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Multiple Origins, Uncertain Destinies: Hispanics and the American Future Freddy Rodriquez Hasta Cuando (1991), Chapita/Bottlecaps (1990) Copyright by the artist; used with permission.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future 5 Realms of Integration: Family, Education, Work, and Health This chapter examines four aspects of the Hispanic experience—family and living arrangements; schools and education; employment and economic well-being; and health status and access to care. These attributes not only portray current terms of belonging, but also highlight risks and opportunities that will ultimately define the future of the U.S. Hispanic population. A focus on features that set Hispanics apart from other groups—notably language use, youthfulness, and large shares of unskilled immigrants—helps assess whether the identified risks are likely to be enduring. FAMILY AND LIVING ARRANGEMENTS1 Hispanic families are often extolled as a source of strength and cohesion that derives from their “familism”—a strong commitment to family life that values collective goals over individual well-being. Indicators of familism that differentiate Hispanics from whites include early childbearing and higher average fertility levels, large family households that often extend beyond nuclear members, and a greater overall tendency to live with kin rather than with unrelated individuals or alone. As a source of support for relatives in the extended network of kin relationships, familism can help mitigate economic and social risks in the face of adversity. These sentiments were echoed across the generational spectrum in focus groups conducted for the panel:
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future Sometimes families here, white families, are not as united as Hispanic families are. We’re always famous for having aunts and uncles and relatives. Americans, it’s just mom and dad and kids. (Mexican immigrant, Raleigh) *** Typically, we have close families. Family is a really big part of our culture. (third-generation Hispanic, Houston) At the same time, consistent with their varied immigration histories and social conditions, Hispanic families are highly diverse. Specific aspects of family behavior, such as intermarriage patterns, cohesion among relatives, and the content of social exchanges, differ by nationality and generation. Mexican Americans are considered particularly familistic, possibly because the large numbers of immigrants among them bring cultural traditions into sharper relief. Most observers agree that the positive aspects of familism are worth keeping, yet there is no consensus on what can be preserved in the face of the rapid Americanization of second-generation youth. Whether ideals of collective support and other positive features of familism will endure and what forms family structure among Hispanics will take in the future are open questions with far-reaching implications for the evolution of group identity and social well-being. If Hispanics follow the paths of other immigrant groups, their familism would appear to be in jeopardy as they acculturate, experience socioeconomic mobility, and adopt U.S. norms, which includes many behaviors that tend to erode kinship patterns and traditional family behavior. The rise in divorce and nonmarital childbearing among Hispanics, evident in the growth of mother-only families, signals what some scholars term “family decline.”2 In 1980, fathers were absent in 12 percent of white families, 38 percent of both Dominican and Puerto Rican families, and 40 percent of black families. By 2000, approximately 14 percent of white families had a single female head, compared with about 20 percent of Mexican and Cuban families, 25 percent of Central and South American families, 36 percent of Dominican and Puerto Rican families, and 45 percent of black families.3 Because mother-only families are significantly more likely to be poor, this trend signals new vulnerabilities for the growing numbers of youths reared by single parents. Generational transitions also dilute familism, although apparently not uniformly among Hispanic subgroups. For example, among Mexicans and
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future Puerto Ricans born in the United States, the percentage of married-couple households is smaller and the percentage of female-headed households larger than among first-generation immigrants. Compared with the immigrant generation, U.S.-born Mexican Americans exhibit higher divorce rates. Only 56 percent of third-generation Mexican children (those who have American-born parents) live with both parents, compared with about 73 percent of children with Mexican-born parents. Another sign of dwindling familism is the shrinking size of extended families, which often results in reduced safety nets for related individuals.4 Rising nonmarital childbearing is another sign of eroding Hispanic familism. Between 1980 and 2000, the percentage of births to unmarried women more than doubled for whites (134 percent), Mexicans (101 percent), and Cubans (173 percent), and increased by more than half for Central and South Americans (64 percent) and other Hispanics (97 percent). Out-of-wedlock childbearing among Puerto Ricans rose more slowly because, as with blacks, their share of nonmarital births was already high in 1980. By 2000, the percentage of births to unmarried Hispanic mothers was between that of whites (22 percent) and blacks (69 percent). The rate for Cubans was closer to that for whites at 27 percent, and the Puerto Rican rate was closer to that for blacks, at 59 percent. At 44 percent, the out-of-wedlock birth rate for Central and South Americans lay between the extremes. Finally, the cultural mergers produced by rising rates of intermarriage—between Hispanics and non-Hispanics and among Hispanic nationalities—can diminish or redefine the content of familism. As a measure of social distance between groups, an indicator of assimilation, and a force that shapes racial and ethnic boundaries, intermarriage can either redefine or erode Hispanic familism over generations. For all Hispanics, the tendency to marry, cohabit, and procreate with members of their own ethnic group declines across generations, though notable differences exist across groups. Mexican Americans not only are considered to be more familistic than other Hispanics, but also, given their large numbers, are far more likely to be paired with a member of the same ethnic group in marriage, cohabitation, or parenthood than are Puerto Ricans, Cubans, Central/South Americans, or other Hispanics.5 One possible explanation for this is that high levels of immigration, buttressed by residential segregation, help preserve Mexican familism in the face of erosion from other sources. Whether traditional Hispanic familistic orientations will persist beyond the third generation, whether they will take the same forms, and whether
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future they will serve similar protective functions is unknown. Trends in marriage, cohabitation, and parenthood offer provocative insights. Hispanics are more likely to partner with another Hispanic in marriage than in cohabitation and nonmarital parenthood. Although generally less common, relationships with white partners frequently involve marriage. U.S.-born Hispanics are more likely than Hispanic immigrants to have a white, or other non-Hispanic, spouse.6 Unions among partners of different Hispanic origins or between Hispanics and blacks are more likely to involve cohabitation and unmarried childbearing. Hispanic-black unions quite frequently produce children out of wedlock. Hispanics’ interethnic unions foreshadow changing ethnic boundaries through childbearing. In particular, children of mixed unions face complex identity issues: Will they retain a mixed identity, adopt the ethnic (or racial) identity of one parent, or perhaps opt for a panethnic identity? Unions between Hispanic women and white partners can facilitate assimilation into mainstream white society, because these mixed marriages are more common among the better educated. Whether and how Hispanics’ ethnic mixing will redraw racial and ethnic boundaries in the United States is uncertain because the prevalence of intermarriage depends on even greater uncertainties, such as the effect of geographic dispersal on the incidence of mixed unions, future levels of immigration, and the way persons of mixed ancestry self-identify ethnically.7 Because of their sheer numbers and relatively high residential concentration, Mexican Americans are likely to retain a relatively distinct ethnic identity, although generational transitions will blur boundaries though unions with whites. Smaller in size, other Hispanic subgroups are less likely to sustain discrete identities over time because of their higher levels of ethnic mixing with other Hispanic groups and with blacks, which creates greater ambiguity about the place of their offspring in the evolving racial spectrum. How settlement patterns recontour marriage markets will also decide the viability of Hispanicity as a panethnic identity. SCHOOLS AND EDUCATION8 The United States houses some of the most outstanding universities in the world, which coexist with countless highly dysfunctional primary and secondary schools. Thousands of young Hispanics must pursue inter- and intragenerational social mobility predominantly via segregated inner-city schools that feature dropout rates well above the national average. The vastly unequal opportunities for academic achievement they confront in the lower
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future grades contribute to widening disparities at higher levels of the education system. Although most demographic groups have experienced significant increases in educational attainment since the 1960s, Hispanics are distinguished by their historically low levels of completed schooling, currently completing less formal schooling than any other demographic group.9 In the context of the rising demand for skills in today’s economy, this liability is cause for concern. In 2000 working-age Hispanics averaged nearly 3 years less of formal schooling than U.S.-born whites and blacks. Moreover, there are large disparities in educational attainment among Hispanic groups, mainly between the native- and foreign-born. On average, foreign-born Hispanics of working age complete 2.5 years less of formal schooling than their U.S.-born compatriots, with negligible differences between men and women. As Figure 5-1 shows, the educational standing of foreign-born Hispanics has eroded since 1980 compared with both whites and blacks. By contrast, FIGURE 5-1 Mean years of education by race/ethnicity and nativity, 1980-2000. NOTE: For ages 25 to 64. SOURCE: U.S. Bureau of the Census (2000b), Integrated Public Use Microdata Series (IPUMS) 1 percent samples for 1980-2000.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future U.S.-born Hispanics have closed the school attainment gap with whites by more than half a year—from 2 to 1.3 years over the same period. Educational disparities between foreign- and native-born Hispanics play out as inequities among national-origin groups of working age because of the changing volume and composition of immigration in recent decades (see Chapter 2). Not only do foreign-born Mexicans feature the lowest educational levels of any Hispanic subgroup, but the gap in completed schooling between the foreign and native born is larger for Mexicans than for Hispanics of other nationalities—rising from 3 years in 1980 to 4.4 years in 2000—owing to substantial educational advances among the U.S.-born rather than declining attainment of recent immigrants (see Figure 5-2). For other Hispanics, the birthplace gap in education rose more modestly during the same period—from 1 to 1.6 years—while for Puerto Ricans it was reduced by half. Cubans are distinguished from other Hispanic ethnicities because their average education level exceeds that of other subgroups, because foreign-born Cubans average more schooling than native-born Hispanics, and because the educational attainment of U.S.-born Cubans equals (in the case of men) or surpasses (in the case of women) that of white men and women.10 If the schooling deficits of foreign-born Hispanics are imported from Latin America, the disparities among the native-born are produced in the United States. Scholastic disadvantages result from a myriad of social and family circumstances—mainly low parental education levels—and are compounded by schools that fail to deliver quality education.11 Fortunately, educational disadvantages can be prevented for Hispanic youths that have not yet begun their school careers and reversed for those already enrolled. Early Beginnings Hispanic students’ educational disadvantages begin in the early grades for two main reasons—their delayed entry into formal school settings and their limited opportunities to acquire preliteracy skills. Parents of Hispanic preschoolers are less likely than black, white, or Asian parents to be fluent in English and, because many have poor educational levels themselves, to have the resources necessary to promote their children’s prescholastic literacy. This is highly significant because reading to preschool children fosters their language acquisition, enhances their early reading performance and social development, and may promote their future academic success. Participation in home literacy activities such as telling stories or visit-
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future FIGURE 5-2 Mean years of education of Hispanics by ethnicity. NOTE: For ages 25 to 64. SOURCE: U.S. Bureau of the Census (2000b), Integrated Public Use Microdata Series (IPUMS) 1 percent samples for 1980-2000. ing libraries is especially low for children reared in Spanish-dominant homes. In 1999, children of Spanish monolinguals were only half as likely as white children to participate in such activities; if both parents were fluent in English, the gap was just 15 percentage points. The lack of exposure to preschool literacy activities, particularly among children from Spanish-dominant households, often creates literacy disadvantages in the early grades. A 1999 study by the U.S. Department of Education showed that Hispanic kindergarten students trailed their Asian and other non-Hispanic classmates in both reading and math skills.12 Only Native American students had lower preschool reading literacy rates than Hispanics whose parents spoke little English (although Hispanic children exhibited lower math skills).
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future Household language partly reflects social class divisions and recent immigrant status—two attributes that influence children’s exposure to literacy activities before kindergarten. Yet differences in school readiness between Hispanic youth reared in Spanish-dominant homes and English-dominant homes are not an indictment of Spanish-language use per se. Moreover, programs such as Head Start appear to raise Hispanic children’s low average preschool literacy rates. Yet quality preschool programs often are either unavailable where the neediest children live or too costly for family budgets. Thus disadvantaged Hispanic children are left to make their way in the public schools, increasing their vulnerability to failure in the years ahead. Primary and Middle Years The academic achievement gap evident when Hispanics first enter school continues through the primary grades. During the first two years, teachers’ perceptions of their Hispanic students’ academic abilities often skew scholastic assessments, regardless of the children’s actual aptitude. Results of the Early Childhood Longitudinal Study revealed that kindergarten teachers systematically rated Hispanic students below white students when first enrolled. As Hispanic children performed above their teachers’ initial expectations, the gap between test-based abilities and teacher assessments decreased by half to two-thirds during kindergarten and was eliminated by the end of the first grade. Such teacher biases are compounded by a shortage of staff who understand Hispanic children’s cultural backgrounds. Nationally, Hispanic students constitute approximately 15 percent of elementary school students—and nearly 20 percent of all school-age students—yet only 4 percent of public school teachers are Hispanic.13 Although Hispanic elementary school children have made steady progress in reading and math, greater gains by other groups have sustained or in some cases widened Hispanic achievement gaps. A 20-year comparison of test scores reported in the National Assessment of Educational Progress shows that Hispanic students continue to lag behind whites in their scholastic achievement throughout middle and high school.14 Evident for all Hispanic subgroups, these gaps are decidedly largest for Mexican Americans, the fastest-growing segment of the elementary school population. Carried into future grades, accumulating deficits in literacy and math competencies inhibit the learning of other academic subjects. Middle school Hispanic students often encounter two circumstances
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future that limit their chances for scholastic success: large, urban schools, generally considered suboptimal for learning in the middle grades,15 and weak ties with their teachers.16 Weak relations with teachers diminish students’ motivation to pursue academic work, and in turn lower teachers’ expectations in a self-perpetuating cycle of academic disengagement and underachievement. That students who become disengaged from school during the middle years cannot well appreciate the practical relevance of what is being taught in the classroom bodes ill for their academic performance in high school and dampens their aspirations for college. Secondary School and Beyond Even under optimal circumstances, the transition from middle to high school is a taxing experience for most students. This passage is especially difficult for Hispanic and black adolescents destined for oversized, resource-poor urban high schools staffed with many inexperienced or uncertified teachers.17 Moreover, students whose parents lack a high school education are most in need of early guidance in course planning and preparation for college. Such guidance is in short supply in the schools these students attend. Given their parents’ limited experience with the U.S. educational system and the blind trust many Hispanic parents are willing to place in teachers’ authority, Hispanic eighth graders are more likely than any other demographic group to express uncertainty about the classes they will take in high school.18 Mexican immigrant parents are especially likely to defer to teachers and administrators, rarely questioning their decisions. High school experiences are vital in shaping students’ educational expectations and occupational aspirations. Yet a recent study found that, compared with 25 percent of blacks, 31 percent of whites, and 37 percent of Asian Americans, only 23 percent of Hispanic eighth graders planned to enroll in a college preparatory curriculum.19 These findings underscore the urgency of effective counseling on course selection in secondary school, particularly for students whose parents may be unfamiliar with the complexities of the U.S. educational system. Despite modest improvements in recent years, rates of school failure among Hispanics remain unacceptably high. Even counting only those who actually attended U.S. high schools, the share of Hispanic high school students 16 to 19 years old who failed to graduate fell only marginally during the 1990s, from 22 to 21 percent.20 The numbers involved are sobering because the school-age population in the United States has been
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future FIGURE 5-7 Time trends in overweight among children and adolescents of Mexican origin, 1976-1980 to 1999-2000. SOURCE: National Center for Health Statistics (2003) (see Escarce et al., 2006). 20 percent for girls. The rate of adolescents (ages 12-19) considered overweight more than trebled for both boys (from 8 to 28 percent) and doubled for girls (from 9 to 19 percent) over the same period.89 Those who claim that acculturation contributes to the rise in Hispanic overweight and obesity point to immigrants’ diets, which are richer in fruits and vegetables and lower in fats compared with those of native-born youths, who are more prone to consume high-fat processed and fast foods. Generational differences in diet are mirrored in the prevalence of overweight adolescents, as about one in four first-generation adolescent Hispanics is at risk of being overweight, compared with about one in three second- and third-generation youths.90 Several other differences in the health circumstances of Hispanic youths are worth noting. With the exception of Puerto Ricans, Hispanic youths have low rates of asthma, the major chronic disease of childhood. This health asset is offset by their worse oral health compared with their white peers. Hispanic youths also register higher blood lead levels than white children, which places them at greater risk for the adverse effects of lead poisoning on cognitive development.91
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future Hispanic adolescents engage in many health-compromising behaviors, such as use of alcohol and illicit drugs and early sex, at rates comparable to those of white teens, although their tobacco use is lower. Cuban-origin youths have the highest levels of tobacco, alcohol, and drug use, followed by those of Mexican and Puerto Rican origin. By comparison, youths from other Hispanic subgroups have low rates of drug use—probably because larger shares of these subgroups are first-generation immigrants, which means they are less acculturated. In general, acculturated youths engage in such health-compromising behaviors more often than the less acculturated. Hispanic young people also experience poor mental health, exhibiting the highest prevalence of depression of any ethnic group. Although Hispanic adolescent girls are as likely as white adolescents to consider suicide, they are twice as likely to attempt it. Their suicide completion rate, however, is lower than that of other ethnic groups. The significance of these and other health-compromising behaviors among adolescents transcends their own physical well-being. In 2003, Hispanics had the highest teen birthrate, with 82.2 births per 1,000 adolescent females ages 15-19. In comparison, the birthrate for teens of all backgrounds was 41.7, while that for white teens was 27.5 and for black teens was 64.8.92 Such statistics bode ill for the educational prospects of Hispanic adolescents, who are more likely than either blacks or whites to withdraw from school if they become mothers.93 Indeed, all health conditions and behaviors that affect scholastic performance—including not only adolescent childbearing, but also drug and alcohol use and exposure to lead and other environmental contaminants—are especially worrisome because of the life-long consequences of educational underachievement discussed above. Access to Quality Care Hispanics face a variety of financial and nonfinancial obstacles to obtaining appropriate health care. Low rates of insurance coverage are perhaps most notable, but limited access to providers, language barriers, and uneven quality of care exacerbate inequities in health outcomes between Hispanics and whites and between native- and foreign-born Hispanics. The lack of insurance coverage is greater among foreign-born compared with U.S.-born Hispanics, Spanish compared with English speakers, recent compared with earlier immigrants, and noncitizens compared with citizens. Undocumented immigrants are least likely to be insured; one estimate of their uninsured rates ranges between 68 and 84 percent.94 Owing
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future to their large shares of recent immigrants, Mexicans and Central and South Americans have the highest uninsured rates. Puerto Ricans and Cubans have the highest insurance rates, with sources of coverage differing between the two groups. Puerto Rican children and working-age adults are much more likely than their Cuban counterparts to obtain health coverage through public insurance programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP), but they are less likely to obtain it through an employer (see Figures 5-8a and 5-8b). For Hispanic seniors, eligibility for the Medicare program keeps insurance coverage rates relatively high. Compared with whites, Hispanics have lower access to employer-provided health insurance because they are more likely than whites to work in small firms, in seasonal occupations, and in part-time jobs.95 Limited eligibility for public insurance programs, such as Medicaid and SCHIP, further accentuates Hispanics’ low coverage rates (with the exception of Puerto Ricans). Many Hispanics—especially Mexicans and Cubans—live in states with restrictive eligibility rules for Medicaid and SCHIP. The federal welfare reforms of 1996 placed further limitations on access to FIGURE 5-8a Health insurance coverage for white, black, and Hispanic children, 1997 to 2001. SOURCE: 1997 to 2001 Medical Expenditure Panel Survey.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future FIGURE 5-8b Health insurance coverage for white, black, and Hispanic working-age adults, 1997 to 2001. SOURCE: 1997 to 2001 Medical Expenditure Panel Survey. public health insurance programs for all recent legal immigrants.96 General confusion about how the new laws affected immigrants triggered declines in their overall utilization of public insurance programs. Partly because of low rates of health insurance coverage, Hispanics are less likely than whites to have a usual source of care or regular health care provider, which in turn restricts their access to more specialized forms of care. The relatively low number of Hispanic physicians, especially in Hispanics’ new destinations, further hinders access to care because Hispanic physicians are more likely than their non-Hispanic counterparts to care for Hispanic patients. Given their large share of recent immigrants, Mexicans are less likely than Puerto Ricans or Cubans to have a usual source of care, as are Spanish speakers compared with English speakers. Furthermore, language barriers undermine quality health care, even among groups with similar demographic and socioeconomic characteristics, by hindering patient-provider communication; by reducing access to health information; and in the worst case, by decreasing the likelihood that sick patients will seek needed care.97 Hispanics’ low rates of insurance and reduced likelihood of having a
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future regular health care provider mean less preventive care, fewer ambulatory visits, and higher rates of emergency room use compared with whites, although Hispanics’ rates of inpatient care are equivalent to those of whites. The preventive services on which Hispanics trail whites include pneumococcal and influenza vaccinations for seniors; mammography, pap smears, and colon cancer screening; blood pressure and cholesterol measurements; and prenatal care for the general population. In 2001, just 75 percent of Mexican and 79 percent of Puerto Rican women received prenatal care in their first trimester, compared with 92 percent of Cuban and 89 percent of white women. Hispanic–white differences in childhood vaccination rates are trivial.98 Evidence on the quality of care received by Hispanics is inconclusive, partly because current assessments are based on populations that are not truly representative, such as low-income Medicaid recipients, and partly because results from satisfaction surveys are inconsistent. Nonetheless, Hispanics’ reported satisfaction with health care delivery reveals large differences, depending on the degree of English proficiency. In general, Hispanics who speak only Spanish report worse experiences with health care than either whites or Hispanics who speak English. Satisfied patients are more likely to seek care when needed, to comply with provider recommendations, and to remain enrolled in health plans and with specific providers. Paradoxically, and for reasons not fully understood, Spanish-speaking Hispanics rate their physicians and health plans higher than do English-proficient Hispanics, despite admitting to worse care experiences. To reduce language barriers to health care, the Department of Health and Human Services issued a directive in August 2000 requiring all federally funded programs and providers to offer interpreter services at no cost.99 Yet only about half of Hispanic patients who need an interpreter receive one. In most cases, the interpreter is a staff person, relative, or friend rather than a trained medical interpreter; in such cases, reported satisfaction rates remain below those of whites. CONCLUSION Hispanic integration experiences are as diverse as the eclectic subgroups subsumed under the panethnic identity, but some general trends are discernible. Hispanic families converge in form and function with those of the white majority and rising intermarriage blurs the boundaries of nationality groups. The rise in divorce and nonmarital childbearing over time and
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future across generations signal family decline. The rise of mother-only families bodes ill for economic prospects of the swelling second generation. There are clear signs of educational progress at all levels both over time and across generations. That other groups also have improved their educational standing has widened attainment gaps, particularly at the college level. Because the fastest-growing and best-paying jobs now require at least some postsecondary education, Hispanics stand to lose economic ground even as their educational attainment rises. Still, employment and earnings trends show clear evidence of economic assimilation, with the greatest gains between the first and second generation. If the most successful third-generation Hispanics “opt out” of Hispanic identity, as available data suggest, economic progress for the third and later generations may well be understated. Trends in Hispanic home ownership and median household income signal a growing middle class, although the dollar growth of Hispanic household assets is small compared with that recorded by white households.100 Variation in financial status by immigrant and citizenship status, by age (favoring middle-aged over young householders) and especially by earnings capacity and educational attainment, largely explains the significant gap in economic well-being between Hispanics and whites. As long as this gap persists, however, Hispanics will remain more vulnerable to economic cycles because they have less of a cushion on which to draw during periods of financial distress. Finally, recent health trends paint the picture of a Hispanic population burdened by the complications of obesity, diabetes, hypertension, and cardiovascular disease, which Americanization appears to worsen rather than improve. The deleterious effects of acculturation are especially evident among second-generation youths and in birth outcomes. Most striking is the high incidence of type 2 diabetes—usually a disease of adults—among young Hispanics and the increased prevalence of multiple risk factors for developing atherosclerosis among children of Mexican origin.101 These trends foreshadow much higher rates of diabetes and its complications in the future, as large cohorts of Hispanic youths become adults. The growing number of uninsured Hispanics will place particular stress on the health care safety net—a loosely organized system for delivering care to the uninsured that includes nonprofit organizations, government agencies, and individual providers. By default, some of the responsibility for health care delivery will shift to states and local communities, many of which are already struggling to compensate for shortfalls created by declin-
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future ing federal funding. Experts in both the public and private sectors consider cultural competence—the ability of health systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs—to be a crucial component of strategies to reduce disparities in care.102 Compliance with the federal directive to provide interpreter services at care facilities is especially warranted in new immigrant destinations. NOTES 1 These findings are documented in greater detail in Landale et al., 2006. 2 Popenoe, 1993. 3 Landale and Oropesa, 2002. 4 Landale and Oropesa, 2002. The evidence for declines in familism among Central and South American nationalities is less clear than is the case for Mexicans because the generational depth is lower. 5 Landale et al., 2006. 6 Lee and Edmonston, 2005. 7 Edmonston et al., 2002, note that all population projections involve higher rates of intermarriage. 8 These findings are documented in greater detail in Schneider et al., 2006. 9 Mare, 1995. 10 See Duncan et al., 2006:Table 6-1. 11 Crosnoe, 2005; Crosnoe et al., 2004; Valencia, 2000. 12 U.S. Department of Education, National Center for Education Statistics, 1999. 13 U.S. Department of Education, National Center for Education Statistics, 1997. 14 U.S. Department of Education, National Center for Education Statistics, 2003b. 15 Carnegie Council on Adolescent Development, 1989. 16 Bryk and Schneider, 2002. 17 U.S. Department of Education, National Center for Education Statistics, 2003b; Valencia, 2002. 18 Bryk and Schneider, 2002. 19 Schneider and Stevenson, 1999. 20 Fry, 2003. This distinction is important because the Hispanic high school dropout rate has been inflated by the presence of foreign-born adolescents who withdrew from school before entering the United States. 21 U.S. Department of Education, National Center for Education Statistics, 2003a: Table 106. 22 Cameron and Heckman, 1993. 23 Fry, 2005; Hirschman, 2001. 24 Carnevale, 1999. 25 Tienda and Simonelli, 2001. 26 Kao and Tienda, 1998. 27 U.S. Department of Education, National Center for Education Statistics, 2002.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future 28 U.S. Department of Education, National Center for Education Statistics, 2003b. 29 Kim and Schneider, 2004; Portes and Rumbaut, 2001. 30 Fry, 2002, 2003. 31 College Enrollment and Work Activity of Year 2000 High School Graduates. Available: ftp://ftp.bls.gov/pub/news.release/History/hsgec.04132001.news [accessed December 23, 2005]. 32 Schneider et al., 2006. 33 Velez, 1985. 34 Alon and Tienda, 2005; Fry, 2004. 35 Clark, 2003; Kochhar, 2004; Wolff, 2004. 36 These findings are documented in greater detail in Duncan et al., 2006. 37 Chiswick, 1978; Schoeni, 1997. 38 The annual employment rate is defined as the percentage of individuals who worked at all during the calendar year preceding the census. Similar results are obtained using annual hours of work as a measure of labor supply. 39 Dominican men also have relatively low employment rates, but nativity differentials for them are small. 40 Duncan et al., 2006:Table 6-4. 41 The estimated deficits are for persons ages 25 to 59 who worked during calendar year 1999, based on regressions by Duncan et al., 2006:Appendix Table A6-7. 42 This is not the case for black men, however, as their 15 percentage point employment deficit would shrink to only 13 percentage points if their human capital endowments were comparable to those of whites. 43 The employment gaps for Puerto Ricans and Dominicans may be due, in part, to their concentration in goods-producing industries in the northeast that have been hurt by deindustrialization, and in part to the fact that their employment patterns are more similar to those of blacks than to those of other Hispanic groups. See DeFreitas, 1991. 44 In contrast to black men, black women’s modest earnings disadvantage relative to white women would disappear if they had comparable levels of human capital. 45 Phillips and Massey, 2000; Rivera-Batiz, 1999. 46 See Duncan et al., 2006. 47 Specifically, there is some evidence that darker, more Indian-looking Mexican Americans are vulnerable to discrimination based on skin color. See Allen et al., 2000. 48 Lowell and Fry, 2002. 49 Smith, 2001. 50 Duncan et al., 2006:Table 6-7. 51 Borjas, 1994; Chiswick, 1977; Neidert and Farley, 1985; Perlmann and Waldinger, 1997. 52 Duncan et al., 2006:Figure 5-8. 53 Borjas, 1993; Smith, 2003. 54 Smith, 2003, reports a 4.94-year mean education gap among all first-generation Mexicans (Table 3). This deficit fell to 2.95 years among second-generation Mexicans. 55 Alba and Nee, 1997; Duncan and Trejo, 2005; Telles et al., 2002. 56 Duncan and Trejo, 2005; Duncan et al., 2006; Reimers, 2006. 57 Edmonston et al., 2002; Rutter and Tienda, 2005. 58 Smith, 2003; see Duncan et al., 2006; Reimers, 2006.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future 59 U.S. Census Bureau; Income 1999. Available: http://www.census.gov/hhes/www/income/income99/99tablea.html [accessed December 27, 2005]. 60 Those who were born in the United States have income levels similar to those of whites. 61 U.S. Bureau of the Census, 2004b. 62 U.S. Bureau of the Census, 2004b. 63 Wolff, 2004. 64 The Hispanic-black median income differential exceeded 90 percent between 1995 and 1997, hovering around 94 to 98 percent. See Wolff, 2004:Tables 7 and 8. 65 Kochhar, 2004. 66 Saenz, 2004:Table 11. 67 U.S. Bureau of the Census, 2000c. Poverty thresholds are not adjusted for cost-of-living differences. That large shares of Hispanics live in high-priced cities magnifies the welfare consequences of poverty-level incomes. 68 Saenz, 2004. 69 See Reimers, 2006:Table 7-2. 70 See Reimers, 2006. 71 McLanahan and Sandefur, 1994. 72 U.S. Bureau of the Census, 2000a. 73 U.S. Bureau of the Census, 2000a. 74 Reimers, 2006. 75 Social Security is an “earned” benefit that automatically increases with the cost of living, but SSI is a minimal, means-tested safety net for those elderly who have no other income. Unlike SSI, Social Security is not viewed as “welfare” by the general public. Persons who qualify for Social Security benefits by working most of their adult years in covered jobs, even at a low wage, receive more generous Social Security retirement benefits than persons forced to rely on SSI, the benefit rates of which are below the poverty line. 76 Using the Federal Reserve Board’s Survey of Consumer Finances, Wolff, 2004, estimates Hispanic median net worth at 3 percent of the white median for 2001, but Kochhar, 2004, estimates the 2002 median gap at 9 percent—$8,000 versus $89,000—based on the Survey of Income and Program Participation. One source of the difference is that Wolff excludes equity in vehicles and other consumer durables from his estimate of wealth. However, both sets of estimates reveal similar trends, if not levels, for their overlapping period, namely mid-1990s to 2001-2002. 77 Kochhar, 2004:Table 9. 78 Wolff, 2004:26. Stock ownership is concentrated among households in the top quintile of the wealth distribution, accounting for 90 percent of all stock holdings. 79 Clark, 2003. 80 Wolff, 2004. 81 This estimate is close to the .62 for 2000 reported by Fischer and Tienda, 2006, on the basis of census data for the largest 100 metro areas. 82 Fischer and Tienda, 2006; Myers et al., 2005. 83 See Kochhar, 2004. 84 Grossman, 1972.
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Multiple Origins, Uncertain Destinies: Hispanics and the American Future 85 Our emphasis on Mexican-white comparisons reflects the paucity of research comparing other Hispanic nationalities in terms of specific health outcomes. This section draws from Escarce et al., 2006. 86 National Center for Health Statistics, 2003. 87 National Center for Health Statistics, 2003. 88 National Center for Health Statistics, 2003. National data are unavailable on the epidemiology of cardiovascular disease for Hispanics. Moreover, experts disagree about the differences in death rates from heart disease between Hispanics and whites because regional studies have yielded conflicting findings, Escarce et al., 2006. 89 National Center for Health Statistics, 2003. 90 Escarce et al., 2006. 91 Escarce et al., 2006. The Centers for Disease Control and Prevention is currently lowering the threshold blood lead level for intervention from 10 µg/dL to 5 µg/dL. More than one-fourth of preschool-age children and one-fifth of elementary school children of Mexican origin would meet the revised threshold. 92 Ryan et al., 2005. 93 Ahituv and Tienda, 2000. 94 Berk et al., 1999. 95 See Brown and Yu, 2002; Dushi and Honig, 2005; Schur and Feldman, 2001. 96 The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (the federal welfare reform law) barred legal immigrants who entered the United States after August 1996 from receiving federal Medicaid or SCHIP benefits for their first 5 years in the country. Although states can offer coverage for legal immigrants during the 5-year moratorium imposed by the federal regulations, few have elected to do so. 97 Langer, 1999; Ruiz et al., 1992. 98 Escarce and Kapur, 2006. A likely explanation for the shrinking gap in childhood vaccination rates is the Vaccines for Children program, created in 1994, which provides vaccines free of charge to eligible children, including the uninsured. 99 Department of Health and Human Services, 2000. 100 Kochhar, 2004:Tables 17 and 19. 101 Escarce et al., 2006. Other consequences of the overweight epidemic among Hispanic youth include elevated blood pressure and high rates of insulin resistance, hyperinsulinemia, glucose intolerance, and abnormalities in serum lipids. Hispanic youth also have higher triglyceride levels and lower levels of high-density lipoprotein cholesterol than white youth. 102 Betancourt et al., 2002.
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Representative terms from entire chapter: