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

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.

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

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

Field Staff Recruiter/Interviewers/Translators
Yazmin Brambila
Javier Fernandez Salvador
Jazmin Gonzalez
Mario Rosales
Elio Cacerras
Victor Elias
Jasmin Guerra
Alonso Oliveros
Patricia Robleto

• 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

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]
318%
268%
178%
81%
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

• 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

• 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 +

• Trust
• Immigration Issues
• Legitimacy of Project
• Building a Presence
• Finding Participants
• Cultural Norms-Talking about Sexual Issues
• Perceived Discrimination Issues

Recruitment and
Networking Strategies
• Building community presence
• Outreach locations
• Marketing
• Face to face/Engaging participants

• 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

• Individual, semi-structured interviews
• 60-90 minutes long
• Bilingual, bicultural staff members conducted interviews in English or
Spanish

• 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

• 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

• 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

• Overall Health:
– Sexual health was fourth
• Sexual Health:
– Over half had no concerns
– About two fifths were concerned about STIs

• 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

• 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

• 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
76%
Too much waiting time at clinics
It is hard for me to get time off work or school 53%
I have transportation problems getting to a clinic 45%
Takes too long to get an appointment
I have no one to watch my kids
No clinic close to where I live
41%
33%
30%
Clinic hours are not convenient for me 30%

• Over half reported ever having been discriminated against or made to feel unwelcome in Oregon.

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
•
Scale adapted from Bird ST, Bogart LM, 2001.

• 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.

• 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

• 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

• Unintended pregnancy high among Latinos
• Use of contraception low
– Inconsistent use
– Reliance on less effective methods

• 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

• 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

• 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

• 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

• 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

Female-controlled methods
Male-controlled method
Women %
(N=243)
Men %
(N=233)
TOTAL
(N=476)
46% 27%
36%
12% 22%
17%
Other 42% 51%
47%

Results: Risk Ratios from
Multinomial Logistic Regression
Variable
Female
HS graduate
Married/cohabitating
Acculturation
Machismo
BC self-efficacy
Perceived vulnerability
Commitment
BC decision-making
Partner support for BC
*p<.05; **p<.01; ***p<.001
Female Control vs. Other
1.15
.75
1.82*
.72*
.79
1.58**
1.25
1.07
1.27
.61**
Male Control vs. Other
.72
.92
.41*
.78
.94
1.35
1.39
1.04
2.12**
1.04
Female Control vs. Male
1.60
.81
4.48***
.92
.84
1.17
.90
1.02
.60*
.59

• 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