Latino dentists in the U.S. Census from 1980 to 2019: Implications for dental care access.

OBJECTIVES: This study describes the supply of Latino dentists in the United States from 1980 to 2019, as tabulated by the Census. The number of Latino dentists per 100,000 Latino population was compared to the number of non-Hispanic White (NHW) dentists per 100,000 NHW population. These four-decade comparisons were made for the entire country as well as the five states having the largest Latino populations. METHODS: Data from the decennial census and the American Community Survey were used to identify the nationwide population, the number of dentists, and their respective Spanish-language abilities, stratified by race/ethnic group (Latinos and non-Hispanic Whites). RESULTS: In 1980, there were only 18 Latino dentists for every 100,000 Latino population in the entire nation, compared to 70 NHW dentists per 100,000 NHW population. While there was an increase to 21 Latino dentists per 100,000 in 1990, the supply remained virtually the same over this almost 40-year period, ending back at 18 per 100,000 in 2019. In comparison, there were about four times as many non-Hispanic White dentists as Latino dentists. This national discrepancy was also reflected in the five states that were evaluated. Similarly, Latino dentists were far more likely to speak Spanish than NHW dentists at both the national and state levels. CONCLUSIONS: The Latino dentist supply, already inadequate in 1980, has remained virtually unchanged over the past almost 40 years. The authors believe that this deficiency will have profound consequences, and recommend that initiatives be undertaken to increase the number of Latino dentists.

The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion.

PURPOSE: The purpose of this study is to examine the number of Latino physicians in residency training and Latino resident physician trends in the nation's 10 largest medical specialties in the United States and in the 4 states with the largest Latino populations: California, Florida, New York, and Texas. METHOD: The authors used data from the United States Census Bureau's American Community Survey to determine Latino populations and a special report from the Association of American Medical Colleges to determine rates of Latino resident physicians in the United States and in California, Florida, New York, and Texas from 2001 to 2017. Rates of Latino residents in the nation's 10 specialties with the largest number of residents were also determined. RESULTS: From 2001 to 2017, the United States had an average of 37 resident physicians per 100,000 population. At the national level, however, Latino residents were underrepresented, with only 14 per 100,000 Latino population. At the state level, California and Texas, the 2 states with the largest Latino populations (39.4% and 39.7% of their population, respectively), had 5 and 9 Latino residents per 100,000 Latino population, respectively. Latino residents in California, Texas, Florida, and New York were also very underrepresented in the primary care specialties examined. CONCLUSIONS: The findings show a severe shortage of Latino resident physicians. While a similar shortage also exists in primary care specialties, the majority of Latinos in states with large Latino populations are consistently choosing to train in primary care. Investment and greater improvement in the representation of certain population groups in medicine and for combating the inequities existing in the current educational system is needed. The authors offer recommendations to increase the number of Latinos in residency programs and for increasing the number of Spanish-speaking physicians and Latino international medical graduates in residency programs.

Post-Pandemic Telehealth Policy for Primary Care: An Equity Perspective.

National telehealth policy thus far has focused on broadening access to service, specialties, and originating sites. Yet telehealth policy can further equity by providing system-level change needed to reduce structural determinants that hamper telehealth access in historically marginalized, low income, and limited English-speaking populations. The authors propose policy solutions for states and CMS to help address these structural determinants of telehealth care. A telehealth "ecosystem" grounded in the following core components would ensure equitable access to care: use of technology inclusive of economically marginalized patients, access to the technology and broadband for completing virtual visits, and concrete support for patients as they develop their digital and telehealth skills.

Latina Women in the U.S. Physician Workforce: Opportunities in the Pursuit of Health Equity.

PURPOSE: Some progress has been made in gender diversity in undergraduate medical education and the physician workforce, but much remains to be done to improve workforce disparities for women, particularly women from underrepresented populations, such as Latinas. This study examines the current level of representation and demographic characteristics of Latina physicians, including age, language use, nativity, and citizenship status. METHOD: The authors used data from the 2014-2018 U.S. Census Bureau's American Community Survey (ACS) 5-year estimates for their analyses. During the time period covered by this analysis, ACS response rates ranged from 92.0% to 96.7%. The authors included in this study individuals who self-reported their occupation as physician and who self-identified their race/ethnicity as either non-Hispanic White (NHW) or Hispanic/Latino, regardless of race. The authors used person-level sampling weights provided by the ACS to convert the original 1% sample to a 100% enumeration of the population. RESULTS: According to the ACS 2014-2018 5-year estimates, NHW physicians make up 65.8% (660,031/1,002,527) of physicians in the United States. Women comprise 36.1% (361,442) of the total U.S. physician population; however, Hispanic/Latina women comprise only 2.4% (24,411). The female physician population is younger than the male physician population, and Hispanic female physicians are the youngest. Latina physicians are far more likely to speak Spanish at home than NHW physicians. Immigrants make up 40.1% (9,782/24,411) of the Hispanic female physician population, and 12.3% (3,012/24,411) of Hispanic female physicians are not U.S. citizens. CONCLUSIONS: This study suggests that Latina physicians in the United States are younger, more likely to be bilingual and speak Spanish at home, and very underrepresented, compared with NHW female and male physicians. Increasing their share of the U.S. physician workforce would benefit the pursuit of health equity for an ever more diverse population.

Meeting them where they are on the web: addressing structural barriers for Latinos in telehealth care.

As we enter an era of health care that incorporates telehealth for routine provision of care, we can build a system that consciously and proactively includes vulnerable patients, thereby avoiding further exacerbation of health disparities. A practical way to reach out to Latino patients is to use media they already widely use. Rather than expect patients to adapt to suboptimal systems of telehealth care, we can improve telehealth for Latinos by using platforms already familiar to them and thereby refocus telehealth delivery systems to provide patient-centered care. Such care is responsive to patients' needs and preferences; for Latinos, this includes using digital devices that they actually own (ie, smartphones). Equity-centered telehealth is accessible for all, regardless of linguistic, literacy, and socioeconomic barriers.

Office of Management and Budget Racial/Ethnic Categories in Mortality Research: A Framework for Including the Voices of Racialized Communities.

Since its founding, the US government has sorted people into racial/ethnic categories for the purpose of allowing or disallowing their access to social services and protections. The current Office of Management and Budget racial/ethnic categories originated in a dominant racial narrative that assumed a binary biological difference between Whites and non-Whites, with a hard-edged separation between them. There is debate about their continued use in researching group differences in mortality profiles and health outcomes: should we use them with modifications, cease using them entirely, or develop a new epistemology of human similarities and differences? This essay offers a research framework for including in these debates the daily lived experiences of the 110 million racialized non-White Americans whose lived experiences are the legacy of historically limited access to society's services and protections. The experience of Latinos in California is used to illustrate the major elements of this framework that may have an effect on mortality and health outcomes: a subaltern fuzzy-edged multivalent racial narrative, agency, voice, and community and cultural resilience.

The Epidemiology of Diversity: COVID-19 Case Rate Patterns in California.

California's diverse population provides a natural laboratory for understanding how diseases and conditions interact within different racial/ethnic groups. This report seeks to illustrate the differential effects of the COVID-19 pandemic in the state's "majority-minority" population and to discuss the resulting implications for public health. Laboratory-confirmed COVID-19 cases in California (disaggregated by race/ethnicity into mutually exclusive groups) were integrated with their respective population values to create case rates per 100,000 population, categorized by age group and race/ethnicity. The case rates within each non-White population, in almost every age group, were higher than the White Non-Hispanic population, ranging from one-and-a-half to nearly six times as high. Public health prevention measures such as sheltering-at-home rely on standard assumptions and models. The disparity in case rates found here suggests that alternative narratives such as the epidemiology of diversity may inform additional policies or measures.

Corrigendum: Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study.

[This corrects the article DOI: 10.3389/fnut.2019.00034.].

Racially Ambiguous Babies and Racial Narratives in the United States: A Growing Contradiction for Health Disparities Research.

Researchers attempting to identify and track health disparities and inequities generally use five racial or ethnic (R/E) categories-four racial groups (white, black, Asian/Pacific Islander, and American Indian) and one ethnic group (Hispanic)-to analyze and predict variations in health outcomes in the overall U.S. population. These categories are used as if they were permanent, naturally occurring, internally homogeneous, and discrete. However, the United States is becoming increasingly racially ambiguous because of (1) the growth of the Latino population, nearly half of whom do not identify with one of the four racial groups; and (2) the growing population of racially ambiguous babies, whose mothers and fathers are of different R/E groups. In California, an average annual 52.6% of the babies born between 2011 and 2015 were racially ambiguous (i.e., their parents were from different R/E groups or at least one parent was something other than a single race).We describe the social-legal construction of hard-edged, binary racial categories in the United States from 1790 to the present (and the subsequent racial structuring of U.S. society along those categories). Researchers should shift the conceptualization of race from that of an innate, individual trait to that of a narrative, and should consider the impact that racial narratives can have on the life courses of individuals categorized as nonwhite. In light of the increasing racial ambiguity in the United States, the Latino fuzzy-edged, multivalent racial narrative that embraces racial mixing may be one alternative to the United States' hard-edged, binary one.

Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study.

Background: The Hispanic/Latino population in the US is experiencing high rates of obesity and cardio-metabolic disease that may be attributable to a nutrition transition away from traditional diets emphasizing whole plant foods. In the US, plant-based diets have been shown to be effective in preventing and controlling obesity and cardio-metabolic disease in large samples of primarily non-Hispanic subjects. Studying this association in US Hispanic/Latinos could inform culturally tailored interventions. Objective: To examine whether the plant-based diet pattern that is frequently followed by Hispanic/Latino Seventh-day Adventists is associated with lower levels of adiposity and adiposity-related biomarkers. Methods: The Adventist Multiethnic Nutrition Study (AMEN) enrolled 74 Seventh-day Adventists from five Hispanic/Latino churches within a 20 mile radius of Loma Linda, CA into a cross-sectional study of diet (24 h recalls, surveys) and health (anthropometrics and biomarkers). Results: Vegetarian diet patterns (Vegan, Lacto-ovo vegetarian, Pesco-vegetarian) were associated with significantly lower BMI (24.5 kg/m2 vs. 27.9 kg/m2, p = 0.006), waist circumference (34.8 in vs. 37.5 in, p = 0.01), and fat mass (18.3 kg vs. 23.9 kg, p = 0.007), as compared to non-vegetarians. Adiposity was positively associated with pro-inflammatory cytokines (Interleukin-6) in this sample, but adjusting for this effect did not alter the associations with vegetarian diet. Conclusions: Plant-based eating as practiced by US-based Hispanic/Latino Seventh-day Adventists is associated with BMI in the recommended range. Further work is needed to characterize this type of diet for use in obesity-related interventions among Hispanic/Latinos in the US.

Plant-Based Diets in Hispanic/Latino Adult Adventists in the United States and Their Association With Body Mass Index.

PURPOSE: To characterize plant-based dietary practices and examine their relationship with body mass index (BMI) in Hispanic/Latino Seventh-day Adventists (SDA). DESIGN: Cross-sectional analyses of data among Hispanics/Latinos in the Adventist Health Study-2 (AHS-2). SETTING: The AHS-2 is a cohort of SDA adults (n = 96 592) in North America. PARTICIPANTS: A total of 3475 Hispanics/Latinos who provided demographic, dietary, anthropometric, and lifestyle data at enrollment. MEASURES: Plant-based dietary practices were determined from food frequency questionnaire; BMI, demographic, and lifestyle data were assessed by questionnaire. ANALYSIS: In linear regression analysis, plant-based diets were modeled as dummy variables with nonvegetarian as the referent group and log(BMI) as the outcome adjusted for age, sex, education, exercise, nativity, alcohol use, smoking, and energy intake. RESULTS: We identified 202 vegans, 664 vegetarians, 409 pesco-vegetarians, 227 semi-vegetarians, and 1973 nonvegetarians. Compared to the nonvegetarian referent (BMI = 27.50), estimated BMI were lower among vegans (23.58, P < .0001), vegetarians (25.24, P < .0001), pesco-vegetarians (26.36, P = .0002), and semi-vegetarians (26.69, P = .130). Other factors associated with lower BMI were being female (P = .001), nativity (Mexico, P = .002; South America, P < .0001; Caribbean, P = .004), having a college degree or higher (P = .01), exercise (P < .0001), and never smoked (P = .0006). CONCLUSION: Hispanic/Latino SDAs who consumed plant-based diets had lower BMI than nonvegetarians. The application of a plant-based diet as practiced by the Hispanic/Latino Adventists in this population may have public health impact on US Hispanic/Latinos.

California And The Changing American Narrative On Diversity, Race, And Health.

The historical narrative on diversity, race, and health would predict that California's population change from 22 percent racial/ethnic minority in 1970 to 62 percent in 2016 would lead to a massive health crisis with high mortality rates, low life expectancy, and high infant mortality rates-particularly given the state's high rates of negative social determinants of health: poverty, high school incompletion, and uninsurance. We present data that suggest an alternative narrative: In spite of these negative factors, California has very low rates of mortality and infant mortality and long life expectancy. This alternative implies that racial diversity may offer opportunities for good health outcomes and that community agency may be a positive determinant. Using national-level mortality data on racial/ethnic groups, we suggest that new theoretical models and methods be developed to assist the US in achieving high-level wellness as it too becomes "majority minority."

Strengthening the Community College Pathway to Medical School: A Study of Latino Students in California.

BACKGROUND AND OBJECTIVES: One third of Latino medical students begin their premedical undergraduate education at a community college (CC) or 2-year college, compared to a 4-year university. This study explored the academic and personal experiences Latino premedical students commonly encounter at the CC. METHODS: In 2013, five focus groups with Latino premedical and medical students (n=45) were conducted in Los Angeles and San Jose, CA. All students were enrolled or attended a CC. In addition, 20 CC key informants participated in semi-structured interviews to further describe the Latino CC premedical experience. The focus group and key informant transcripts were transcribed and analyzed for common themes using qualitative methods. RESULTS: Content analysis of 2,826 distinct comments identified major themes: (1) Personal health-related experiences in underserved communities, (2) CC relevant premedical guidance, (3) Limited preparation in navigating the pathways to medical school, and (4) Competing demands and college affordability. CONCLUSIONS: Early CC enrichment programs with direct ties to health professions advising programs, 4-year universities, medical schools, and physician mentors are needed to support Latino pre-medical students.

Latino Physicians in the United States, 1980-2010: A Thirty-Year Overview From the Censuses.

PURPOSE: To update and extend a 2000 study on the California Latino physician workforce, the authors examined the Latino physician workforce in the 30-year time frame spanning 1980 to 2010, comparing changes in the rates of physicians per 100,000 population for the Latino and non-Hispanic white (NHW) populations in the United States as a whole and in the five states with (in 2010) the largest Latino populations. METHOD: The authors used detailed data from the U.S. Census (Public Use Microdata Samples for 1980-2010) to identify total population, total number of physicians, and Spanish-language ability for both the Latino and NHW populations. They examined nativity for only Latinos. RESULTS: At the national level, the NHW physician rate per 100,000 of the NHW population increased from 211 in 1980 to 315 in 2010 while the Latino physician rate per 100,000 of the Latino population dropped over the same period from 135 to 105. With small variations, the same trend occurred in all five of the states examined. At the national and state levels, Latino physicians were far more likely to speak Spanish than NHW physicians. Over the 30-year period, the Latino physician population has evolved from being primarily foreign born to being about evenly split between foreign born and U.S. born. CONCLUSIONS: The Latino physician shortage has worsened over the past 30 years. The authors recommend immediate action on the national and local level to increase the supply of Latino physicians.

Undocumented students pursuing medical education: The implications of deferred action for childhood arrivals (DACA).

There are about 1.8 million young immigrants in the United States who came or were brought to the country without documentation before the age of 16. These youth have been raised and educated in the United States and have aspirations and educational achievements similar to those of their native-born peers. However, their undocumented status has hindered their pursuit of higher education, especially in medical and other graduate health sciences. Under a new discretionary policy, Deferred Action for Childhood Arrivals (DACA), many of these young immigrants are eligible to receive permission to reside and work in the United States. DACA defers deportation of eligible, undocumented youth and grants lawful presence in the United States, work permits, Social Security numbers, and, in most states, driver's licenses. These privileges have diminished the barriers undocumented students traditionally have faced in obtaining higher education, specifically in pursuing medicine. With the advent of DACA, students are slowly matriculating into U.S. medical schools and residencies. However, this applicant pool remains largely untapped. In the face of a physician shortage and the implementation of the Affordable Care Act, an increase in matriculation of qualified undocumented students would be greatly beneficial. This Perspective is intended to begin discussion within the academic medicine community of the implications of DACA in reducing barriers for the selection and matriculation of undocumented medical students and residents. Moreover, this Perspective is a call to peers in the medical community to support undocumented students seeking access to medical school, residency, and other health professions.

The Latino adolescent male mortality peak revisited: attribution of homicide and motor vehicle crash death.

OBJECTIVE: The Latino Epidemiologic Paradox describes favourable health profiles for Latinos compared to non-Latino whites despite poverty, low education, and low access to healthcare. The objective of this study was to determine if the anomaly to the Latino Epidemiological Paradox and the Latino Adolescent Male Mortality Peak in California mortality data persists. METHODS: Cases were California residents (1999-2006) of any race and ethnicity that died (N = 1,866,743) in California from any cause of death. Mortality rates and rate ratios were calculated according to causes of death for 5 year age groups. RESULTS: For males and females combined, age adjusted mortality rates were 509 for Latinos and 681 for non-Latino whites per 100,000/year. Latino male mortality rate ratios exceeded 1.0 compared to non-Latino white males only for age groups 15-19 years (1.41, 95% CI 1.35 to 1.49) and 20-24 years (1.24, 95% CI 1.19 to 1.29). Latinas had lower mortality rates than non-Latino white females for all ages over 15 years. Male homicide rates for Latinos increased over the study period, but did not reach the rates reported for the years 1989-1997. Both male homicide and motor vehicle crash mortality rates were higher for Latinos than non-Latino whites and peaked at 20-24 years. The Latino crash mortality rate exceeded the rate for non-Latino whites overall and for each year 2003-2006. Crash mortality for males aged 15-24 years increased from 2000 to 2006. CONCLUSION: The anomaly and the mortality peak persist, with notable attribution to homicide and crashes. Without homicide, the mortality peak would not exist. Mortality disparities for Latino adolescent males from these two causes of death in California appear to be growing.

The rise and fall of the Latino dentist supply in California: implications for dental education.

The purpose of this study was to determine the number of Latino dentists in California, identify the schools and countries where they were educated, and compare Latino dentist demographics with that of the state's new demographics. From the 2000 California Department of Consumer Affairs list of 25,273 dentists, we identified Latino U.S. dental graduates (USDGs) by "heavily Hispanic" surnames and Latino international dental graduates (IDGs) by country and school of graduation. From the 2000 U.S. census Public Use Microdata Sample (PUMS), we described Latino dentist characteristics such as Spanish language capacity and practice location. The number of Latino dentists acquiring licenses to practice in California has fallen dramatically, by nearly 80 percent, between 1983 and 2000. This decline is not merely an affirmative action issue; it results in an issue of access. Latino dentists are far more likely to speak Spanish and be located in a heavily Latino area than non-Latino dentists. Currently, although the supply of Latino dentists is dwindling, the Latino population is growing rapidly. In California and out-of-state schools, first-year matriculation of Latino USDG must increase. Further, non-Latino dentists should be prepared and given incentives to learn Spanish and locate practices in areas of need. The reintroduction of IDG Latino dentists needs to be seriously considered.

Hepatitis A: the burden among Latino children in California

OBJETIVO: Determinar la tasa de prevalencia de la hepatitis A entre ciertos grupos de población de los condados del sur de California. MATERIAL Y MÉTODOS: Se calcularon las tasas de hepatitis A por edad y raza/etnia utilizando los datos de los archivos del Centro de Servicios de Salud y Vigilancia de California, y los denominadores demográficos del ciclo 1996-2001 de la Sección de Estadísticas del Departamento de Finanzas de California. RESULTADOS: Los 2.3 millones de niños latinos (de 0 a 14 años) de cinco condados del sur de California presentaron una tasa de 31.1 casos por cada 100 000 niños, lo que muestra que es cinco veces más alta que la tasa anglosajona. CONCLUSIONES: El Comité Consejero de Prácticas de Inmunización del CDC recomienda vacunar rutinariamente a los niños con índices "muy altos" de hepatitis A. La frecuencia anual de hepatitis A, especialmente en el sur de California, alcanzó el índice "muy alto" de acuerdo con lo establecido por el CDC; por lo tanto, debería considerarse a los niños latinos de estos condados para la administración rutinaria de vacunas contra la hepatitis A. Como la salud no tiene fronteras, este problema debería tomarse en cuenta por los servicios de la salud pública de ambos países, México y Estados Unidos.

Hepatitis A: the burden among Latino children in California.

OBJECTIVE: To determine the prevalence of Hepatitis A within subpopulations of southern California counties. MATERIAL AND METHODS: Age and race/ethnic-specific hepatitis A rates were derived from the California Department of Health Services Surveillance and Statistics Section for 1996-2001 and from demographic data of the California Department of Finance. RESULTS: 2.3 million Latino children (aged 0-14 years) in five southern California counties had a rate of 31.1 cases per 100,000, five times higher than the non-Hispanic white rate. CONCLUSION: The CDC Advisory Committee on Immunization Practices recommends routine vaccination for children with "very high" rates of hepatitis A. The annual prevalence of hepatitis A in California, especially in southern California, met the CDC's "very high" definition, therefore Latino children in these counties should be considered for routine childhood hepatitis A vaccination. As health has no borders, this issue should be addressed by the public health services of both, the United States' and Mexico's public health services.