative
surveys with trained interviewers lasting ~1 hr
Participants
• Over 60% born outside the US
• One quarter spoke only Spanish
• Just over half completed high school
• Almost half were married or living with partner
• Median income was $15,000 and average
household size was 3.5
Effective Use of Contraception
Three groups defined:
• Female-controlled= use of LARC (IUDs, injections,
rings, etc.) or regular use of pills
• Male-controlled=male condom used at every sex in
past three months
• Others= non-use, use of ineffective methods, and
inconsistent use of effective methods
Other Variables
• Sex (female/male)
• At least HS graduate
• Married and/or
cohabitating
• Acculturation Scale
• Machismo Scale
• Birth control use selfefficacy scale
• Perceived vulnerability to
pregnancy with partner
• Relationship commitment
scale
• Contraceptive decisionmaking scale
• Perceived partner support
for birth control
Effective Contraceptive Use
TOTAL
(N=476)
Women %
(N=243)
Men %
(N=233)
Female-controlled
methods
46%
27%
Male-controlled
method
12%
22%
17%
Other
42%
51%
47%
36%
Results: Risk Ratios from
Multinomial Logistic Regression
Variable
Female Control
vs. Other
Male Control
vs. Other
Female Control
vs. Male
Female
1.15
.72
1.60
.75
.92
.81
1.82*
.41*
4.48***
Acculturation
.72*
.78
.92
Machismo
.79
.94
.84
1.58**
1.35
1.17
Perceived vulnerability
1.25
1.39
.90
Commitment
1.07
1.04
1.02
BC decision-making
1.27
2.12**
.60*
Partner support for BC
.61**
1.04
.59
HS graduate
Married/cohabitating
BC self-efficacy
*p<.05; **p<.01; ***p<.001
Discussion
• Over half of the sample practiced effective use, with
female-controlled methods more common
• Factors related to effective use varied by method
• Importance of married/cohabitating—more likely for
female controlled, less likely for condom users
• Lower acculturation finding consistent with previous
studies of contraceptive use
• Partner factors important across methods
• Self-efficacy related only to female-controlled methods vs
others, but greater decision-making predicts condom use