The Hispanic Health and Nutrition Examination Survey (HHANES) was the first special population survey undertaken by the National Center for Health Statistics. The HHANES was designed to assess the health and nutritional status and needs of Mexican Americans, mainland Puerto Ricans and Cuban Americans. Data were collected using five data collection techniques: direct physical examinations, diagnostic testing, anthropometry, laboratory analyses, and interviews. Unlike other surveys conducted by the National Center for Health Statistics, the HHANES was not designed as a national survey. The HHANES was a survey of three Hispanic subgroups of the population in selected areas of the United States with a survey universe that included approximately 76 percent of the 1980 Hispanic-origin population in the United States. This article discusses statistical issues that should be addressed by researchers when analyzing HHANES data. Specifically, analysts need to account for the complex sample design, nonresponse bias, potential non-coverage bias, and the regional nature of the HHANES sample.

There are numerous indicators that Hispanics face a disproportionate risk of exposure to environmental hazards. Ambient air pollution, worker exposure to chemicals, indoor air pollution, and drinking water quality are among the top four threats to human health and are all areas in which indicators point to elevated risk for Hispanic populations. These data, juxtaposed with data on the health status of Hispanics, tell us that the environmental health status of Hispanics and their children is poor. At the same time, significant inadequacies in the collection of data on Hispanics make it difficult to make improving Hispanic environmental health status a priority. These inadequacies include the failure to use Hispanic identifiers in data collection and failure to collect sample sizes large enough to allow for breakouts of data by Hispanic subgroup. In addressing environmental justice issues, the U. S. Environmental Protection Agency (U.S. EPA) and the Department of Health and Human Services (DHHS) should prioritize improving the quantifiability of environmental exposures and risk based on race or ethnicity. However, improving data should not be the prerequisite to significant, affirmative steps by DHHS and U.S. EPA to address environmental and environmental health problems facing Hispanic communities. In particular, a health-based approach to environmental justice should be the priority.

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To better understand social and structural changes needed to maximize community-based participation in emergency preparedness, 27 organizations, representing 12 states, participated in a study of the National Alliance for Hispanic Health. The study assessed social change needs (social will, community readiness, assets, and barriers) and structural needs (organizational capacity to integrate services into emergency management efforts locally). Results show high social will but little community readiness. Most non-governmental organizations (NGOs; 96%) were willing, but ill-prepared (65%) to face large-scale emergencies. Assets include bilingual/bicultural personnel, cultural competency, local knowledge, and public trust. Barriers include lack of culturally appropriate training and resources. Structurally, most NGOs want to link with voluntary organizations (79%) and public health departments (74%), but lack integration and coordination. Maximizing timely participation of these underutilized stakeholders in emergency planning can ensure culturally-proficient, community-tailored emergency plans, increased public confidence, and timely compliance with evacuation orders, thus helping to save lives.

This paper conducts a review of the demographic and health status data for Hispanic communities and relates them to the role of culture in health care. The author's recommend that promotion programs for Hispanic communities should focus on specific community data (morbidity rather than mortality), understand the impact of culture and language (cultural competency training and staffing), develop strong outreach components (establish community advisory boards, identify credible community spokespersons and incorporate community residents as health educators), and work in partnership (sharing funds and resources) with community-based organizations.