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Cathy Schechter & Susan Poag Co-Principals. SUMA/ORCHARD SOCIAL MARKETING, INC. Research with Latinas. 6 Focus Groups with Hispanic women Ages 18-27 Born in U.S. and/or immigrated at <5 years old 4 Preconception/2 Interconception Woodburn/Salem, Eugene, Medford and surrounding areas

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research with latinas
Research with Latinas
  • 6 Focus Groups with Hispanic women
    • Ages 18-27
    • Born in U.S. and/or immigrated at <5 years old
    • 4 Preconception/2 Interconception
    • Woodburn/Salem, Eugene, Medford and surrounding areas
    • All groups conducted in English
research with providers
Research with Providers
  • 3 “Provider” groups (staff from clinics, agencies serving Latinas)
    • Salem, Eugene, Medford
  • 15 Provider In-Depth Interviews
    • All five target counties represented
a note about eugene
A Note about Eugene
  • Findings among women in Medford and Woodburn very resonant and consistent
  • University students in Eugene were significantly more educated, web-savvy and knowledgeable about their bodies and health care/birth control options
  • Providers in Eugene did not describe serving the women who came to the Eugene focus groups, indicating that university students are more acculturated and assimilated.
lines of inquiry
Lines of Inquiry
  • Top-of-Mind thoughts about “health”
  • Definition of “good health” and “bad health” habits
  • Differences between them and their mothers vis-à-vis health and healthy habits
  • Health concerns and how they face them
  • Response to information in mock-up health magazines
  • Values
  • Media preferences
  • Recommendations for communications strategies
generation 1 5 straddling two worlds
Generation 1.5: Straddling Two Worlds
  • Women place highest value on maintaining family connections, but also value the freedom to make their own decisions based on what is best for them
  • Most are bilingual & bicultural (media preferences, music choices)
  • They straddle two worlds, and this can be a source of stress & confusion

I chose this family picture because they’re all different ages. My family’s bigger, but we’re always together, and not so cheesy like, “Thumbs up happy.” But when everybody’s together, we’re happy. Then I chose this for myself because it just kind of reminds me of goals that I have and things I want to do for myself. So it kind of keeps me motivated to do that.


Like, our family comes from Mexico. When I go to Mexico everybody’s happy and they have nothing close compared to what we have. And we’re like, “I gotta get this, I gotta get that,” and a lot of people are like, “I got to go to college because I’ve got to make money.”It’s like the material things make the person. In Mexico everybody’s with joy and happiness. I want to live over here, but I don’t know about the lifestyle.

key influencers
Key Influencers
  • Mom
  • Sisters and other female relatives
  • Friends
  • Boyfriends and husbands
  • Health care providers
but mom rules
  • Number one source of health information: Mom
  • Number one source of home remedies: Mom
  • Who do you respect most: Two thirds of all participants said MOM or MY PARENTS
parents often lack knowledge skills to educate them about their bodies
Parents Often Lack Knowledge & Skills to Educate them about their Bodies
  • Many women did not learn about reproductive health in school
  • Parents are not educated about anatomy and reproduction
  • Many cultural taboos surround family discussions about menstruation and sexual relationships

I think that issue of changes and bringing up pregnancy, or even just talking about that is just like, forbidden. It’s just like we don’t talk about that. And especially sex. [Agreement] That’s a no.My mom was like, “… you can’t go swimming and you can’t have sex because you’ll get pregnant! And even if they touch your boobs!” If I talked to her about tampons, she’d be mad because she thought I was having sex.


They want to be able to use a tampon and not feel guilty about it…if a girl, another Latina, sees them and tells their mom, “You know Julie uses a tampon,” you’re worried the word’s going to get out. “Oh her daughter’s not a virgin, I heard she uses tampons.” That’s a huge issue for these young women.

young women need information about women s health care
Young Women Need Information about Women’s Health Care
  • Most women lack access to health insurance
  • Without Medicaid, young women may not know what their health care options are or when to use them unless they become pregnant

As a minor we always had OHP through my mom. Whenever I needed to go to the clinic, that was always taken care of. But now I’m kind of on my own. I don’t have no insurance, nothing, so I don’t really go unless it’s crucial, something really important.I need to get insurance soon. I turn 26 in two weeks and so I’m getting kicked off my parents’ insurance and my current job doesn’t provide it for me, so I’m looking for work that will give me that.


Without family role models or explanation, appropriate health education at school or a health care provider, many young women do not understand the reproductive process, birth control options and the components/reason behind well-woman check-ups (e.g., PAP smears)


Like you hear all this stuff on TV, this is new. Or get your yearly exam. Or like the HPV. You just hear different things. Then you go to the doctor, it’s like, “Oh you’re fine. Do you want me to check you for Chlamydia.” I was in my head thinking, “That’s what they were going to check for, they already checked for that stuff, like that’s what they gave me a PAP for.” But they asked me do you want to get checked for this, but I’m thinking what the heck is the test for? I thought I was getting checked for everything that’s out there…I don’t know what’s out there.

access to health care limited
Access to Health Care Limited
  • Many lack health insurance
  • Many discuss their lack of health care options
    • Use of emergency room
    • Use of public health and/or indigent care clinics
    • Go only when they are really ill
  • Women in all groups describe mixed treatment in clinics by staff or doctors
    • Prevalence of feeling “dismissed,” or rushed
    • Long waits, lack of trust

If you don’t have insurance they won’t see you.They talk medical language, like what is that? I don’t even know. Can you please just talk to me in English? But that’s what they do sometimes.

cultural challenges with healthcare
Cultural Challenges with Healthcare
  • Some doctors try by learning Spanish etc.
  • Questions and concerns about US healthcare system vs care in Mexico
  • Some stories about lack of cultural sensitivity

I think it’s just that they don’t know the culture. They can’t relate to it….It’s like if you don’t have friends or family or whatever, someone that’s close to them to understand exactly what kind of people we are, what kind of customs we carry and the kinds of diets we carry and all those remedies our grandmas talk about. So to me it’s like there’s no way you can relate even if you were to take a Spanish class, sorry.


Respondent 1: There are a couple of friends and family members I know that went to the doctor. Something was wrong with them, and she said they couldn’t find a solution. They go to Mexico and get treated over there. They come back and they’re perfect.Respondent 2: Yeah, that’s what my mom said. She’s like, “They just want to use your insurance money here.


Yesterday I went to take an ultrasound, right here at maternal natal clinic, and they were giving me the paperwork in Spanish, and I’m like, “Can you give it to me in English please?” And the girl just looked at me and said “Aren’t you Hispanic?”

perceived generational differences
Perceived Generational Differences
  • Education
  • Openness
  • Traditional Ways
    • Cuarantina
    • Healthy foods
    • “Mom is there for me.”
top of mind preconception interconception define health differently
Top of Mind: Preconception & Interconception Define “Health” Differently
  • Interconception, women often think of their children’s health first
  • Interconception, women more motivated to stay healthy for their children
  • Preconception women tend more to associate health with diet, exercise, mental health, sleep, skin care,
  • STDs, health insurance access and family history mentioned across groups
staying healthy
Staying Healthy
  • High awareness of what they need to do (eat well, exercise, avoid drugs and tobacco, etc.)
  • Barriers to taking steps to good health include time, money, motivation, skills
many use home remedies
Many Use Home Remedies
  • Cinnamon sticks boiled in water with red onion for cough
  • Tobacco in the baby’s belly button for colic
  • Wear a red shirt with a safety pin during an eclipse during pregnancy to prevent sick babies
  • Put breast milk in eyes for pink eye
  • Put breast milk in ears for ear infections
more home remedies
More Home Remedies
  • If baby has diarrhea and soft spot has dropped, turn baby upside down and slap his feet
  • Rub raw egg over baby with a fever
  • Rubbing alcohol, marijuana and garlic for sore bones
  • Candle in the belly button to take the devil out
and more
And More…
  • Alfalfa tea to improve eyesight
  • Smoke in the ear for an earache
the curanderos
The Curanderos
  • In all groups, almost half of the women had been to a curandero in Mexico, and some have seen one in Oregon

Respondent 1: My mom, when I was younger, she thought the devil was inside of me because I wouldn’t listen to her, so in December we went to Mexico for our vacation and she decided to take me. So they laid me down on a bed and this guy started shaking leaves. (Laughter)Respondent 2: Time out! I opened the garage door once and I thought my grandma was beating my brother with rosemary. I thought he was busted (overlapping laughter), I was like six.Respondent 1: And then they put a candle on my belly button and I guess the devil came out of me. (Laughter)

they laugh through uncertainty
They Laugh Through Uncertainty

Respondent 1: My boyfriend is like, “Are you wearing red?” I’m like, “Yes I am!” (laughter) But I don’t freak out about it.

Respondent 2: But I wonder if it’s true!

Respondent 1: No, I actually don’t think it’s true.

Respondent 3: I think it’s true. Because when my boyfriend’s mom was pregnant she actually did wear something red, and a lady that was also pregnant didn’t, and her baby came out with defects.

quarentena 40 days of rest
Quarentena = 40 Days of Rest

The forty days after they have the baby, you can’t do anything. You have to have someone cook for you, do all the chores for you. You can’t go outside.

Every time my mom sees somebody that already they’re in their quarentena, “Oh my god, I can’t believe she’s out! What is she doing?” Like seriously, you know. And I’m like, “She looks fine to me. But okay.”


Well, there is this thing called quarentena, which is like 40 days. After I delivered even my mom was wrapping me up in all these clothes, “In Mexico, you can’t even take a shower for 40 days.”…then she’s like going upstairs she made me walk backwards…you have to wear a sweater when you go out…cover your head.

perceptions of latina paradox
Perceptions of Latina Paradox
  • Believable
  • Number 1 Difference: Stress levels
  • Number 2: Nutrition
  • Number 3: Family support

I think a lot of the stress is cultural here versus there, because there people are more accepting. People want to be more nurturing and caring for mothers, whereas here a mom has all these stresses. She has to worry about people accepting her. Maybe she’s younger, so it’s like oh my god, all these people are looking at me like this, and that’s because I’m young and I gotta get a job, and what’s going to happen with my family, if your family is here. You have more of those stresses as opposed to in Mexico where it’s a little more accepting and people want to take care of you.


I think it’s probably worse because here you’re pregnant, you’re like, “Oh, I have to work and work and work, because buying this for the baby and buying a house and we’re paying the car and in Mexico, you’re pregnant, you’re like, you stay home and clean.


I think nutrition has a lot to do with it, too. Because I know that if you’re over there with your family, the way that you’re raised and stuff, the mom that is about to give birth needs to be taken care of. She needs to be eating right. And you have people around you. Your abuelas, your tÌas, whatever you want. People that raised you that are making sure you’re eating right.Down there the foods are a lot more natural. What you eat and drink is more natural. They don’t put chemicals down there like they do here.

consequences of unplanned pregnancies
Consequences of Unplanned Pregnancies
  • Interconception groups have lived it and express it
  • Preconception groups express consequences
    • Drop out of school
    • Depression
    • Financial instability
    • “Not succeeding”
    • Disowned by family
    • Boyfriend leaves you
prospect of birth defects mentioned in a few groups
Prospect of Birth Defects Mentioned in a Few Groups

I think birth defects also, because people are either drinking or drugs, and they’re not thinking they’re going to get pregnant, and it passes on to their babies.


Not being physically ready. Or even mentally. Like say you are 19 and it was about partying. You smoke weed now and then. You weren’t thinking about being a mom yet. You were just doing your own thing. Then you find out you’re pregnant. It’s like, ‘Okay, now I have to step it up. I need to find a good job. I need to find a place to live.’ You need to get mentally quick.

we hardly ever see things like this very positive response to reproductive life plan
“We hardly ever see things like this.”Very Positive Response to “Reproductive Life Plan”
  • Information seen as new and valuable
  • Many appreciate the questions and answers
  • Many like having resources for more information
  • Many expressed motivation to act on new information (vitamin chart, STDs, etc.)

I think it’s good that it has phone numbers and web sites on here that you can actually go and look up information if you want more.I like how it says, “The better you feel, the better you look.”It gives you the solutions, too, if you want to take it. I love this, “Life is full of ups and downs, but good news, when you’re down there’s no place to go but up.”


Anytime I do read something about health, it always makes me feel better when it says there’s “no normal.” Because mine are always three days late, but if you ask me that’s my normal, and it just always makes me feel not weird when I read this. I’m a chart person, so I love the vitamin chart, like what it is, the benefits, the source.It makes it simple and easy to understand, and it’s comfortable to read.


It speaks to truth. Like some ladies have one baby right after another. You need to wait. You need to give yourself time to rest.

Very important. It has questions in here that I would think about, that I would be asking, that I’ve thought about.

I like the breastfeeding part because I always wondered, because I’m not getting my period, can I still get pregnant?


I like this part, where it says a mother that gets pregnant within six months of having a baby is 40% more likely to have a premature baby. I didn’t know that.

more information desired
More Information Desired
  • Understanding their menstrual cycle
  • Birth control options
  • Stress management/emotional health
  • Vitamins & nutrition
  • Managing family issues
  • Health and appearance (skin care, e.g.)
distribution points
Distribution Points
  • Clinics, doctors’ offices
  • WIC
  • Schools
  • Out in community (grocery stores, WalMart)
  • Group meetings
  • Community events
when you want to learn new things how much do you rely on each
When you want to learn new things, how much do you rely on each?
  • When you want to learn new things, how much do you rely on each?
    • A lot =3
    • A little =2
    • Not much = 1
    • Not at all = 0
  • Highest possible = 174 (3 x 58)
ways to learn new information in order
Ways to Learn New Information (In Order)

Top Choices

Used Less

Radio (76)

Magazines (75)

Television (74)

Facebook (65)

Posters (60)

Bus Ads (39)

Twitter (14)

  • Family (152)
  • Friends (131)
  • Search Engines (130)
  • Books (126)
  • Websites (125)
  • Health Care Providers (119)
  • Pamphlets & Brochures (104)
important consideration
Important Consideration
  • Though web sites came close to search engines in usage, only 9 of the 54 people who go to web sites were able to name that specific web site (Planned Parenthood, WebMD, Redbook, Oregon Health Care, March of Dimes)
  • SOSM previous findings indicate people type the topic on the search engine line. Any website needs to be very easy to find!
use of technology
Use of Technology
  • 31% use Internet more than 2 hours per day
  • 22% use Internet an hours or less daily
  • 29% use Internet a few times weekly
  • 17% use Internet infrequently or never
  • Divided evenly (half & half) on use of social networking site such as My Space or Facebook
  • Only 4 people of 58 “tweet”
favorite search engine google
Favorite Search Engine: Google
  • 71% use Google; 19% Yahoo
  • 59% (N=34) have used a website with women’s health information
  • Only 11 of them remember which one
    • Planned Parenthood: 3
    • Web MD: 2
    • 1 each: Yahoo search, Regence, Redbook Oregon Health Care, March of Dimes, Google search on pregnancy
passing on strengths or sharing the best of both worlds
  • Mothers and Daughters both have strengths to pass to one another
  • Mothers have traditional wisdom
  • Daughters want and need factual information
  • Everyone wants to maintain respect
lines of inquiry1
Lines of Inquiry
  • Knowledge & perspectives about preconception and interconception health
  • Perspectives and concerns about Gen 1.5 Latina health
  • Potential training topics of interest
  • Potential campaign participation
critical finding 1
  • Most health care providers do not see these young women.
    • Most health care providers do not see them until they are pregnant.
    • After 18, they do not have health insurance (if they ever had it to begin with)
    • They see providers for for illness or birth control, though they face many barriers. Without social security number, options are limited.
generation 1 5 is falling through the cracks
Generation 1.5 is Falling Through the Cracks

If she’s young and hasn’t had any babies yet… we’re talking [ages] 18-27 and no children…we don’t do a home visit to them because they don’t need our services, yet. So I think that’s the generation that has fallen through the cracks in our communities because we just see them wandering around.

knowledge perspectives on pre and interconception health
Knowledge/Perspectives on Pre- and Interconception Health
  • Uneven, depending upon profession and location
    • Medford is exception because of their Spring 2009 conference.
  • Consists of various components which may be well-understood in isolation, but are not often viewed as a whole
    • E.g., Planned Parenthood focuses on birth control, WIC on folic acid, etc.
concerns about gen 1 5 latina health
Concerns about Gen 1.5Latina Health
  • Lack of parental knowledge
  • Lack of appropriate education in schools around reproductive health
  • Prevalence of teen pregnancy
  • Relationships with father of baby
  • Lack of access to money for birth control (and incorrect usage)
  • Lack of access to health care until pregnancy
  • Cultural Norms & Stigmas
  • Nutrition, Obesity, & Diabetes
parents need to be educated
Parents Need to Be Educated

We had … a program, a curriculum that goes into the schools, and they also come to our complex. It was beautiful talking to the young women, and I was like, “Wait a minute. We’re missing a whole piece right here. We need to talk to the parents” … Because these girls are going to have a lot of questions when they go home. Who is going to answer those questions? They’re going to be in limbo again, like I was when I was twelve years old.


I’m 42, and my children are grown. But it was hard for me to talk to my daughter, and I’m educated. What do you think is going to happen to the rest of the community?(From Provider who organized a local program with a nurse practitioner to explain tampons so girls would go to school/swim class during menstruation) Moms had the cultural piece, that that is just not talked about. They didn’t use tampons because of the virginity issue…the moms wanted to know, is this safe for them. Can they touch themselves down there to put this thing in? What’s going to happen to them?

barrier lack of citizenship documents
Barrier: Lack of Citizenship Documents

(On lack of FPEP for undocumented residents)

We try to get them in touch with other resources, but it does get challenging. It gets overwhelming; it’s overwhelming even when you know the system.

For our Hispanic women they have no health insurance not even if they are pregnant, no labs, no post partum, no ultrasounds, they pay on a sliding scale. It is a huge issue.

prevalence of teen pregnancy
Prevalence of Teen Pregnancy

Most providers mentioned teen pregnancy as a primary concern for the population.

We are seeing more and more 13-14-15 year olds pregnant.

We take them on prenatally. So I work with these very young girls and they say, “If I would have known. If I had known where to go for birth control. I did not know because my mom doesn’t use any.”

cultural norms and early pregnancy in mexico many mexican women start families as teens
Cultural Norms and Early Pregnancy: In Mexico Many Mexican Women Start Families as Teens

They expect that their kids will start relationships as teenagers, and they don’t have that same message about deferring activity and pregnancy.

My big concern is the age, getting these 14 and 15 year old girls showing up pregnant. In that culture, it’s okay that they’re pregnant at that age…the mother was pregnant at that age.

In the Latina community there is way more support; it is almost expected that you are going to have babies young whether you have your ducks in a row or not.

limited options for young undocumented women complicate matters
Limited Options for Young Undocumented Women Complicate Matters

If they’re undocumented… they may opt for pregnancy, a choice by default, because they have limited choices. They graduate from high school, but have no choices because they’re illegal… they can’t get loans, can’t get insurance, can’t get jobs.


Our culture in Mexico is very poor. We go to the doctor only for emergencies, or when you’re dying. You never go to the doctor because you need to get a physical exam…We had children in our culture that immigrated or were born here. We’re changing. We now have to take the children to get a physical exam, we have to take the little girl because she’s having a menstrual period and cramps. The problem I see is a gap in between the teenaged phase to the pre- or interconception phase. That’s where I see the big old gap, and it’s not the provider’s fault. I think it’s cultural. Not only in our Latino community. It’s a gap somewhere right here. I mean there’s nothing.


**Most young Hispanic women, even college students, live at home until they marry. While the strong family can be a strength when childbearing, it can also be a barrier to reproductive planning.They do a lot behind their parents’ back at the mall…They’re seeing their boyfriends, or doing things outside of work. They cannot bring the boyfriend to the house or they better marry. Because they can’t have this one dating, and break up with him, and bring another one.

providers top concerns nutrition obesity diabetes
Providers Top Concerns:Nutrition, Obesity, & Diabetes

They think generally they want to lose weight, but oftentimes have not put it together with being better for the baby. Latinas are often very motivated to do what is best for the baby and will try harder.

If they are obese I encourage them to lose weight, and let them know it’s harder with each pregnancy.


More and more are obese because of fast food; it’s cheaper.

Drown it in salsa, just don’t cook it in lard! People need nutrition education on a budget.

Once they become ‘more Anglo’ they start losing some of those qualities they had in the more traditional society. In Mexico they walk all the time, here they drive. They don’t exercise there is more obesity. They eat processed foods their health goes down.

a word about substance abuse alcohol tobacco
A Word about Substance Abuse, Alcohol & Tobacco
  • Some providers discussed growing concern about gang-related activity, including drug use. More so with men than women.
  • Providers note that while Generation 1.5 is more likely to use drugs, alcohol and tobacco than immigrants, they seem less likely to use it than Caucasian young women. (The young women discussed this issue more than providers.)

Don’t see many 1.5’s smoking. They’re fairly forthright, we do universal drug screening. It there is marijuana, they talk about it. Haven’t seen a lot of addiction in that group.

They are not big smokers, drugs, although they are more likely than the immigrants to maybe have alcohol vs. Caucasian girls who at 17 are smoking, drinking, smoking marijuana, you don’t see that with girls of immigrants.

top concern relationship with baby s father
Top Concern: Relationship with Baby’s Father
  • Providers frequently expressed concern about the baby and mothers well-being in light of unstable relationships
  • Common-law marriage not unusual

Some of the partners seem to drink heavily, be into drugs. I wonder how they’re treated, what they’re future is going to be in this relationship.

I am most concerned about their relationships. Fathers are often gone by 7 month into the pregnancy or they are no longer in a safe relationship. So they don’t have proof of citizenship and are no longer in a relationship. Families take care of them.

Men will not use condoms or get vasectomy

electronic medical records
Electronic Medical Records
  • Many still do not have expect it soon
  • NextGen electronic record systems are mentioned most
  • Providers can pull patient education handouts from system on many topics. However, there are NONE on preconception health.
  • At least one provider said if it is not in electronic system, they do not keep track of it as well.
opportunity with medical assistants and staff who are 1 5
Opportunity with Medical Assistants and Staff who are 1.5
  • Most one-on-one interviewees have bilingual, bicultural support staff and medical assistants who are children of immigrants.

All clinics are becoming more and more dependent on MAs, and they have legal status or come up with papers, they’re integrating.The majority of our medical assistants are first or second generation Latinas.They (referring to local clinic) have bilingual bicultural staff, and the girls who are interns take stuff to their friends. The girls are curious and interested. More could be done.

teachable moments
Teachable Moments
  • Well women exam
  • Negative pregnancy test
  • Healthy woman exam starting at sixteen.
  • Teen well child check-up
expressed needs for tools education training
Expressed Needs for Tools, Education & Training
  • Brochure/ Reproductive Life Plan
  • Training for staff who can also be peer educators
  • Brochure on pregnancy spacing
  • Wellness prescription pad for preconception
  • Video as teaching tool or to take home
  • Poster
medford best practice models opportunities
Medford Best Practice Models & Opportunities
  • Medford clinics stress birth control for interconception health
  • Medford area clinics following Dr. Chasnoff’s Four P’s (though at least one provider tweaks it)
  • Mother/daughter spring event in Medford
strategic musts
Strategic “Musts”
  • Media/marketing tools must guide and propel word-of-mouth/grassroots marketing
  • Training Gen 1.5 medical assistants and other community advocates/peers will carry message a long way
  • Events to bring mothers and daughters to a “common language” about preconception health and reproductive information will enable the passing of strengths to be knowledge-based
tactical musts
Tactical “Musts”
  • Bilingual/bicultural
  • Feature people, situations and places relevant and familiar in a respectful way
  • Consider that while many use the web, equally as many do not
  • Keep community needs and capabilities at forefront (in other words, one size does not fit all; tactics must be tailored to community needs and strengths to succeed)
next steps
Next Steps
  • Full report generated and digested
  • SOSM needs strategic guidance
  • Specific strategies, tactics and materials field-tested with target audiences
  • Final strategic communication plan complete by November