Posted by James
Implications for Improving Care of Hispanic Children with ADHD
The cultural, socioeconomic, linguistic and other differences between Hispanics and whites as well as those differences among Hispanic subgroups create a need for specialized care in Hispanics. Specialized care includes provisions to effectively overcome language barriers and an increased knowledge among healthcare providers regarding culture-specific practices that may have an impact on the ability of the parent to recognize the symptoms of ADHD or to seek or accept treatment. Furthermore, strategies must be employed to offset many of the socioeconomic barriers, such as lower educational status and lack of health insurance, which may be common in newly immigrated, economically disadvantaged or unemployed families.
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Posted by James
Disparities in Cultural Beliefs between Hispanics and Whites
In addition to the distinguishing features of individual Hispanic subgroups, clinicians who treat Hispanic children with ADHD must consider important cultural differences that distinguish the overall Hispanic population from non-Hispanic white children. A large national survey conducted for McNeil Consumer & Specialty Pharmaceuticals by Harris Interactive online and through telephone interviews sought to explore cultural differences among more than 3,300 parents or caregivers of children from 6-17 years of age. A random selection process with two sampling methods was used to sample respondents. The first sample was generated through random-digit-dialing procedures and was comprised of respondents who completed a survey within the past two years. The second sample was also a random-digit telephone sample but was targeted to exchanges with a high-er-than-average number of minority residents. This ensured inclusion of minority participants who might have been excluded if the survey were limited to Internet users alone. People who chose not to answer >3 questions were not included in the total sample. The survey asked questions about ADHD, including how familiar the caregivers were with the symptoms and treatment of ADHD and how they believed race or ethnicity might have an impact on the diagnosis of ADHD. Approximately 30% of these respondents were Hispanic (1,034), including persons from Latin America, Mexico, Puerto Rico and Cuba.
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Posted by James
Impact of Diversity on Healthcare in Hispanic Populations
Before attempting to contemplate strategies that may aid in the diagnosis and treatment of ADHD in Hispanic children, it is necessary to reflect on the diversity of subgroups that comprise the Hispanic population in the United States. Increasing our knowledge regarding the diversity of this group is especially important, considering that the Hispanic population is now the largest minority group in the United States. Therefore, to best meet the needs of this large and growing population, it is important for clinicians to recognize factors that contribute to the diversity of the Hispanic population and that may impact medical care.
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Posted by James
INTRODUCTION
Epidemiologic data on the prevalence of ADHD in the Hispanic population are lacking because few population-based studies have been performed. One estimate by the National Center for Health Statistics reported that the prevalence of ADHD is 3.3% in Hispanics and 6.5% in whites. Of those Hispanics who are diagnosed, many are undertreated. A national study analyzed data from 26,000 office- and hospital-based primary care visits and reported that Hispanic children were significantly less likely than white children to be treated with a stimulant medication. Similarly, a study of children in Maryland public schools reported that Hispanic students received methylphenidate at approximately one-third the rate of white students. Also of concern are data from parent questionnaires, which suggest that treatment regimens are not adhered to by Hispanic patients with ADHD. One survey of almost 2,000 island-Puerto-Rican caregivers reported that only 3.6% of children with ADHD who received stimulants during the previous year were adhering to treatment one year later. The treatment of ADHD in Hispanic patients must be improved, since untreated ADHD has been associated with multiple negative outcomes, such as comorbid conduct disorder, school failure, mood disorders, substance abuse and the development of adult antisocial personality.
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Posted by James
As indicated in Table 4, lower perceived health status, belief that genetic testing will lead to racial discrimination, belief that all pregnant women should have genetic tests, and belief that God’s Word is the most important source for moral decisions were significantly associated with race when controlling for other factors.
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Posted by James
Demographics
Fifty percent of the respondents were African-American and 50% Caucasian. Distributions for sex, marital status, level of education, household income, self-rated health, likelihood of having a physical examination within the last year, religion and religious influence differed significantly between races (Table 1). Interestingly, a higher percentage of African Americans thought God’s Word was the most important source for moral decisions than did Caucasians (79% vs. 56%, PO.001).
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Posted by James
Sample and Recruitment
In 2004, we surveyed by telephone patients from four inner-city health centers. These centers were included because they were known to serve large numbers of persons of color and of disadvantaged persons and were willing to implement quality improvement initiatives. Most of these patients were part of a panel of 325 persons that was initially selected from a random sample (of billing records) of patients who were >50 years old and had been seen at one of the health centers in the last year and who continued to participate in our studies. A personalized introductory letter and a letter from the health centers endorsing the project and encouraging participation were sent to each of the sampled patients. A $10 honorarium was offered for completing the survey. Of the panel, 248 participated, 14 refused and 15 were ineligible—for a response rate of 80% [248/(325-15)]. This panel was augmented by a convenience sample that, following HIPAA guidelines, was recruited by the sites using an introductory letter and recruitment sheet that was distributed by office staff during visits. Among these 104 new recruits, 83 interviews were completed, 0 refused and one was ineligible—for a response rate of 81% (83/103). As such, the total sample for this study was 331 patients.
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