Community Assessment and Analysis: Hispanic Obesity in Las Vegas, Nevada
Concepts in Community and Public Health

Community Assessment and Analysis Part II: Hispanic Obesity in Las Vegas, Nevada
In this report, the Hispanic community was assessed using Gordon’s 11 Functional Health Patterns. The Hispanic people were found to have a high rate of obesity and other health related problems. From looking the different social, cultural, behavioral, environmental, and economic aspects, obesity, and chronic diseases impact not only individuals and families but society as a whole. Their strengths and weaknesses were put into two clusters and nursing diagnoses were provided for each cluster. Next, they were prioritized by level of importance and a rationale was provided. The Hispanic community in Las Vegas, Nevada has many strong points, as well as many weaknesses regarding their health.
Value/Belief Pattern: Hispanics believe that there is a path of life is set in stone for them. These beliefs deter Hispanics from getting preventative care and screened for chronic diseases or cancers. The majority of Hispanics in Las Vegas are Catholic and this accompanies strong beliefs. A chronic disease or cancer is believed to be a punishment from God (Carteret, 2011). Some illness and diseases are believed to be an imbalance of ‘hot’ and ‘cold’ and it is believed that these illnesses can be treated with consuming the opposite (Kemp, 2005). Family and higher powers of authorities in respect is very much valued for the Hispanic people.
Health Perception/Management: The majority of Hispanics use primary care physicians as their source of healthcare. Many wait until the illness has become severe and use hospitals as a form of healthcare because they have a low rate of health care coverage. Hispanics like to use herbal remedies as the first choice to treat an ailment. Hispanics are less likely to have health insurance than other ethnic groups whereas many do not use dentists. Obesity is a predominant health problem for Hispanics. According to the CDC, Hispanics are 21% more likely to be obese than non-Hispanic Whites. Immunization rates in Las Vegas are especially low at 66%. There is an expo called ‘La Opportunidad’ that is held once a year to encourage more people, especially children, to get vaccinated (Ion News, 2011).
Nutrition:
The majority of Hispanic diet includes beans; rice, breads, and corn that included are high in carbohydrates and fiber. This leads to a rise in obesity in Hispanics. The CDC, reports that 24.5% of Hispanics living in Nevada were obese. Many Hispanics in Las Vegas have a cultural diet as well as a progressed diet from American culture.
Elimination:
Hispanics cultural diet is high in fiber so, for the majority, bodily elimination patterns should be within normal limits. Hispanics living in the Las Vegas area mostly all live in places with running water for proper disposal of wastes and hand hygiene. Elimination on pollutants into the air is a bigger problem for Hispanics than other ethnic groups because they are less likely to treat chronic disease due to lack of health insurance (Denis, 2012).
Pattern of Activity/ Exercise: According to the Physical Activity Guidelines for America, physical activity is “anything that gets your body moving” (Obesity in Latino Communities, 2006). Barriers to physical activity, which have been commonly believed by Hispanics, are varied but some of the common themes relate to constraints on time and environmental access. Individuals of the Hispanic community perceive their lack of time as directly correlated with the multitude of role responsibilities within the family unit. The environmental variables include perceived neighborhood safety and access to adequate facilities that “work at” breaking down these constraints. Clark County addresses this area of disparity by promoting community facilities such as the Parks and Recreation Department and the YMCA. Both facilities are culturally sensitive and diligent in assessing and providing for the needs in the communities in which they serve. Since activity preferences vary, culturally “focused strategies” have been advocated; dancing, walking and family centered activities are preferred by a majority of this Hispanic population. The city of Las Vegas is accommodating to such preferences with its multitudes of parks and hiking trails. Juggling family responsibilities and transportation become obstacles. In many highly Hispanic populated areas the YMCA’s and Parks Department, in conjunction with the public school system, offer before and after school care, tutoring services, school intermission relief, and computer education (for all ages). Yet, transportation remains a barrier. Public transportation is poor and many designated stops are often “3-5 miles from the residential areas in need of this service” (Living in Las Vegas, 2013). Although walking may be advantageous, in this desert “oasis” it can quickly become dangerous and heat stroke/exhaustion is quite common therefore, pool use is a viable option but necessary precautions need to be taken as accidental drowning are the number one cause of injury/death in younger Nevadans. The local YMCA’s offer education on pool safety, often for free. The Latino populations are a socially connected culture therefore, interventions aimed at successful adherence and continuance are largely reliant on their support networks or the extent at which they connect with others involved.
Pattern of Sleep/ Rest: According to the National Institute of Health, the average adult should receive 7-9 hours of sleep/night. Recent studies have suggested that there is an association between sleep deprivation, daily performance, and illness including the likelihood of weight gain. Based on research data, the Hispanic culture has a “high prevalence of risk factors” such as “obesity, diabetes, alcohol consumption, propensity to live in the inner city and acculturation” (Staff, 2010). Acculturation difficulties contribute greatly to the worsening of sleep habits, primarily fewer hours of substantial sleep. There are significant environmental or cultural effects on sleep “practices and quality.” For example, the Hispanic culture is generally associated with culturally specific practices such as “la siesta” and finds this ritual acceptable, unlike their “white” counterparts. According to the Hispanic Nurses Organization, “shorter sleep duration was most closely associated with living in the inner city and acculturation habits adopted” (Staff, 2010).
Pattern of Cognitive and Perception: “Las Vegas Valley’s booming Hispanic population has transformed entire neighborhoods into ethnic enclaves” (Living in Las Vegas, 2013), where Spanish is the dominant language. The demographic “transformation” of Clark County mirrors that of much of the country. “Latinos are the largest and fastest growing minority group in the U.S. yet have the lowest education attainment levels” (Improving the Education for the Latino Community, 2011). Graduation rate of Hispanics in Clark County are “well below” that national average; graduating at a rate of 59.8% of which most of these are not necessarily graduating “on time” or with their own class. The city of Las Vegas is beginning to take notice; enhancing existing programs such as UNLV’s extension programs that provide continuing education classes, literacy programs, adult diploma and GED attainment, computer training etc.
Pattern of Self -Perception/ Self Control Research presents support that socioeconomic status is a key factor that influences quality of life in individuals “across the lifespan;” SES (socioeconomic status) affects function in many ways including “development, psychological health and physical health” (Staff, 2010). Evidence is clear that there is a link between SES and “negative psychological health outcomes while more positive outcomes such as optimism and self-esteem” (Staff, 2010) continue to wane affecting “emotional and behavioral” states. Clark County has begun initiation of public programs to bridge the gap between SES and acculturation including the stressors that are clearly intertwined. One such program includes the implementation of the H.A.R.T. program (Hispanic American Resource Team). This team works to “build relationships” and addressing community issues by improving relations between the community protectors/advocates and its inhabitants. Interventions are aimed at improving language barriers, improving educational attainment, promoting career enhancement and largely to institute safety measures such as gang related education and substance abuse; “taking back” neighborhoods “one at a time.”
Role/Relationship
The boundaries that define a community have invisible barriers such as the role and relationship of the community. The Hispanic community is a very family oriented community. They are loving and loyal within the family, but are suspicious to non-family members. Gangs in the Hispanic community are large and organized and the strong connection to family leads to very tight bonds within the gang. This unfortunate has led to putting them at risk for violence. The most recent figures provided by law enforcement are 50 percent Hispanic/Latino gang members, 32 percent African-American/black gang members, 10 percent white gang members, and 8 percent other race/ethnicity of gang members (NGC, 2009). Many Hispanic youth have had encounters of violence within a gang whether it is physical assault or gun violence (NGC, 2009). The relationship with the local authorities is then strained due to the violence that is prevalent. There many agencies that have entire units dedicated to gangs, helping reduce the violence.
Sexuality/Reproductive
The relationships in the Hispanic community that develop are very strong and the importance for family is paramount. The Hispanic community is primarily Catholic in their belief structure and leads to large families. Birth control within in the Catholic religion has been opposed due to their understanding of the Bible. So the use of condoms and other forms of birth control are not used as common. The CDC in 2011 reported that the rates of sexually transmitted diseases (STDs) among the Hispanic community are twice as likely as all races, except for the African-American community. There is a need for the community health nurse to educate this community on the importance of the use of condoms to reduce the risk for STDs.
Coping/Stress
The Hispanic community is less likely to drink than are non-Hispanic Whites. In fact, Hispanics have high rates of abstinence from alcohol. But Hispanics who choose to drink are more likely to consume higher volumes of alcohol than non-Hispanic Whites ("Alcohol and the Hispanic Community," 2011)
Limited research shows that treatment can help Hispanics who speak English and who are highly acculturated to American life. Nevertheless, Hispanics with severe alcohol problems are less likely than non-Hispanic Whites to seek treatment. Hispanics also are less likely to join Alcoholics Anonymous, even though AA groups are available for free and in Spanish. The community health nurse can focus on the Hispanics that report that they drink. This is due to their incidence of consuming higher amounts of alcohol when they do drink. The nurse can also provide literature in Spanish about the health problems associated with chronic use of alcohol.
Cluster One * Major health problem: obesity and chronic related disease are the leading causes of death in the Hispanic communities. * Lack of access to the grocery store * They won't exercise frequently * Lack of access to health care * Because of religious beliefs they get delay in seeking medical attention, don’t believe in protection * The uninsured seek help from community centers * In times of need there are good family support
Nursing Diagnosis: Ineffective community Therapeutic Regimen Management and health maintenance R/T delay in getting medical care of chronic diseases and factors leading up to becoming obese.
Cluster Two * Effect of language barrier * Immunization rate * Addiction and prevention and recovery programs * Mental health disorders and statistics * Bad dietary habits * Occupational health dangers
Nursing Diagnosis: Ineffective community coping R/T inadequate problem solving violence, drug abuse and mental health problems.
Cluster Three * Low educational rate and educational programs * Limit for participation to higher positions * Currently increasing educational level * Church support and community support. * Role importance based on sex * Ethnic and racial discrimination in the community
Nursing Diagnosis: Risk for low education levels and violence due to poor communication within English speaking community and low educational rate.
Prioritized Nursing Diagnoses
1. Ineffective community Therapeutic Regimen Management and health maintenance R/T delay in seeking medical care and chronic diseases and factors leading up to becoming obese.
Rationale: They lack proper knowledge on health maintenance. Their access to care may be limited due to impaired family support, lack of resources, and negligence.
2. Ineffective community coping R/T inadequate problem solving violence, drug abuse and mental health problems.
Rationale: There may be a lack of affection within the family. Lack of communication and non-cooperation by the family members may lead to maltreatment from one or more family members. This can lead to violence, drug abuse, and mental health problems. This causes an unsafe environment within the community.
3. Ineffective community coping R/T inadequate problem solving violence, drug abuse and mental health problems.
Rationale: There could be a lack of affection between the families. Lack of communication and non-cooperation by the family members may lead to maltreatment from one or more family members. This may result in mental health problems, drug abuse, and violence. This can also result in a dangerous environment inside the community. In conclusion, the Hispanic community lacks proper health management and education is one cause of why many people are obese in their community. A few problems faced by Hispanic Americans in Las Vegas Nevada are chronic diseases, heart disease, low educational rate, and not proper care of nutrition and diet. On the other hand, they have good family support and are rooted firmly in their faith. By focusing on the prioritized areas and through education and proper health management, their health can be significantly improved.

References
Carteret, M. M. (2011). Culture values of Latinos, Patients and Families. Dimensions of Culture. Retrieved from http://www.dimensionsofculture.com/2011/03
Centers for Disease Control. (2009). http://www.cdc.gov/obesity/data/adult.html
Centers for Disease Control. (2009). Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults. MMWR. http://www.cdc/mmwr/preview/mmwrhtml/mm5827a2.htm
Denis, M. (2012). Air Pollution and the risk to Hispanic people. Las Vegas Sun. Retrieved from http://www.lasvegassun.com/news/2012/sep/01
Department of Education. (2011). Retrieved from http://www.whitehouse.gov/sites/WinningTheFutureImprovingLatinoEducation.pdf
Gambetta, R., & Burgess, M. (2011). National League of Cities Center for Research and Innovation. Retrieved from http://www.public-safety-programs-in-the-immigrant-community-gid-2011
Nevada State Division of Health/UNLV. (2012). Retrieved from http://www.health.nv.gov/PDF’s/InjuryInNevada.pdf
Kemp, C. (2005). Mexican and Mexican Americans: Health Beliefs and Practices. Retrieved from http://bearspace.baylor.edu/CharlesKemp/www/hispanic.health.htm
Kirby, B. (n.d.). Nevada Diabetes Prevention and Control Project. Hispanics and Diabetes.
Latino Coalition for Health. (2006). Retrieved from http://www.chc.org/documents/ObesityLatinos.CHC.pdf
National Youth Gang Survey Analysis . (n.d.). Retrieved from http://www.nationalgangcenter.gov/Survey-Analysis/Demographics
Nevada Chamber of Commerce. (2013). Retrieved from http://www.lvchamber.com/living-las-vegas
Nevada’s Vaccination Rate Lower than National Average; Latin Chamber Encourages Community to get vaccinated. (2011). Retrieved from http://ionnews.wordpress.com/2011/08/26/nevada
The National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2011). Retrieved from http://pubs.niaaa.gov/publicatins/HispanicFact/HispanicFact.htm
Staff, N. (2010). Transforming to Support Healthy Communities for Latinos. Retrieved from http://www.thehispanicnurses.org/2010conference.pdf
United Health Foundation Nevada. (2009). Retrieved from http://nevadapublichealthfoundatin.org/userfiles/AboutPublicHealth/Nevada