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2022 LCSNA - English

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Suggested Citation Revens K E Caro L Ordonez S Walsh A Alvarez Orlachia D Rodriguez D 2022 2022 Latino Community Strengths and Needs Assessment Mecklenburg County North Carolina Camino Research Institute Camino Community Development Corporation Inc FOLLOW US caminoresearchinstitute www camino org research

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Table of Contents Executive Summary 1 4 Acknowledgments Introduction 5 Latinos in NC Socioeconomic Health disparities COVID 19 Pandemic Research on NC Latinos Study Purpose Methods 13 Community Advisory Board CAB Research Team Part I Electronic Survey Part II Focus Groups Study Findings 21 Strengths Needs Barriers Education Employment Mental Health Physical Health Discussion 37 Latinos in 2006 vs Today Latinos Today vs all Mecklenburg Co Residents Implications 43 Limitations Conclusion References Appendix A 47 Appendix B 60 What is Camino s Role 51 55 59

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Latino Community Strengths and Needs Report Camino Research Institute EXECUTIVE SUMMARY The Future is Latino The Latino population is diverse young and rapidly growing In 2021 there were more than 170 000 Latinos in Mecklenburg County1 The population has more than doubled since 2010 but the last assessment that examined the needs of the Latino population was 16 years ago Although Latino communities experience social economic and health disparities they also have many strengths Community needs assessments often fail to account for community strengths which can be leveraged to help meet identified needs and lead to improved outcomes Camino Research Institute conducted the first comprehensive Strength and Needs Assessment of Latinos across North Carolina starting with a pilot in Mecklenburg County We used Community based Participatory Research CBPR approaches to hear directly from Latino community members to better understand the strengths needs experiences Executive Summary 1

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Latino Community Strengths and Needs Report Camino Research Institute This is a multi phased study conducted by Camino Research Institute the research arm of Camino using principles of CBPR The first phase is a 15 minute anonymous electronic survey targeting Latinos 18 and older living in Mecklenburg County 458 responses were collected from September 2021 to May 2022 Immigrants were oversampled 88 are immigrants from 18 different countries Survey data was analyzed using SPSS 26 Descriptive statistics were conducted on all variables and logistic regression was conducted to understand whether there were significant relationships between several variables including documentation status The second phase of the study included focus groupsI targeting Latino immigrants 18 or older living in Mecklenburg County Four focus groups were conducted with 36 participants at four locations across Mecklenburg County A rapid appraisal approach was used for qualitative analysis to ensure timely results 458 responses were collected from September 2021 to May 2022 Latinos have numerous strengths and positive attributes Latinos rate their willingness to start a business bilingual language skills adding cultural diversity to the broader community and work ethic as the top strengths Latinos report having strong social support systems through their faith church and family which they turn to during times of need Latinos indicate that dental vision and preventative health services are most needed and the top barriers to accessing these services are health insurance cost and language One third of Latinos report experiencing symptoms of depression and anxiety but most have never sought professional counseling services Latinos also indicate a need for more employment opportunities employment training programs and help recredentialing degrees from other countries Executive Summary Latino parents express the need for help applying and paying for higher education for their children and point to a lack of information in Spanish lack of Spanish speaking staff in the school system and unfamiliarity with US school systems as barriers Findings show that undocumented Latinos experience higher rates of need for services and lower rates of service accessibility than Latinos as a whole Almost 100 of undocumented Latinos are uninsured limiting their access to necessary medical dental vision and behavioral health services Undocumented Latinos also report the inability to obtain a driver s license and unreliable public transportation as barriers that prevent them from getting to work and other activities needed for daily living 2

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Latino Community Strengths and Needs Report Camino Research Institute To create systemic and sustainable changes we urge elected officials and funders to consider this data when making or adjusting existing policies and when deciding where and how to allocate funding and resources aimed to serve the most vulnerable communities in Mecklenburg Co and across NC Results point to an overwhelming need for dental and vision services for Latinos indicating priority to create culturally competent services in Spanish There is a need for more Spanish speaking staff across multiple disciplines including medical doctors behavioral health specialists and teachers or other staff in the school system Latino parents view Latino children s ability to speak two languages and navigate between cultures as an asset to the future of all Latinos More opportunities for higher education and advanced degrees for Latino children can help fill the gap in the need for Spanish speaking professionals We urge Latino serving organizations and any agency that wants to serve the Latino population to use this data to create data driven programs Data from this assessment shows the issues faced by Latino communities are relatively the same as they were in 2006 meaning they are not new nor are they changing Executive Summary 3

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Camino Research Institute Latino Community Strengths and Needs Report Acknowledgments Thank you to each participant volunteer intern Community Advisory Board member funder partner and Camino staff member who made this project possible We would also like to thank our partner organizations who allowed us to present to their networks A special thank you to the Marketing and Communications team of Camino for producing materials for recruitment and dissemination of study findings including this report Interns and Volunteers Gabriel Sosa UNC Charlotte Glamar Galeas UNC Charlotte Missel De Leon UNC Charlotte Sara Leiva UNC Charlotte Daniel Alvarez Orlachia UNC Charlotte Julia Chandler Gordon Conwell Theological Seminar David Rodriguez UNC Charlotte Lidiz Mora Los Andes University Lizeth Alcantar UNC Charlotte Amanda Walsh UNC Charlotte Community Advisory Board Members Alba Sanchez Nori Maldonado Amittay Rodriguez Paulina Martinez Bertha Lucia Caro Pastor Frank Garcia Latin American Coalition Camino Church L deres Colombianas en Charlotte Dr Carla Fallas Camino Health Center Lenoir Rhyne University Dr Carolina Benitez Camino University Gordon Conwell University Diana Torres ReNew Support Services Atrium Health Diego Torres Learning Help Centers of Charlotte Donna Smith Mecklenburg County Health Department Dr Rosanna Saladin Subero Charlotte Mecklenburg Schools CMS Jessica Montana Mecklenburg County Health Department Jeffrey Baldwin The Libre Initiative Karina Ruyan Novant Health Camino Arriba Camino Health Center Iglesia Puerto Nuevo Pilar Perez YMCA of Greater Charlotte Rafael Prieto Fiestas Patrias Ricardo Torres Center for Prevention Services Rita Dom nguez Atrium Health Roger Suclupe UNC Charlotte Susana Cisneros UNC Charlotte Tania Parra Sherwin Williams Tatiana Martinez Camino Health Center Veronica Corral Charlotte Library Karina Gonzalez Mecklenburg County Health Department Magbis Love Atrium Health Maria Diaz Carolina Youth Coalition Maria Laura Monachesi Camino Health Center Maura Chavez City of Charlotte Nhora Gomez Charlotte Mecklenburg Schools CMS Executive Summary 4

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Latino Community Strengths and Needs Report Camino Research Institute INTRODUCTION Introduction 5

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Latino Community Strengths and Needs Report Camino Research Institute The Future is Latino So what does that mean In 2020 the US Latino Hispanic population surpassed 62 million2 More than 50 of the growth of the US population over the last decade has been Latino3 The Latino population has more than quadrupled over the past four decades an increase that has historically been driven by immigration Throughout the 1980s and early 2000s there has always been at least 1 million more Latino immigrant arrivals than Latino births in the US4 However immigration rates dropped sharply between the early 2000s and 2010 causing a shift in this trend For the first time in history the growth of the US Latino population was being led by new Latino births and not immigration The number of Latino births not only outpaced the number of new immigrants but did so by more than 3 million4 This trend further accelerated from 2010 to 2019 when over 9 million Latinos were born in the US while only 3 5 million immigrated4 As a result the Latino population living in the US today is a combination of US and foreign born Latinos with the majority being US born Of the one third who are immigrants 80 are US citizens and another 800 000 become citizens every year5 Given the spike in Latino births over the past two decades it is not surprising that the majority of Latinos are young In fact Latinos are the youngest racial or ethnic minority group in the US6 The most common age of Latinos is 11 which is more than 5 times lower than the most common age of non Latino white Americans at 587 Moreover the median age of Latinos in the US is 30 meaning half are 30 or younger This number is 14 years lower than non Latino whites at 44 Almost 40 of Latinos in the US are Gen Z and younger ages 0 21 25 are Millennials ages 22 37 21 are Gen X ages 38 53 and only 17 are 54 or older7 Many of these Gen Z and Millennial Latinos will go on to have children of their own ensuring the continued growth of this population the Latino population is projected to make up almost one third of the US population by 2050 topping 111 million The terms Latino Hispanic are often used interchangeably to refer to someone of Latin American origin We asked participants of this project which term they prefer and the majority said Latino so the term Latino will be used throughout this report Introduction 6

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Latino Community Strengths and Needs Report Not only is the Latino population growing rapidly it is becoming more diverse Though the term Latino may imply a homogenous group of people quite the opposite is true Latinos represent 33 different countries in Latin America and the Caribbean each with distinct cultural values and traditions While Mexicans continue to make up the largest portion of the Latino population at 62 South and Central American populations are growing Venezuelans Guatemalans and Hondurans grew the fastest over the last decade at 126 47 and 47 respectively4 Immigrants are also coming from a greater range of countries across Central and South America and the Caribbean than they did a decade ago Although more than half still come from Mexico 115 are from El Salvador Guatemala and Honduras Central America 10 are from Colombia Peru and Venezuela South America and 13 from Cuba and the Dominican Republic Caribbean 4 Latinos offer unique skills and perspectives to the broader community through cultural diversity and bilingual language skills An estimated 36 of Latinos are bilingual in English and Spanish9 Camino Research Institute By 2030 Latinos are projected to account for 1 out of every 5 workers in the labor force12 Furthermore Latino immigrants are 25 more likely than the overall US population to own their own businesses11 Not only are Latino immigrants more likely to start their own businesses but most are not relying on loans to do so 40 use their personal savings while 15 obtain a business loan15 It is projected that if Latino owned businesses were to grow as fast as the US average they could add an additional 1 4 trillion or 8 of the total US economy15 Latina owned businesses are the fastest growing segment of the business community in the US currently topping 2 3 million 14 Latinos also play a significant role in shaping the nation s economy contributing 2 7 trillion and holding more than 781 billion in spending power10 The employment rate for US Latinos is 95 and even higher for Latino immigrants at 96 11 Consequently Latinos participate in the labor force at higher rates than non Latinos meaning they are more likely to be working age 16 65 and be able and willing to work12 Latino males have the highest labor force participation rates of any racial or ethnic group13 With 29 million Latinos currently in the workforce12 Latino households earn more than 1 trillion and pay more than 252 2 billion in taxes11 Introduction The number of US Latinos with a high school diploma or college education have also been steadily increasing over the past decade The percentage of Latino immigrants arriving with a high school diploma increased by 18 and the number of US Latinos with college experience increased from 2 9 million to 3 6 million16 Moreover 20 of Latino immigrants arriving in 2017 have a bachelor s degree slightly higher than the US national average American Community Survey 2017 and 27 of students enrolled in undergraduate programs are Latino17 7

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Latino Community Strengths and Needs Report LATINOS IN NC The Latino population in the South has grown faster than any other region in the US since 20103 North Carolina NC is one of 12 states with over 1 million Latinos and has the third fastest growing rate of those states18 The NC population grew by 10 from 2010 2020 with Latinos accounting for one third of that growth the Latino population grew by 40 while the non Latino population only grew by 7 19 1 in 10 people in NC are Latino and 1 in 6 children are Latino1 Camino Research Institute Although there are more Latinos in the labor force both nationally and statewide Latinos are more represented in industries like service 22 production and transportation 17 and agriculture construction and maintenance 16 compared to their non Latino white counterparts21 Conversely almost 50 of non Latino whites work in managerial or professional positions compared to a quarter of Latinos21 The most common occupations held by Latinos are often low wage and do not offer benefits like health insurance Consequently many Latinos experience socioeconomic and health disparities which are discussed on the following page NC s Latino population is projected to reach almost 2 million by 20401 Like the national population the growth of the population is attributed to new Latino births meaning the NC Latino population is young more so than non Latinos Six out of ten NC Latinos are US born and the other 40 are immigrants1 The makeup of the NC Latino population is similar to the national population the majority are Mexican followed by Puerto Rican and Central American and most immigrants come from Mexico followed by Honduras El Salvador and Guatemala1 Following national trends labor force participation is higher among NC Latinos 71 compared to the national Latino population 68 20 There are currently 557 566 Latinos in the Civilian Labor Force in NC a 58 growth since 201020 Half of Latinos in NC are 25 or younger and 37 are under age 18 compared to 20 of non Latinos19 Introduction 8

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Latino Community Strengths and Needs Report Camino Research Institute SOCIOECONOMIC AND HEALTH DISPARITIES Despite the many strengths of Latinos they experience disparities in income levels educational attainment and insurance coverage compared to their non Latino white counterparts nationally and statewide In 2019 the national median household income for Latinos was estimated to be around 55 000 as compared to 71 000 for non Latino whites22 In NC the median household income of Latinos is 48 244 which is 47 lower than that of non Latino white households at 70 78023 Moreover though more Latinos have been pursuing higher education the percentage of Latinos with advanced degrees is lower than non Latino whites 17 of Latinos have a bachelor s degree and 6 have a graduate or advanced degree compared to 37 and 14 of non Latino whites respectively22 In NC 11 have a bachelor s degree and 6 have a graduate or advanced degree compared to 23 and 13 of non Latino whites24 Socioeconomic factors combined with sociocultural barriers like language and documentation status contribute to subsequent health disparities Lack of health insurance makes it difficult to access health services necessary for optimal physical and mental wellbeing Latinos have higher rates of obesity in both children25 and adults26 have more poorly controlled blood pressure26 and are 50 more likely to die from disease than non Latino whites27 Latinos have the highest uninsured rates of any racial or ethnic group in the US22 The mental health status of Latinos is also impacted by socioeconomic and cultural factors Serious mental illnesses are on the rise for Latino adults between the ages of 18 2528 Although Latinos experience mental health disorders at similar rates as non Latinos they face disparities in access and quality of mental health treatment These disparities are attributed to lack of access to culturally competent diagnostic tools and treatment in Spanish or other Latin dialects documentation status lack of health insurance and stigma related to seeking mental health treatment among Latino communities30 Only 35 of Latino adults with mental illnesses seek treatment compared to the US average of 46 29 Introduction COVID 19 PANDEMIC National data shows many of these socioeconomic and health disparities were exacerbated by the pandemic since Latinos are more likely to work in service related industries29 31 This makes them more vulnerable to job loss pay cuts and contracting the virus 31 In fact Latinos contract COVID 19 at 1 5 times the rate are hospitalized at 2 1 times the rate and die at 1 8 times the rate of non Latino whites32 Research conducted by Camino Research Institute found similar patterns in data collected from Latinos living in and around Mecklenburg County NC33 We conducted a mixed methods study in early 2021 approximately one year into the pandemic and at the beginning of the vaccine rollout to understand how those served by Camino were impacted Latinos especially immigrants experienced physical economic and emotional hardships as a direct result of the COVID 19 pandemic many lost their jobs needed food and rent assistance and lost family members due to the virus33 The findings of this study pointed to the need for additional research on the current issues being faced by Latinos in and around Mecklenburg County as well as across the state 9

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Camino Research Institute Latino Community Strengths and Needs Report RESEARCH ON NC LATINOS Despite the significant growth of the Latino population nationally and statewide research on Latinos is still limited The data that has been presented thus far is mostly demographic or socioeconomic data collected from the American Community Survey ACS as part of the US Census or Community Health Assessments CHAs conducted by Public Health Departments CHAs provide information about the current health status needs and issues of residents within a specific community While this and other data continues to show that Latinos experience health disparities additional data is needed to understand the specific issues Latinos face County specific assessments were conducted in Chatham a mostly rural county35 and Mecklenburg a mostly urban county36 Although these assessments were conducted ten years apart and in vastly different parts of the state the top issues and barriers were more or less the same access to educational classes English as a Second Language computer literacy affordable healthcare lack of bilingual staff and materials at agencies driver s licenses identification and issues related to employment including discrimination mistreatment and exploitation36 35 NC LATINO POPULATION Latino Strengths Needs Assessment CRI 2022 1 250 000 Mecklenburg Latino Needs Assessment UNCC 2006 1 000 000 750 000 Latino Assessment IOM El Pueblo 2003 500 000 250 000 0 1990 2000 There have been three Latino specific Community Needs Assessments conducted in NC The only statewide assessment of Latino communities was completed in 2003 by the North Carolina Institute of Medicine The study reported that Latinos living in NC faced many barriers to achieving health equity including issues related to lack of bilingual services unfamiliarity with the American healthcare system documentation status and fear of deportation34 It is important to note however that the results of the report were not derived from direct information collected from Latino community members but rather from a taskforce of notable community and professional leaders with knowledge and expertise on health issues impacting Latinos 34 Introduction 2010 2020 Data from all three assessments reinforce the notion that Latinos face unique challenges to accessing health economic and educational services Latinos in different regions may be experiencing some of the same issues but to different degrees or under different circumstances but ultimately we see that the top issues faced by Latino communities are not changing 10

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Camino Research Institute Latino Community Strengths and Needs Report Strength based Approaches to addressing Health Disparities Evidence shows the use of strength and asset based approaches can help address individual and community needs ultimately decreasing disparities and increasing quality of life37 As previously discussed Latinos have numerous strengths contributing significantly to the economic educational and cultural landscape of the broader community Latinos also have high levels of resilience social support and faith all of which help them cope with stress and can result in better health outcomes38 39 30 Latinos have numerous strengths contributing significantly to the economic educational and cultural landscape of the broader communit Camino has been a trusted community resource for Latino families in and around Mecklenburg County for more than 25 years allowing CRI to reach hidden segments of the population including those who are undocumented and may otherwise be left out of research CRI is well positioned to not only conduct research with Latino communities but to put the data collected from that research into practice National and statewide population surveys as well as CHAs and other community needs assessments are limited when it comes to collecting data from Latinos These methods tend to be deficit based often failing to account for the unique strengths and positive qualities of Latinos both as individuals and as communities Moreover data collected by governmental entities like the US Census Bureau and Public Health Departments often fail to include all subgroups of the population including those who are immigrants and or undocumented many undocumented and even documented Latinos do not participate in these initiatives due to mistrust in all levels of government and fear of repercussions for those who are undocumented41 Innovative approaches to both research and program policy development are needed to not only understand issues important to Latinos but to ensure the data is applied towards solutions that are both effective and sustainable Camino Research Institute CRI was founded in 2021 for that reason CRI is a hub for community driven research that aims to fill the gap in research on Latinos in NC CRI is the research arm of Camino a nonprofit community organization that provides bilingual multicultural holistic health educational economic and hope services to Latino families Camino includes Camino Church42 a nondenominational bilingual church church services prayer worship and bible study groups Camino Health Center primary care behavioral health food security wellness 43 Camino Arriba economic and educational services 44 and Camino University training and educational certifications Data collected by CRI directly informs the programs and services at Camino However Camino and other community organizations and churches have been lacking the data needed to show how crucial our services are to Latino communities The nature of our work allows us to see both the challenges and strengths of those we serve firsthand There has never been a comprehensive research study that empirically measures both the strengths and needs of Latino communities If we know both we can build from the strengths to help meet the needs CRI uses community based participatory research CBPR approaches to collaborate with all entities of Camino and other community partners to identify strengths and address issues faced by Latino families Introduction 11

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Latino Community Strengths and Needs Report CRI launched the first ever North Carolina Latino Community Strengths and Needs Assessment in September 2021 We use a combination of quantitative and qualitative data to hear directly from Latinos about what they want and need to live healthy hopeful and productive lives We conducted a 15 minute anonymous electronic survey with questions on health employment education children social support housing and other basic needs This survey was developed specifically with Latinos in mind and also includes questions related to immigration language and culture Any Latino who is 18 or older and lives in NC is eligible to take this survey Camino Research Institute Focus groups allowed us to gain deeper insight into some of the issues uncovered by the survey data and allowed participants an opportunity to share more of their experiences as Latino immigrants living in Mecklenburg County The purpose of this report is to present and summarize survey and focus group data collected from September 2021 July 2022 from Latino adults living in Mecklenburg County This report provides data on the strengths needs barriers and other experiences of Latinos Our goal is for this data to inform 1 the development and implementation of culturally competent services 2 necessary systemic and policy changes and 3 the allocation of additional funding and resources towards these efforts Data from other assessments like the ACS and CHA are used to inform the planning of community services and the allocation of federal funding towards these services However without proper representation of all Latino subgroups in those data it is difficult to determine whether the allocation of funding from local state and federal governments are sufficiently meeting the needs of the culturally diverse and dynamic Latinos living across Mecklenburg County and NC Without these resources it will be difficult to close gaps in social economic and health outcomes between Latinos and non Latinos This is a statewide project that started with a pilot in Mecklenburg County We started there because it is where Camino is headquartered and is the home to 170 000 Latinos more than any other county in NC1 Not to mention the Latino population in Mecklenburg County grew 52 over the last decade46 but the most recent Latino needs assessment was 16 years ago36 revealing a gaping hole in current data on how Latinos are changing during times of rapid growth Although we are still collecting data across the state data collection in Mecklenburg County is complete From September 2021 to May 2022 we collected 458 survey responses After survey data collection and analysis was complete we conducted 4 focus groups with 36 Laitno immigrants in Mecklenburg County in July August 2022 Introduction 12

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Latino Community Strengths and Needs Report Camino Research Institute METHODS This is a mixed methods study conducted in two phases The first phase is a 15 minute anonymous electronic survey to identify the strengths needs and barriers experienced by Latinos living in Mecklenburg County The second phase completed after survey data collection and analysis is focus groups with Latino immigrants to hear more about their lived experiences and gain a deeper understanding of issues uncovered in the survey data To ensure the research process is directly informed by the community we used Community Based Participatory Research CBPR approaches Methods 13

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Latino Community Strengths and Needs Report Community Based Participatory Research CBPR CBPR is one of the most successful approaches to conducting research with minority communities including Latinos47 CBPR involves community members as equal partners ensuring the research is grounded in the community and appropriately reflects their needs and perspectives Throughout the CBPR process community members and researchers work together to leverage the strengths and resources of the community creating community empowerment to solve a problem or issue48 CBPR puts research findings into practice using the data to create sustainable culturally appropriate interventions that improve health outcomes and reduce health disparities in Latino communities37 Camino Research Institute All interns and volunteers were trained by CRI staff on the principles of CBPR and study procedures including study methodology recruitment methods basic data coding and data interpretation The student intern and volunteer team members consisted of three undergraduate Public Health students two graduate Public Health students one graduate Health Administration student and one graduate in Christian Counseling student One student volunteer is an international doctor who is currently in school to revalidate their credentials 75 of the research team is Latino and 83 are bilingual in English and Spanish Since the research team is primarily US born the CAB was crucial in ensuring community input and immigrant representation for this project Community Advisory Board CAB CRI Team The research team includes three full time and one part time staff Dr Keri Revens Director of CRI and principal investigator Lenin Caro Community Research Assistant Sarai Ordonez Community Research Assistant and Amanda Walsh data analyst Dr Keri Revens holds a Doctorate in Philosophy in Public Health Sciences with expertise in CBPR approaches and is a Certified Health Education Specialist CHES Lennin Caro has a Master of Arts in Anthropology and Sarai Ordonez has a Bachelor of Science in Public Health and is a CHES Both Lennin and Sarai have expertise in qualitative research and were trained by the PI on basic quantitative and qualitative research Amanda Walsh is the data analyst a former student intern who recently graduated with a Master of Public Health To ensure this study is culturally competent and representative of Latino communities in Mecklenburg County we developed a Community Advisory Board CAB composed of 36 stakeholders and key community leaders from diverse Latin American countries 97 of the CAB are Latino and 69 are immigrants from a variety of countries including Colombia Venezuela Argentina Mexico Honduras Cuba Ecuador Costa Rica Chile and the Dominican Republic CAB members were recruited based on recommendations from various Camino staff and Camino Church members with extensive experience working with Latino communities in Mecklenburg County The CAB met monthly from May 2021 to September 2022 most CAB meetings were held virtually via Zoom but some were held in person at Camino with food provided CAB members were instrumental in guiding the project and assisted with the development and translation of the survey and focus group questions survey and focus group recruitment with individuals and partner organizations community outreach to promote the survey and the dissemination of findings Lennin and Sarai are first generation Americans with immigrant parents from Colombia and Honduras respectively Dr Keri though not Latina is an expert in CBPR and has been conducting research with Latino communities with Camino for 7 years Amanda is not Latina or bilingual but her primary focus was on the analysis of quantitative data Nine student interns and volunteers also helped at various times throughout the project Methods 14

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Latino Community Strengths and Needs Report Part I Electronic Survey For the first phase of this project we conducted a 15 minute anonymous electronic survey The CRI team worked in collaboration with the CAB to develop translate and pilot the survey Survey Development The initial step of survey development involved reviewing the literature to identify previous Latino needs assessments conducted in Mecklenburg County NC and other states36 49 50 51 The literature provided a foundation of information and guidance on survey methodology and structure Using previous assessments as a guide a preliminary survey structure and categories were decided upon by the CRI team in April 2021 Survey categories are related to the Social Determinants of Health health social support housing food security stress and coping education employment and family specific questions including questions on children We selected questions from previous assessments and added additional questions not included on other assessments to create the first draft of the survey these included strength based questions and questions related to the immigrant experience The decision to ask about documentation status was unanimous amongst the CRI team and the CAB given that documentation status can completely change the experience of living in the US Questions related to strengths were placed at the beginning of the survey given our emphasis on using a strength based approach Methods Camino Research Institute The first draft was written in English and was presented to the CAB in May 2021 CAB members met in person to provide input suggest revisions and recommend new questions the survey was revised in English based on these recommendations The CRI team revised the survey based on CAB recommendations to create the final English draft CAB members were then separated into smaller groups based on their area of expertise small groups met virtually guided by a CRI staff member to review the corresponding sections of the final draft of the English survey Once the final version of the survey was agreed upon a group was formed to translate the survey to Spanish This group was composed of five people from various Latin American countries with expertise in Spanish language The survey went through four rounds of revisions in the Spanish language each draft was cross checked for comprehension across multiple Spanish dialects by natvie Spanish speakers who were part of the CAB or affiliated with Camino The final versions of the Spanish and English survey were inputted in JotForm a HIPAA compliant electronic survey platform the survey is Spanish facing with the option to change the language to English The final English and Spanish electronic surveys were then piloted with CAB members and immigrant community members from various countries of origin and socioeconomic status to ensure comprehension of questions ease of use and survey length Small changes to the survey were made based on recommendations 15

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Camino Research Institute Latino Community Strengths and Needs Report B Survey Respondents Years living in the US The target population for the survey is Latinos 18 or older living in Mecklenburg County The target sample size was 383 this was based on a sample size calculation using Latino population estimates from the US Census a confidence level of 95 and a confidence interval of 5 A total of 458 Latinos responded to the survey 91 took the survey in Spanish and 9 took the survey in English The majority 89 are immigrants coming from 18 different countries with the top four countries being Mexico n 128 28 Colombia n 52 11 Honduras n 44 10 and Venezuela n 35 8 A Puerto Rico 2 4 Nicaragua 1 3 Brazil 0 7 Age C Guatemala 3 3 Mexico 28 Dominican Republic 3 5 Peru 3 7 Ecuador 4 4 Colombia 11 4 El Salvador 6 6 Venezuela 7 6 US but outside of NC 7 9 Honduras 9 6 Country of birth A Zip codes D Immigrants have lived an average of 16 years in the US B Documentation status varied among respondents 42 are either a US citizen or a permanent resident 16 have a conditional or temporary status Visa DACA recipient TPS and 30 are undocumented immigrants The sample is 77 female and 23 male The average age of respondents is 43 C When asked which term they prefer to identify with 53 said Latino 45 said Hispanic less than 2 said Latinx and 1 said other Latinos living in 32 different zip codes of Mecklenburg County took the survey D While Latinos living in the North West and South sides are represented most live in the East side of Mecklenburg County 0 9 2 8 5 7 7 0 5 9 3 5 5 5 10 7 0 9 2 4 0 7 0 2 8 1 4 8 0 2 0 4 3 3 2 6 0 7 3 7 6 3 4 4 6 6 0 9 1 7 2 2 1 3 1 5 4 4 0 4 Methods 16

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Latino Community Strengths and Needs Report Camino Research Institute Survey Data Collection The survey received Institutional Review Board IRB approval from Solutions IRB in June 2021 and was implemented in September 2021 The survey initially took an average of 25 30 minutes to complete The survey was administered using JotForm through a link QR code or phone number Survey respondents did not receive an incentive to take the survey because maintaining anonymity was our top priority Due to the sensitive nature of questions related to documentation status and mental health respondents were provided with information on how to access resources for services at Camino Health Center including behavioral health services at the end of the survey Survey data was confidential and only accessible by the CRI team After two months of data collection CAB members Camino staff and others in the community expressed concerns that the survey was too long The survey created a large participant burden and without an incentive it would be difficult to reach our target sample size Consequently the survey was shortened in November 2021 Survey revisions were made in collaboration with CAB members and were agreed upon by the CRI team The shortened version of the survey was piloted again and took an average of 15 minutes to complete The revisions were submitted to Solutions IRB and received approval in November 2021 Survey data collection took place from September 2021 to May 2022 We never stopped collecting data while revising the survey rather we switched from the long to the short version upon receiving IRB approval Questions that were removed from the original survey were omitted from final data analysis Sampling To reach the Latino population we used convenience and snowball sampling Recruitment relied heavily on established networks of trust in the Latino community this was especially important to ensure inclusion of immigrants including those who are undocumented CRI leveraged Camino s longstanding history of trust among Latinos in Mecklenburg County The survey was promoted to patients accessing all of Camino s services including Camino Health Center and Arriba Flyers were posted throughout Camino and patients of Camino Clinic received reminders via a text messaging service The survey was promoted on all of Camino s social media accounts and in local Latino Facebook groups In addition because most Latinos have a strong connection to their faith and church we relied heavily on recruitment through Camino Church and other church partners The survey was promoted at Camino Church through Sunday services text messages and small groups called Circles We also leveraged Camino s existing networks and partnerships including other local Churches nonprofits and community organizations across the county CAB members and CRI interns assisted with recruitment through their personal and professional networks CRI staff promoted the project to community organizations through 18 presentations and media interviews in Mecklenburg County Finally CRI staff interns volunteers and CAB members promoted the survey at 30 festivals and community events throughout Mecklenburg County Everyone who took the survey was also asked to share it with their friends and family to reach more Latinos Methods 17

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Latino Community Strengths and Needs Report Camino Research Institute Survey Data Analysis Data was exported from Jotform as an Excel file which was then reviewed by the CRI team to remove invalid and duplicate survey responses Open ended survey responses were reviewed by the bilingual community research assistants to create a common codebook Using this codebook bilingual student interns and volunteers assisted in coding open response questions Once the data file was cleaned and coded it was then inputted to SPSS Version 26 for analysis Descriptive statistics were conducted for all variables within each survey question The descriptive statistics include the averages frequencies and percentages of responses for each answer choice within the survey Logistic regression tests were then conducted in SPSS to understand whether there were significant relationships between several variables First ordinal logistic regression tests were performed to identify whether documentation status i e undocumented or documented predicted the level of needs and worries among Latinos in the community Second binary logistic regression tests were performed to understand whether documentation status predicted the likelihood of reporting a particular community strength Third binary and multinomial logistic regression tests were performed to identify whether documentation status was a predictor for survey responses related to healthcare accessibility The healthcare accessibility questions were multiple choice and asked participants the last time they had a routine check up prostate exam colonoscopy mammogram pap smear and STD screening There were also questions asking where participants go when they are sick and whether they or anyone in their family had ever received therapy All regression tests included age and gender as control variables and some tests also controlled for education level or health insurance status Results tables were created to present the significant results at the p value of less than 0 05 for all main predictors in the adjusted regression models These results and tables have been included throughout this report Methods 18

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Camino Research Institute Latino Community Strengths and Needs Report Part II Focus Groups To gain a deeper understanding of the strengths and needs identified in the survey data focus groups were conducted at several sites throughout Mecklenburg County Since 88 of survey respondents were immigrants we aimed to recruit adult Latino immigrants living in Mecklenburg County to better understand how issues specific to immigration like acculturation language barriers and residency status can impact their access to resources and services In addition since Latino immigrants are an understudied population focus groups provide an opportunity for them to voice their experiences and concerns 52 Focus Group Guide Development The focus group interview guide was initially drafted in English after preliminary analysis of the survey data CRI staff identified patterns in the data that may warrant further exploration through focus group discussions The initial draft of the focus group guide contained questions aimed to elicit lived experiences with issues related to immigration employment access to physical and mental health services and how Latino immigrants define and perceive their community CAB members with expertise in these topic areas assisted in brainstorming and developing culturally sensitive questions that would elicit relevant discussions CAB members assisted in the selection wording and translation of questions Native Spanish speakers from Mexico Ecuador Colombia Argentina and Honduras were asked to provide input on the Spanish translation of focus group questions to ensure they were understandable across dialects Previous qualitative research shows 80 of themes are identified after the first 3 4 focus groups54 and that the probability of identifying a theme among a sample of six individuals is greater than 99 if the concept is shared among at least half of the larger population 55 A total of 36 Latinos participated in focus groups Females are overrepresented in the sample with 89 being female and 11 being male Most participants 64 were married or in a domestic partnership and a third were single or never married 28 two reported being widowed Almost half 44 of the focus group participants are undocumented with five others indicating that they preferred not to respond 31 are US Citizens Green Card holders or permanent residents and 11 have a conditional or temporary status Visa TPS refugee Most participants originated from Mexico 47 or Venezuela 11 but individuals from Colombia Honduras Puerto Rico Guatemala Dominican Republic and El Salvador also attended Focus group participants lived in the US for an average of 14 7 years with responses ranging from less than 1 year to 44 years On average participants have lived in Mecklenburg County for 11 7 years with responses ranging from less than 1 year to 28 years A convenience sampling strategy was used to recruit participants Since Latino immigrants especially undocumented immigrants are best recruited through networks of trust CRI collaborated with other trusted community stakeholders and organizations to recruit participants These community partners provided us with the names and contact information of potential participants and the CRI team contacted each potential participant to provide more information about the focus groups and confirm their attendance Male 11 Focus Group Participants The target population for focus groups is Latino immigrants 18 or older living in Mecklenburg County The target sample size was four focus groups with approximately 6 8 in each group for a total of 24 32 participants The number of focus groups was determined based on a calculation to achieve 80 power in detecting themes 53 Methods Female 89 Focus Group Genders A 19

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Latino Community Strengths and Needs Report Camino Research Institute Focus Group Data Collection Focus groups were conducted by two Latino bilingual CRI staff members who are trained in qualitative research and CBPR methods A trained bilingual Latina CRI intern was also present to observe take notes and assist with logistics Focus groups were conducted in Spanish in July and August 2022 at four locations across the County including Camino Health Center The Learning Help Centers of Charlotte Iglesia El Buen Samaritano de Lake Forest and Iglesia Adventista del S ptimo D a Central de Charlotte Focus group sites were selected based on partnerships with organizations who are trusted resources within Latino immigrant communities as well as location proximity to ensure ease of participation across Mecklenburg County Participants were provided with a meal childcare and a 20 gift card for their participation At the beginning of the session participants were given 30 minutes to engage in platica small talk and share a meal creating a comfortable environment The childcare was provided on site but in a separate room from the focus group to allow participants to fully engage in the discussion without distraction The research team explained the focus group rules procedures and consent form which participants then signed Focus group participants also completed a brief demographic To ensure that community members and stakeholders can learn and take action on findings a rapid appraisal approach was used Once consent and demographic data were obtained the focus group discussion began Focus groups were recorded and ranged from an hour to an hour and a half in length Upon completion of the focus group participants were provided with the gift card as well as information on Camino s services in case retelling or listening to the experience of other participants triggered feelings of stress or trauma Methods Focus Group Data Analysis The analysis of qualitative data is often very time consuming taking months to complete the transcription and subsequent textual analysis of focus group data A rapid appraisal approach was adopted to ensure that community members and stakeholders can learn and potentially take action on focus group findings Rapid appraisal is a research approach that employs data collection methods and analysis in a short time frame to generate preliminary data and results that can be used to guide existing policy decisions and directions in future research 56 57 Rapid appraisals are commonly used to study time sensitive events to gain a quicker insight on current activities in the field 57 58 To increase the speed of data collection and analysis multiple researchers are actively involved in both data collection and analysis 56 For this analysis three researchers that were present in the focus groups two CRI staff members and one graduate intern independently reviewed the audio recordings and took notes on how participants responded to each focus group question The researchers convened and compared individual findings and notes to develop overall themes for each focus group A consensus was reached on what themes were deemed significant across multiple focus groups Quotes were then identified based on relevance to overall themes and quantitative findings While rapid appraisals allow researchers to create timely reports the findings are often not as in depth as standard analysis procedures that require extended time to transcribe and code qualitative data 20

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Latino Community Strengths and Needs Report Camino Research Institute STUDY FINDINGS Findings from our study highlight numerous strengths of individuals and the Latino community as a whole while also identifying obstacles that make it difficult to access the economic health and educational services needed for optimal health and wellbeing The strengths and needs of Latinos are presented in the next section Study Findings 21

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Camino Research Institute Latino Community Strengths and Needs Report STRENGTHS Latino communities possess unique qualities that add value to the environments where they live work and spend their time The top community strengths are entrepreneurship willingness to start a business bilingual language skills work ethic and adding cultural diversity to the community One focus group participant said they liked the sense of unity and cultural diversity within the Latino community What I like about our Hispanic community in Mecklenburg County is that although we come from a large variety of many nationalities there is a sense of closeness and more connection I have almost been in Mecklenburg County for 7 years and I used to live in Miami where there are more Hispanic people much more people than there are in Charlotte Mecklenburg but they are all dispersed Everyone is how they say on their own Latinos also have a heart for volunteer work and helping others When respondents were asked what they could personally do to contribute to their communitya the top responses were related to volunteering or community work 36 sharing knowledge or information 12 and positive personal characteristics like empathy courage and strength 9 Donations Personal characteristics Work ethic Psychology Music Art Volunteering Health education Culture Nationalism Unity Knowledge Being bilingual Entrepreneurship Mentorship Latinos are also highly educated The majority have some college education or degree and only 1 report having no education at all 27 have a technical associate or bachelor degree and 8 have some college 11 have a Master s degree or graduate certificate and 2 have a doctorate degree Finally 19 have a high school diploma or GED 15 have some high school but no diploma and 12 have no high school education B Graduate certificate 2 6 Technical degree 5 2 High school diploma GED 19 4 Some college 7 6 Bachelor s Degree Master s Degree 17 9 8 7 No high school 12 2 B High school no diploma 14 8 Education level We consistently see the Latino cultural value familismo reflected throughout survey and focus group data Familismo is a collectivist cultural value commonly found in Latino cultures where a higher emphasis is placed on the family unit than on the individual 59 60 Individuals who hold this cultural value make decisions based on what is best for the family rather than for oneself and feel a sense of obligation to help family members 61 Familismo is also evident in the reasons Latinos move to the US 66 of immigrants moved to the US for better opportunities and improved quality of life for themselves and their children or to reunite with family members already living in the US A Personal contributions Study Findings 22

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Latino Community Strengths and Needs Report Focus group participants readily shared reasons for migrating to the US For example one female participant said I came here because I had no education so I wanted my daughters to study My family my children are now achieving that They are achieving their education They are becoming bilingual They learned another language other than Spanish So it is all extremely beneficial Camino Research Institute I do not discriminate against any job I clean houses and I am very proud to do what I do to earn a living because it would be worse to steal right But I visualize my children having a position where they don t have to waste the hours that I kill myself to get a few dollars I would like them to be professionals or hold professional positions Consequently most parents are actively involved in their child s education and development Parents also report regularly helping with their homework 57 talking to their child s teacher 39 or attending parent teacher conferences 37 The majority of parents with children under 10 years old 68 read to their child at least 3 5 times a week 95 of Latino parents also believe it is important for their children to maintain Latino cultures and Spanish language Many focus group participants felt being bilingual is a highly valued skill for children that would benefit them and the broader community in the future One focus group participant said Even after immigrating Latinos remain dedicated to supporting their families despite living in different countries Over half of survey respondents 52 say they send money or items to family members outside of the US regardless of their financial situation Children are a central component of most Latino families More than half of respondents are parents or the primary caregiver to a child Focus group results show that Latino parents have a desire to create better opportunities for their children than what they had growing up Parents often talked about moving to the US so their children could pursue higher education and obtain professional jobs One participant commented Study Findings if they Latino children dedicate to maintaining Spanish as an alternative language those children are going to be highly valued really And at all levels it seems in all types of work in health centers in immigration itself in the education system People who speak both languages are needed 23

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Latino Community Strengths and Needs Report Another strength uncovered through this study is Latinos strong reliance on faith Faith related sources were most commonly reported as the FIRST place Latinos turn in times of need compared to other sources like friends family community organizations and government entities Faith related sources were most commonly reported as the FIRST place Latinos turn in times of need compared to other sources like friends family community organizations and government entities Nearly half of participants 40 report they would turn to God Church or their Pastor faith leader first when they have a problem or need Furthermore a quarter report that they pray or read the bible when stressed Turning to God or faith related sources during times of need was also a theme of focus group discussions One participant said I believe that God regardless of what makes me sick or the situations that arise he has never left me alone God always provided me with the team of people the people I need to arrive Another participant discussed turning to church for help when experiencing issues related to mental health She commented Another option is looking for help through the church taking part in a prayer group listening to the bible bible study and there are a lot of people there that can also help you Camino Research Institute Over half report talking to friends or family as their primary mechanism for coping with stress Moreover 31 say they turn to friends and family first when faced with a problem In each focus group participants pointed out the strong sense of community they felt amongst Latinos Participants indicated being able to lean on other Latinos to help with or meet their needs One participant said In this group we are a community where we support each other If I have a need another person comes that tells us here is help or you can go through this path So I think that is a part of community support letting us know about our needs Other participants discussed concrete examples like relying on fellow Latinos to help take care of their children when they have to work but cannot afford childcare Although Latino communities are strong faith based and have supportive familial and social networks some needs or problems require external help 17 of respondents report they would turn to a community organization first when they have a need Participants across focus groups discussed how much they rely on community organizations to help meet some of their needs One participant commented Thank god there are organizations that help our community a ton like Ada Jenkins or Camino They are angels for us but they do not have vision or dental services Although these community organizations are helpful participants still felt they have needs that need to be addressed Strong social support systems among Latinos are evident across survey and focus group data 72 report they have people they can rely on for help and 70 indicate they have someone to talk to about their problems Study Findings 24

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Latino Community Strengths and Needs Report NEEDS AND BARRIERS Although Latino communities have many strengths like all communities they also experience problems and have unmet needs The next several sections discuss the needs of Latinos related to education employment mental health and physical health along with the corresponding barriers that may prevent respondents from accessing services Overall immigrants who are undocumented experience a higher level of need for many services and experience unique barriers to accessing these services As such we have often aggregated data by documentation status Education While study findings show Latinos are involved in their child s education some parents report experiencing barriers due to language 39 and documentation status 4 This was echoed in focus group discussions where some participants explained they frequently have to find a community member to interpret for them just so they can communicate with the staff at their child s school One participant recounted her experience helping translate for a fellow Latina mother Camino Research Institute Although only 4 of parents indicate that documentation status is a reason they are not more involved in their child s school multiple participants in different focus groups stated it is a barrier One parent explained that volunteering at CMS schools requires a driver s license something that undocumented individuals are ineligible for They are discriminating you because one does not have documentation papers one mother said regarding her inability to help out at her child s school Across multiple focus groups there was a pattern of perceived discrimation against Latino children in the school system One mother demanded I feel that work needs to be done so that the education system here of CMS Charlotte Mecklenburg Schools sees Hispanic students with more respect There needs to be more respect More decisions to make them equal not less than A mom called me to interpret that her son had gotten sick at school and she had to go pick him up So the problem was not when I talked to the teacher it was that the mom was nervous because when she got to the school how would she go there to say I came to pick up my son So I think that it causes a lot of stress that the schools do not have a person that speaks our language that can help us Hispanics As this quote demonstrates language barriers can place significant stress on parents as they try to navigate the school system especially during a situation that is already stressful like picking up a sick child some parents report experiencing barriers due to language 39 and documentation status 4 Study Findings Although many Latino parents want their children to pursue higher education they experience difficulties navigating that system 73 report they need help applying and or paying for higher education either for themselves or their children 25

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Latino Community Strengths and Needs Report Undocumented immigrants are 1 69 times more likely to need help applying and or paying for higher education compared to documented Latinos Across multiple focus groups participants expressed difficulty in navigating the education system in the US exemplified by this exchange between two participants Participant 1 The education system of our countries are really different from the ones here in the US So even though the schools make you think that anyone can go to university it is very difficult because first of all we arrive not speaking the language well or at all Participant 2 On top of that it is a totally different education system So we don t know where to start where to find information and where to find scholarships because I know they exist but one thinks Where can I find them How do I apply Because on top of everything since it is all up to you it would be helpful to have an organization that can help Just seeing the ton of paperwork and not being able to understand the terms and all it is truly really difficult and it is sad to see talented children that are putting in effort and getting good grades and everything in school but then the next steps is where I feel lost there is nowhere where we can ask Help me Overall participants express having insufficient knowledge to prepare their children to apply for college While barriers like not being familiar with the college application process and insufficient English proficiency were mentioned some participants also mentioned that Latino children who are not US citizens experience additional barriers Undocumented Latino children do not qualify for governmental aid programs like FAFSA Free Application for Federal Student Aid and they have to pay out of state tuition rates even for local colleges and universities Camino Research Institute Although Latino parents have difficulty navigating US education systems that does not mean they are uneducated 48 have some college education or a college degree but 61 of those received their highest degree outside of the US This is noteworthy because some degrees and credentials may not transfer to the US One participant a former medical specialist assistant in Mexico describes this experience There is no place here where I can recertify my degree or title to work here So as it happens to a lot of people I have to find whatever work I can find and not in what I would like to do Much help is needed in that aspect to recertify one s degree so that they can continue their career here Continuing the same profession after moving to the US is not an option for many immigrants The inability to recertify credentials is just one reason for this The next section elaborates on issues related to employment and socioeconomic status and how it can impact access to Employment Of employed immigrants 79 held professional careers like teachers healthcare providers business administrators counselors and engineers in their country of origin but only 54 held professional careers after moving to the US 17 of employed immigrants worked as skilled laborers in their country of origin which remains relatively the same after moving to the US at 16 However only 4 of employed immigrants worked in food or cleaning industries in their country of origin but 30 work in food and cleaning industries after moving to the US Data shows a 790 increase in the number of Latino immigrants working in food or cleaning industries and an 11 decrease in the number of Latino immigrants who hold professional careers after moving to the US Study Findings 26

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Camino Research Institute Latino Community Strengths and Needs Report These changes can impact economic and social status in the US and lead to feelings of stress and worry 66 of undocumented Latinos reported feeling worry related to work Similarly focus group data suggests that many immigrants are unhappy with their jobs but feel they have no other choice One participant said I try to find more options for different jobs Not what you like but what there is Comments from focus groups coupled with survey data shows Latino immigrants want more employment options and express the desire for employment training One in three undocumented Latinos report a need for employment training programs and those who are undocumented are 3 12 times more likely to report a higher level of need for employment training programs compared to those who are documented For undocumented immigrants obtaining and maintaining employment may be especially challenging due to issues related to documentation and transportation One focus group participant recounted the time her husband was temporarily fired due to documentation status and then rehired Recently my husband here at the employment site they checked documentation papers Many hispanics left and only 3 people remained working They checked papers but thank God my husband was able to find work Only 3 days passed and they called him to return back to work This story demonstrates the uncertainty of employment for many Latinos with undocumented Latinos being at risk of job loss if employers decide to investigate immigration documents Student Prefer not to respond Furthermore undocumented immigrants were 3 13 times more likely to report a higher level of work related worry compared to those who are documented Although some immigrants are not satisfied with their current positions most are currently employed A higher percentage 37 were unemployed in their country of origin compared to now in the US 27 Many focus group participants discussed how opportunities for economic and social mobility are limited in their country of origin One participant talked about being pushed out of employment due to age She commented I am from Guatemala and over there they begin to take people out of their job at 50 years old But here I am in awe that I am 72 years old and I can still work So it is a benefit for us Latinos I am productive here so that is giving me more life more will to live and I feel useful This participant felt that work opportunities are a largely positive characteristic of the US Of all Latinos in the sample 49 are employed full time 17 are employed part time and 11 are unemployedA 69 of those who are unemployed report barriers to finding work with the biggest being language n 96 36 and documentation ID n 68 27 In fact 64 of all Latinos and 88 of undocumented Latinos indicate a need for English as a Second Language ESL classes Study Findings Disabled 3 3 2 4 5 Self employed Entrepreneur 7 8 Employed full time Unemployed 38 4 10 4 Housewife or caregiver 13 5 Employed part time 16 1 Employment Status A Documentation status is also linked to obtaining a driver s license Undocumented immigrants are not eligible for a driver s license in NC which makes daily tasks like getting to work not only difficult but extremely stressful While 50 of all Latinos have a license 92 of undocumented Latinos do not Many undocumented Latinos fear that a traffic stop could lead to legal repercussions that reveal their documentation status resulting in deportation Although deportation is unlikely to occur as a result of driving without a license the fear that it could happen is very real for many 27

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Camino Research Institute Latino Community Strengths and Needs Report Undocumented Latinos are 4 35 times more likely to report a higher need for public transportation compared to those who are documented But only 10 report using public transportation as their primary mode of transportationA The gap between the need for public transportation and its use was discussed during focus groups Interestingly we did not ask questions specific to public transportation during focus groups but the topic came up organically Public Transit 6 1 Rely on others w cars 11 Personal Car 78 A In another focus group participants discussed feeling unsafe if they tried to walk to where they needed to go Participant 1 There are no sidewalks Participant 2 Drivers can run you over Participant 3 If one does not drive one does not know how to drive a car you can t go out safely to the store or take the children It is necessary to drive for things Since we are undocumented it is difficult because we cannot obtain a driver s license and so it is something that is sometimes worrying for us The inability to drive or use public transportation limits options for many Latinos to get to work and obtain a steady income Unfortunately although two out of three Latinos are employed most face financial issues This is not surprising given that many immigrants are unable to continue their professional careers after immigrating 46 of the immigrant sample work in food service cleaning or skilled labor positions jobs where Latinos are more likely to experience large pay gaps compared to non Latinos 62 63 Mode of Transport Focus group participants expressed disappointment with the public transportation system and felt it pales in comparison to what they had in their country of origin For example one focus group participant said When I first arrived in Charlotte there was almost no public transportation In Mexico public transportation is good there is a lot of transportation to get around Other participants from the same focus group added that the buses are not reliable because they do not always come to their stop One participant said That s why I don t use public transportation It sometimes passes and sometimes it doesn t I prefer using an old car that can take and bring me Many focus group participants also indicated they do not feel safe using public transportation both in regards to violence on the bus and on the journey to the bus stop For example one participant said Sometimes you obviously have to take public transportation out of necessity but there are times when you see things on the train or on the bus that even scares you Study Findings we estimate that 48 of immigrants employed in their country of origin and now likely experienced a decrease in socioeconomic status 28

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Latino Community Strengths and Needs Report Nearly three fourths 71 of the sample report they do not have money left over after paying monthly billsA Not having enough money makes it difficult to purchase basic necessities like food which can impact the entire household A considerable number of participants are at risk for food insecurity Almost half run out of food before being able to buy more and 38 skip or reduce meals before having money for more food Never 12 2 Often 14 Always 14 7 Sometimes 32 8 Rarely 26 9 Money Left After Monthly Bills A A lack of disposable income may indicate financial instability and the inability to save money securely Nearly 80 of respondents have a bank account but those who do not report barriers related to insufficient funds 34 not knowing how to open a bank account 19 and expensive account fees 16 Loans are another important financial indicator of access to resources and 63 of Latinos report they need help obtaining a loan Many respondents report barriers to obtaining loans including low credit score 23 no credit history 20 being unsure of how or where to obtain a loan 20 and not having personal identification or documentation 15 These barriers make it difficult to obtain assets like cars or houses Only 35 of Latinos in the sample own their home which is far lower than the overall NC population at 66 46 All of these issues can lead to feelings of stress which can impact mental and emotional wellbeing Study Findings Camino Research Institute Mental Health Mental Health deals with emotional psychological and social wellbeing A healthy mind is important to overall health wellbeing and happiness Unfortunately the socioeconomic issues discussed in previous sections can lead to high levels of stress potentially placing Latinos at an increased risk for mental health issues Our data shows Latinos experience high levels of worry discrimination and symptoms of mental health disorders Only 32 of Latinos report seeking mental health services The top rated worries experienced by Latinos are related to family responsibilities money and physical health However once data is aggregated by documentation status the top worries for immigrants are different the top three are family responsibilities domestic or family abuse and housing Moreover the average scores for the degree of worry are higher in every area for undocumented compared to documented Latinos For example on a scale of 1 4 where 4 indicates a lot of worry the average level of worry for domestic or family abuse is 3 08 for undocumented immigrants compared to 1 32 for documented Latinos housing for undocumented immigrants is 3 04 compared to 2 33 for documented Latinos 29

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Latino Community Strengths and Needs Report 44 experience discrimination for being Latino Over half of those who experience discrimination 55 report it is due to language 36 report documentation status and 29 report appearance The places where Latinos most often feel discriminated against are places of employment local businesses and the criminal justice system Discrimination was a theme across all focus groups One participant discussed discrimination specifically related to the hiring process at work commenting There is always like a separate point for the Hispanics Let s see if we have 10 employees and if one is not filled we give it to the Hispanic But they will always give priority to the others Another participant discussed experiencing discrimination at work for appearing Latino and speaking Spanish I had jobs where they treat you really bad simply because you speak Spanish I know how to speak English but my language is Spanish Because of that there are people that treat you badly and I m legal documented There are people that treat you like that simply because they see you as Latino whether you are legal or not it does not matter to them Another interesting point of discussion that came out during focus groups was the notion that Latinos discriminate against other Latinos This was a contentious topic of conversation during one of the focus groups with one participant saying Study Findings Camino Research Institute I also see that the Latinos here are very hateful and also discriminate against other Latinos What I am going to say is awful but Latinos who have more education and documentation they become more hateful become worse people So when you are in a clique with people who have their house or they have their papers and work or can travel and leave the country and come back they become hateful and they discriminate against you less privileged Latinos They discriminate against people that are from the same country the same city and that really hurts more because you understand each other s language and body language That has happened to me people who have more education more money end up being the worst Other participants echoed the notion that Latinos who hold a more prestigious position at work or have received legal documentation treat other Latinos less favorably The worst enemy of a Hispanic is another Hispanic Another participant further elaborated on the thought process they believe creates this sense of interethnic discrimination It is like the Hispanic does not like when another Hispanic is advancing It s like if I look Oh she s already started her own business Then the envy comes like oh no she probably doesn t even do it well or they speak badly about the person Experiences about discrimination and exploitation between Latinos especially between more established affluent immigrants and less established immigrants were previously reported in the Mecklenburg County Latino Community Needs Assessment from 2006 suggesting that this is a long time issue within Latino communities in Mecklenburg County 36 30

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Latino Community Strengths and Needs Report Despite experiencing high levels of worry discrimination and mental health symptoms the majority of respondents 68 report that they nor anyone in their household has ever recieved therapyA When asked why they have not received therapy 44 feel they do not want or need it 28 cannot afford it 8 experience language barriers and 7 report stigma Yes 28 No 68 Received therapy A Mental health is often described as a taboo subject in Latino culture which may explain the low rate of Latinos accessing mental health services However focus group discussions with Latino immigrants show that the subject may not be as taboo as previously thought Participants were asked to imagine a scenario in which someone they cared about was demonstrating symptoms of depression and to describe the steps the person should take The question was structured this way in an attempt to make participants feel more comfortable talking about mental health issues To our surprise participants responded to this question more directly than anticipated Some openly shared about their own personal experiences receiving therapy to treat mental health issues like depression and Post Traumatic Stress Disorder PTSD Others gave examples of how they helped family members find counseling services Camino Research Institute Other participants talked about seeking professional mental health treatment for their children One participant said Whenever I see my daughters are sad or depressed I go to the pediatrician and call them and send them to a specialist Another focus group participant talked about seeking help for her child who was experiencing symptoms of PTSD but emphasized how difficult it is to obtain services mostly due to cost and a lack of bilingual professionals She commented On the way from country of origin to here we were kidnapped So at Camino they found us a psychologist and they were doing workshops My young child still can t sleep by themself or with the lights off They are easily scared If they are sitting and hear a lot of noise they will leave crying They are very nervous I think those workshops worked we looked for our own psychologist but we can t find one I think we need it but I don t know where to find that service A lack of affordable professional mental health services in Spanish may contribute to lower rates of service utilization and subsequent diagnosis of mental illness Many participants feel it is the family s responsibility to help the individual seek mental health treatment reiterating reliance on social support networks and the value of familismo This was largely attributed to the notion that when people are in a depressed or negative emotional state they may not have the ability to seek help One participant said The ones that should be working with them are their close family They should ask for help ask for medical assistance to their community the church with whatever person that they can ask for help because that person will not do it Study Findings Mental and physical health are closely related and both impact quality of life The next section discusses some of the issues faced by Latinos related to accessing healthcare services 31

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Camino Research Institute Latino Community Strengths and Needs Report Physical Health Physical health deals with the condition of the body Maintaining good physical health involves taking care of yourself when sick or injured and engaging in behaviors and activities that help prevent illnesses or injury like annual physicals and preventive screenings Our data shows that all of the services Latinos report needing the most are related to physical health dentalA visionB and preventative healthcare servicesC These three scored highest among a list of needs that encompass other service areas like employment housing food transportation education and legal services Very little 6 9 Not at all 10 7 Somewhat 17 6 A lot 64 9 Need for dental services A Not at all 12 Very little 12 5 Somewhat 19 4 A lot 56 1 Need for preventative healthcare services C The biggest barrier to seeking dental vision and preventive healthcare services is a lack of health insurance Over half of respondents 60 do not have health insuranceD This number is higher among immigrants and even higher among undocumented immigrants Health insurance is an issue that can impact the whole family Although most parents report that their child has health insurance documentation status and cost were found to be the most common reasons for children lacking insurance 62 of immigrants and 96 of undocumented immigrants do not have health insurance 67 9 Very little 8 7 Not at all 13 3 36 7 Somewhat 21 3 B 34 7 A lot 56 7 3 7 Need for vision services Insured Rate by Immigration Status D Study Findings 32

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Camino Research Institute Latino Community Strengths and Needs Report Unfortunately in this country I feel that we treat health as a second priority I know many people who were very sick for a while and do not go for the same reasons Because of work because they don t have enough to pay for an ambulance or because they don t have access to medical insurance Dental care ranked highest of all the needs across all subgroups regardless of documentation status On a scale of 1 not at all to 4 a lot the average score for documented Latinos US born and immigrants is 2 98 3 45 for those with temporary status Visa or TPS and 3 76 for undocumented immigrants Although this was the highest reported need across all groups undocumented Latinos are 4 3 times more likely to report a higher need for dental services compared to documented Latinos Yes 23 8 No 73 1 Regular dental care A The top three reasons Latinos are not receiving regular dental care are related to access lack of dental insurance 72 high cost 52 and language barriers 7 Vision care was the second highest ranked need amongst the sample as a whole Only 37 of the sample receive regular vision careB For those who do not the reasons are similar to dental care over two thirds 67 lack vision insurance and 44 report cost is a barrier Yes 37 1 B Study Findings No 60 9 Regular vision care 33

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Latino Community Strengths and Needs Report During focus groups participants expressed difficulty in accessing affordable dental and vision care While they are grateful for free and low cost health services provided by different Latino serving nonprofits they are disappointed that they do not offer dental or vision services Participants say that the prices for such services are too high as exemplified by this exchange between two focus group participants Participant 1 Camino Research Institute Another barrier to healthcare access and utilization is language 74 of undocumented immigrants report a high need for a Spanish speaking doctor Although documented Latinos report a lower need for this it may still be an issue for some of them 75 of the sample report their preferred language is Spanish but only 28 report their doctor speaks to them in Spanish It is important to be able to communicate effectively with your doctor to understand the state of your health and adhere to the recommendations they provide Almost all the places for vision charge you 150 and that s just for checking your eyes Participant 2 And we don t know where those affordable vision services are Participant 1 I went and said I need glasses For the consultation and the glasses it was almost 400 500 dollars every time Participant 2 It s terrible I had a problem with my teeth one tooth and I went to a dentist and the first consultation was free Oh how wonderful I said And to fix my problem they said Okay to begin it s 2 500 dollars With that I can go to Guatemala and get them fixed there But not everyone has that privilege it is way too expensive Dental and vision care are costly especially when paying out of pocket Given that many Latinos regularly experience financial difficulties they likely have to prioritize how money is spent and basic needs tend to take priority over other things like regular dental and vision care However both of these are important to overall health Lack of regular dental care increases the risk of oral infections like tooth decay and gum disease which are associated with diabetes heart disease and stroke all of which are leading causes of death for Latinos 64 Without regular vision care common eye diseases can go unnoticed and lead to complications related to existing chronic diseases like diabetes which impacts 12 of the US Latino population 65 66 Study Findings Another important component of overall health is preventive healthcare which includes services like annual physical exams vaccinations and cancer screenings Preventive care appears to be a high priority for most Latinos It is the third highest ranked need amongst the whole sample and among documented Latinos second for those with temporary status and fourth for undocumented 78 report having regular doctor visits and over half 60 report having a routine annual checkup within the last year Annual visits are important because they can help detect chronic conditions like cardiovascular disease diabetes and high blood pressure early Latinos have a 50 higher death rate from diabetes than non Latinos and 24 more poorly controlled high blood pressure 7 Early detection can help prevent worsening of conditions that lead to complications and even early death 34

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Latino Community Strengths and Needs Report Preventive healthcare is also important for detecting cancer which is the second leading cause of death in Latinos Fortunately 64 of females 40 and older had a mammogram within the past two years and 67 of females 18 and older had a pap smear within the last 3 years Data on frequencies of prostate and colonoscopy exams are not included here as recommendations vary depending on risk and a number of other factors For all preventive cancer screenings health insurance is the biggest reported barrier to receiving them as recommended Maintaining good health also includes taking care of oneself when sick or injured We asked respondents where they go when they are sick 35 go to a doctor s office 23 go to a community clinic 16 stay home and 15 go to urgent care or a hospital emergency roomA There are various reasons Latinos report choosing not to go to the doctor when sick For some it is because they do not have a doctor 16 For others it comes back to health insurance 58 and cost 38 For those who are low income and uninsured it may feel as if staying home or going to the hospital or emergency room are the only options Undocumented immigrants are 8 times more likely to report going to the emergency room when they are sick rather than going to a doctor compared to those who are documented Other 0 9 Hospital ER 7 9 Urgent Care 7 9 Camino Research Institute Focus group participants discussed the frequent use of home remedies when they are sick they feel that seeking professional medical care is the last step you take and that you only do so if you feel seriously ill for multiple days One participant said First of all we do not have access to go quickly to the emergency room nothing because we do not have insurance or anything You know a bill will arrive of 800 1 000 So I put up with the pain or sickness Why Because I don t have the money If I had the money you have to do it But there isn t Another participant said Well we look for home remedies first because to go to wherever to go to a doctor is expensive Often there are multiple barriers that impact accessibility of healthcare services including health insurance cost and residency status One focus group participant explained how her son was having eye issues and she was struggling to find a low cost eye clinic because they do not have insurance She said My son for example had a month now of having an issue with his eye like it jumps And he says to me Mom I m scared What is wrong with my eye So we have been calling places to ask where we can find an eye clinic that is not so expensive because the visit is very expensive without insurance And we have not been able to find it So I say I have been looking for a month What am I going to do with my son In any case I am going to have to take him because it s his eye because it continues to bother him So I think also it is like one does not know where to go or where to ask In that topic I feel lost because I do not know where to look for help Doctor s office 34 5 Stay home 16 2 Community clinic 23 4 Where respondents go when sick A Study Findings 35

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Latino Community Strengths and Needs Report Camino Research Institute Focus group participants also report that their employers may pressure them to work while sick and potentially put their health in jeopardy One explained There are many people who do have the need to go to work even though they are sick It has happened to me like that working while sick On one occasion I came from the Emergency Room because I was very ill And until 12 I was allowed to go home by the man well the boss But if not they never give permission So you have to come in while sick Overall our data suggests that healthcare is important to Latinos This data also shows that Latinos know what type of care is needed but barriers related to insurance cost and language prevent them from seeking the care they need regularly Respondents had the option to select I did not know it was needed for all healthcare questions including regular medical care dental and vision care and cancer screenings but a low percentage of respondents selected this option for all questions Your health comes first Study Findings 36

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Latino Community Strengths and Needs Report Camino Research Institute DISCUSSION The results of this study show Latinos are strong and diverse communities who value education hard work and faith Many Latinos are bilingual and bicultural offering unique skills to the communities in which they live and work Some Latinos are born in the US and some emigrate from a variety of Latin American and Caribbean countries Those who immigrate do so to pursue better employment and or educational opportunities for themselves and their families However once they arrive many are faced with obstacles that make it difficult for them to pursue what many consider the American Dream Discussion 37

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Latino Community Strengths and Needs Report Camino Research Institute A third of Latinos in this sample are experiencing symptoms of depression and many others are having a hard time managing their stress but most are not accessing professional mental health services Documentation language and transportation are all barriers to finding and maintaining work in Mecklenburg County Undocumented immigrants are unable to obtain a driver s license but still need to work to provide for their families Public transportation is not readily available accessible or safe for those who need it most Many Latinos want to pursue higher education but that is difficult when information on how to apply and pay for school is not readily accessible nor available in Spanish It is also difficult to navigate the higher education and public school systems when there are limited Spanish speaking staff at schools within the Charlotte Mecklenburg School CMS System Latinos who already have higher education degrees often have a hard time recredentialing or certifying degrees in the US and may end up working in jobs they do not like or are overqualified for Many of those jobs are low paying and do not offer health insurance often resulting in financial difficulties Many of the resources that are available for low income families require a social security number disqualifying undocumented immigrants from participation Due to financial struggles many Latinos have to choose between paying for basic necessities like food and rent or paying for medical or other needed services It is not only access to educational and employment opportunities that hinder Latinos in Mecklenburg County it is also access to health and behavioral healthcare Dental vision and preventive healthcare are the most highly reported needs for Latinos and are crucial to optimal health and wellbeing Barriers like health insurance cost language and residency status prevent many Latinos from accessing these services Discussion Many of these issues are heightened for undocumented immigrants who make up almost one third of the study sample Results strongly suggest residency status may influence the degree of need for resources among Latinos living in Mecklenburg County Comparative analysis shows undocumented Latinos tend to report a higher need for services and experience more worry on all issues than their documented counterparts Undocumented immigrants have less options for employment often forcing them to accept any work they can find some of those jobs may be low paying inconsistent and even result in exploitation NEEDS OF LATINOS IN 2006 VS TODAY The results of this study resemble those of the Mecklenburg County Latino Community Needs Assessment MCLNA The MCLNA was conducted between 2005 2006 by the UNC Charlotte Urban Institute in partnership with the Latin American Coalition The study utilized telephone surveys and focus groups with low income Latino residents to better understand the needs and barriers impacting the growing Latino population of Mecklenburg County Through these methods the MCLNA report concludes that Latinos are most impacted by limited English language skills discrimination residency status lack of bilingual services cost of healthcare services lack of higher paying employment opportunities and transportation issues 38

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Latino Community Strengths and Needs Report Camino Research Institute Unfortunately such issues remain significantly relevant to the Latino residents of Mecklenburg County over 15 years later Significant portions of Mecklenburg County Latinos are still uninsured feel discriminated against because of their language skills lack access to services due to residency status and language and are unable to continue their professional careers Focus group participants in both studies report experiencing or witnessing discrimination not only between Latinos and non Latinos but also between documented and undocumented Latinos In the MCLNA study language barriers were most commonly reported as the greatest challenge facing the Latino community followed by discrimination and then issues related to residency status Our findings illustrate that not only do these issues remain prominent but they are interrelated We found that Latinos experience discrimination related to employment with focus group participants further detailing how lack of residency status can lead to labor exploitation Latinos also experience discrimination related to speaking Spanish or even speaking English with an accent and have difficulty navigating education systems due to language barriers and lack of Spanish speaking staff In all while the Latino population of Mecklenburg County has more than doubled since 2006 the same issues continue to persist There are however some notable differences between the findings of these two studies The MCLNA found that 40 of Latinos reported jobs and better employment opportunities to be the greatest needs for Latino residents in Mecklenburg County while only 13 reported healthcare services as the greatest need In contrast the results of the current assessment suggest access to affordable healthcare services especially dental and vision services are the greatest needs for Latino residents in Mecklenburg County However this is not to say that issues related to employment are not apparent or important results of our study show Latinos experience significant worry over employment and personal finances Discussion 39

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Latino Community Strengths and Needs Report LATINOS TODAY VS ALL MECKLENBURG COUNTY RESIDENTS There is a Community Health Assessment CHA conducted every four years in Mecklenburg County to identify the top issues facing Mecklenburg County residents 68 Though the Mecklenburg County Community Health Assessment MCHA targets all residents the report does not provide data aggregated by ethnicity This report includes data from many different sources data from the Behavioral Risk Factor Surveillance Survey BRFSS is aggregated by ethnicity but data on Latinos is not readily accessible We requested this data from Mecklenburg County Public Health see Appendix A 69 In this section we compare some of our data to all residents in Mecklenburg County and whenever possible to the Latino sample from the BRFSS Camino Research Institute The most common employment sectors of Latinos in our study are cleaning and food service 30 skilled labor 16 and education 7 Alternatively for all Mecklenburg County residents the most common employment sectors are health care and social assistance 12 finance and insurance 10 5 and retail trade 10 3 71 Consequently there are notable differences in the percentage of Mecklenburg residents who work full time but are uninsured 12 compared to Latinos in our study 45 The most recent MCHA was conducted in 2019 The MCHA revealed that the top issues impacting residents are mental health access to care chronic disease prevention and violence prevention 68 Similarly many of the issues identified in our data are directly related to access to care including health insurance cost and language However our data also showed there are other issues related to immigration economics employment and access to educational opportunities Issues related to violence did not come out strongly in our data but we also did not ask many questions on violence Domestic violence did however come up as a top worry for undocumented immigrants but not the whole sample suggesting a need for additional research on this topic with undocumented Latinos Questions related to chronic disease prevalence and prevention were also not included in our survey Comparing our data to county wide data shows differences in high school graduation and college completion rates Among all Mecklenburg residents almost all 91 have at least a high school diploma or higher 70 compared to 67 of Latinos in our sample While 31 of Latinos in our sample have a bachelor s degree or higher nearly half 46 of all people living in Mecklenburg have a bachelor s degree or higher 70 Discussion That means there is a 275 difference between Latinos and all Mecklenburg County residents when it comes to the number of people who work full time but still lack insurance 40

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Latino Community Strengths and Needs Report Lack of health insurance and cost can prevent all racial and ethnic groups from seeking regular medical care However these barriers prevent Latinos from accessing these services at higher rates compared to all residents County wide data shows 19 of residents could not see a doctor due to cost 68 but our results show this number is 43 for Latinos One in four 25 of Mecklenburg adults did not see a dentist due to cost68 but our data shows that 82 of Latinos do not receive regular dental care due to cost or lack of insurance Camino Research Institute We also asked questions differently which can influence response choices For example when asking about mental health status we gave specific symptoms and asked participants to select which symptoms they are experiencing whereas the BRFSS asked whether mental health was not good It is possible that some individuals did not understand what was meant by not good without further context or examples how the terms were translated in Spanish could also influence how the question was answered We also did not indicate a specific time frame whereas the BRFSS asks whether they have felt bad 8 or more days over the past 30 days There are also differences in data related to mental health 16 of Mecklenburg County adults reported their mental health was not good on at least 8 of the last 30 days 69 Although the question was asked differently in our survey we found that 52 of Latinos are experiencing some form of mental health difficulty including symptoms of depression anxiety and uncontrollable anger Interestingly when looking at the Latino only sample from the BRFSS 2021 only 12 report their mental health was not good which is over 300 lower than what was reported by our sample 69 When comparing the Mecklenburg County Latino sample from the BRFSS with our Latino sample we still found notable differences on several variables This is likely because we sampled different Latino subgroups We oversampled immigrants resulting in a sample that is 88 immigrant with 30 being undocumented Though residency status is not revealed in the BRFSS data it is unlikely that the majority of the sample are immigrants given that most Latinos in Mecklenburg County are US born70 Moreover due to issues of mistrust it is likely that many of the Latino immigrants who took our survey do not participate in the BRFSS Discussion 41

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Latino Community Strengths and Needs Report Camino Research Institute Overall our data shows that the biggest issues faced by all residents in Mecklenburg County are still prevalent when assessing only Latinos But many of the underlying factors that contribute to those issues are unique to Latinos especially those who are undocumented Moreover comparison of these two assessments further highlights the disparities that exist between Latinos and other Mecklenburg County residents The next sections provide recommendations for reducing some of the barriers faced by Latinos creating equitable access and opportunities for all Mecklenburg County residents Discussion 42

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Latino Community Strengths and Needs Report Camino Research Institute IMPLICATIONS The issues impacting Latinos are not new or changing meaning it is time to begin thinking creatively about how to address them As highlighted by this study the Latino community is full of strengths To decrease health and socioeconomic disparities we suggest leveraging those strengths to empower Latino communities with the services they need to achieve optimal health and wellbeing Implications 43

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Camino Research Institute Latino Community Strengths and Needs Report Latinos have a strong entrepreneurial spirit yet 57 report barriers to obtaining loans There is a need for loan assistance programs and programs that guide Latino entrepreneurs through the process of starting a business Most Latinos also have a desire to work and perceive themselves to be hard workers They want more employment opportunities and employment training programs At the same time there is a need for education on the rights of undocumented immigrants when it comes to employment to reduce exploitation in the workplace Findings from this study also strongly suggest the need for healthcare services that can effectively serve Latinos Creating dental and vision service programs that are affordable and accessible to Mecklenburg County Latinos should be a top priority Issues related to healthcare access transcend residency status ranking as the top two needs for documented and undocumented Latinos There is a need to make health services more affordable for those without health insurance and or make health insurance more accessible especially to those who are undocumented Additionally increased health insurance opportunities should be made available to individuals working full time in less professional fields like housekeeping food services skilled labor or nannying Finding a place like Camino that can assist Latinos in the process can increase the amount of professional Latinos in NC Those who were not previously credentialed can also take advantage of educational opportunities that may provide a new path and economic opportunities For more information on how Camino is helping see Appendix B Nobody 2 8 Church Pastor 8 7 Government agency 2 4 God 31 Community Organization 17 2 Family Friends 31 Where Respondents Seek Help First A Many low cost services already exist through the Mecklenburg County Government but our data demonstrates a lack of utilization of those services This is likely due to a number of factors including lack of awareness language barriers and residency status but our experience tells us the primary reason is mistrust Only 2 of Latinos said they would turn to a government entity for help first suggesting these institutions need to improve their engagement and community outreach efforts with Latinos A Since these services already exist efforts should be made to increase awareness and availability to Latinos in Spanish Organizations should increase efforts to hire more Spanish speaking multicultural Latino staff to reduce language barriers and create a more welcoming environment for Latinos who primarily speak Spanish Moreover some immigrants are already credentialed in their home countries but need assistance recertifying their degrees Implications Trust is extremely important when engaging with Latinos Many Latinos are suspicious of governmental entities and choose to look for help through networks and entities they trust We suggest leveraging the informal networks and institutions that already exist and are trusted resources within Latino communities One example of this is The Promotores de Salud program Promotores de Salud uses a train the trainer approach to train lay community members to teach topics related to health and wellbeing to their peers creating community buy in and empowerment throughout existing social networks Decades of evidence shows Promotores de Salud have been effective in improving health outcomes for Latino individuals their families and their communities 72 Promotores de Salud translates directly to Promoters of Health and is often used interchangeably with Community Health Workers 44

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Latino Community Strengths and Needs Report Faith and Church are central to the lives of most Latinos Pastors and other faith leaders are often the most trusted community resource among Latino families Leveraging trusted relationships within the church is a crucial step towards connecting Latinos with the services they need the most Partnering with Latino churches and pastors is an effective approach that has been used by Camino and other organizations for many years and is reinforced by our data A pastor or faith leader has the ability to influence an entire congregation creating buy in and motivation to connect with services or enroll in specific programs Furthermore attending church and engaging in other religious activities often involves the whole family For many Latinos family is everything and for immigrants it is often the entire reason they moved to the US Consequently we recommend delivering programs and services that include the whole family whenever possible Camino Research Institute However we urge Latinos living in Mecklenburg County to take advantage of these opportunities whenever possible and encourage their fellow Latinos to do the same We continue to come back to the phrase The Future is Latino What this boils down to is that Latino children are the future They are also well situated to solve some of the most pressing issues faced by Latinos namely the lack of Spanish speaking professionals like doctors nurses dentists behavioral health specialists and teachers These professions require advanced training and degrees reinforcing the importance of creating more opportunities for Latino children to pursue higher education Latino parents can be a part of this change by continuing to advocate on behalf of their children While only 5 of Latino parents report attending school board meetings focus group discussions demonstrate perceived discrimination in CMS schools and tension between parents and the education system Latino parents must have a presence at school board meetings where they can voice their concerns and suggestions related to language barriers discrimination documentation required for participating in school activities and the lack of assitance in applying and paying for college We also believe it is important for non Latinos to have an understanding and appreciation of Latinos and the strengths they offer to the broader community Cultural events where Latinos can showcase aspects of their heritage through food and dance are meaningful ways to accomplish this However they should not be limited to Hispanic Heritage month and we encourage more non Latinos to attend and engage in these types of activities to learn about their fellow community members It is also important to provide opportunities for Latino children to do these types of activities at school and other places where they spend their time Latino children are the future RECOMMENDATIONS FOR LATINOS In line with the principles of CBPR Latino community members should be equipped and empowered with the knowledge and tools necessary to address the issues that are impacting them We have provided many suggestions for programs services and strategies that could help provide these tools Implications 45

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Latino Community Strengths and Needs Report Camino Research Institute Ultimately Latino parents believe their bilingual children are assets to the future of all Latinos and can help bridge gaps in services Latino children are bilingual and possess the unique skill to navigate between American and Latin American cultures However there are many Latino children who do not speak fluent Spanish reflecting a national decline in the share of Latino households that primarily speak in Spanish 73 Immigrants have historically been urged to assimilate to American culture in pursuit of their new life in the US 74 Latino children of immigrants were often encouraged to prioritize English when outside of the home especially at school so they could communicate with teachers and fellow students Although many second generation Latinos maintain the Spanish language they are less likely to speak Spanish with their children in the future In fact the number of Latino parents who ensure Spanish lives on with their children declines as their immigrant connections become more distant meaning future generations will be far less likely to be fluent in Spanish 75 Consequently 78 of third generation Latinos and higher report being English dominant while 72 of first generation Latinos report being Spanish dominant 76 Fortunately in recent years there has been an apparent push for and prioritization of bilingualism and biculturalism causing many Latinos to begin re establishing their Latino cultural roots In fact our data shows that nearly all Latino parents want their children to maintain their culture and language Latino parents who participated in our study urge all Latino parents to continue teaching and speaking Spanish with their children Our data also indicates a need for Latinos to be more supportive of their fellow Latinos as they work towards their goals As one participant said I want to start my own business It is so nice when someone tells you Give it your all Go straight ahead and not hear No you should just stay where you are And it is beautiful when they tell you you give your all Latinos can create a better future for themselves and their families if they unite and work together Implications 46

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Latino Community Strengths and Needs Report Camino Research Institute LIMITATIONS Limitations 47

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Latino Community Strengths and Needs Report This study provided updated insight on the status of the Latinos residing in Mecklenburg County but it is not without limitations The survey and focus group sample are not fully representative of the Latino population in Mecklenburg County Most notably US born Latinos are underrepresented in this study making up only 12 of the survey sample though they make up approximately 51 of Latinos in Mecklenburg County 24 However this underrepresentation may be partially due to the fact that around 36 of Latinos living in Mecklenburg County are under the age of 18 and likely US born 24 77 making them ineligible for the survey Another possible explanation is that the website for the survey opens in Spanish first with the option to change the survey language to English While this design decision was made to help Spanish speaking immigrants feel more comfortable participating it may have deterred US born Latinos who are not well versed in Spanish Finally immigrants are likely oversampled because we heavily recruited through Camino s networks and Camino s primary demographic is Latino immigrants Nevertheless the data from this study is biased towards the immigrant population and experiences Though this is a methodology limitation we also see it as a strength given that Latino immigrants especially those who are undocumented are highly underresearched and perceived to be hard to reach by academic and governmental institutions 78 Another notable limitation is that the Latino male population of Mecklenburg County is underrepresented in this study both in survey data and focus groups Although Latino males comprise 50 of the Latino population in Mecklenburg County 46 only 23 of our survey sample is male Limitations Camino Research Institute The difficulty in recruiting Latino men in research has been noted in other studies and speculated to be caused by barriers related to work responsibility mistrust of research institutions and literacy issues 79 80 Though not representative of all men in Mecklenburg County the sample is fairly representative of those who access services at Camino and other organizations suggesting the need for additional research that targets Latino men who are not regularly accessing services allowing us to understand why It is also important to note that the use of an electronic survey designed to be completed independently by the participant may have excluded individuals who do not have access to technology internet or adequate literacy skills However focus groups provided an opportunity for immigrants to participate regardless of access to technology or literacy skills We chose to use an electronic survey to allow for a wider reach across the county and state and to reduce face to face contact during the COVID 19 pandemic Furthermore given the length of the survey the use of paper surveys would have been costly to administer and distribute to other organizations and partners who were helping us recruit participants Another potential limitation of this study was the use of a rapid research approach for the analysis of qualitative data from focus groups in order to ensure the timely reporting of study results To save time audio files were not transcribed Instead multiple bilingual researchers analyzed the focus group audio files and took notes on themes and notable quotes that provided more insight on survey results like the high need for dental and vision services 48

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Latino Community Strengths and Needs Report However such rapid research methods may not produce the same kind of results that extended engagement with focus group data can yield In the future we plan to transcribe the audio files and conduct a more complete analysis of focus group data to better understand the lived experiences of Latino immigrants in Mecklenburg County Other limitations include the fact that the survey was revised after two months of data collection Although this was done to ease participant burden those who took the longer version may have answered questions differently than they would have if it were shorter As participants progress through the survey they are likely to get tired and spend less time reading and responding to questions Questions that were not included in the revised version were omitted from the analysis Ultimately we believe making revisions to the survey is part of the CBPR process and shows our commitment to accepting and acting upon feedback from community and CAB members Limitations Camino Research Institute The survey was comprehensive and asked questions related to all of the social determinants of health but the lack of some questions may be a limitation Although we included questions about preventive healthcare screenings we did not ask questions about lifestyle behaviors that help prevent chronic disease and illness like physical activity diet and tobacco alcohol or other drug use We also did not ask questions that would allow us to determine the prevalence of chronic diseases like diabetes hypertension and cardiovascular disease Doing so would allow us to better understand the specific health conditions faced by Latinos However our goal was to ask a few questions about each topic area rather than going in depth about any one specific area We were concerned about the length of the survey and had to prioritize which questions to ask we chose to prioritize those questions that are not already asked on another survey Questions related to lifestyle behaviors and chronic conditions are included on the BRFSS For the most part the study results are not generalizable to all Latinos across NC or the US Mecklenburg County is mostly urban and is one of the most populous counties in NC The experiences of Latinos living in urban areas are likely to be different from Latinos living in more rural areas of the state Nevertheless the aim of CBPR is not to generate generalizable results but rather to better understand particular local issues and empower communities to think of appropriate ways to resolve them 81 Ultimately we do want to understand the local issues faced by Latinos across NC which is why we are still collecting data in all other counties 49

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Latino Community Strengths and Needs Report Limitations Camino Research Institute 50

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Latino Community Strengths and Needs Report Camino Research Institute CONCLUSION Conclusion 51

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Latino Community Strengths and Needs Report The Latino population in Mecklenburg County has grown exponentially over the last decade The population is diverse and has many strengths Latinos are hard workers entrepreneurs and family oriented Many Latinos are bilingual and enjoy serving their community through their faith Despite many strengths they continue to have unmet needs that contribute to disparities Health services are the biggest need and point to the need for affordable dental vision and other preventive health services in Spanish Other needs include access to better employment opportunities information on applying and paying for higher education financial security assistance and the ability for undocumented immigrants to obtain driver s licenses Conclusion Camino Research Institute Leveraging existing networks of trust and resources within Latino communities is an effective way to develop and implement services targeted at Latinos Although there are many organizations like Camino who offer free or low cost services for Latinos and other minority groups they are often limited by resource and funding constraints The mission of the North Carolina Department of Health and Human Services NCDHHS is to ensure the health and wellbeing of all North Carolinians especially the most vulnerable We urge NCDHHS and other funders to consider allocating more resources towards these efforts specifically for vulnerable Latinos 52

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Overall our data shows that Latinos want to be educated work and be healthy but are hindered by systemic inequities To create environments that allow Latinos to thrive we must make changes We urge policy makers and elected officials to consider the data from this study when creating or making adjustments to specific policies or laws that impact all communities including Latinos We also urge Latino community members and leaders to utilize this data to guide collaborative efforts to resolve issues affecting the Latino communities of Mecklenburg County Ultimately we hope this data helps inform the linguistically and culturally competent services Latinos need and deserve to live healthy hopeful and productive lives

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Latino Community Strengths and Needs Report Camino Research Institute REFERENCES NUMBERED LIST 1 Tippett R 2021 North Carolina s Hispanic community 2021 snapshot The University of North Carolina at Chapel Hill Carolina Demography https www ncdemography org 2021 10 18 north carolinas hi spanic community 2021 snapshot 9 Krogstad J M amp Gonzalez Barrera 2015 A majority of English speaking Hispanics in the US are bilingual Pew Research Center https www pewresearch org fact tank 2015 03 24 a majority of english speaking hispanics in the u s are bilingual 2 Jones N Marks R Ramirez R amp R os Vargas M 2021 2020 Census illuminates racial and ethnic composition of the country The United States Census Bureau https www census gov library stories 2021 08 improved race ethnicity measures reveal united states population much moremultiracial html text The 20Hispanic 20or 20Latino 2 0population origin 20grew 204 3 25 20since 202010 10 New American Economy Research Fund 2021 The economic contributions of Hispanic Americans https research newamericaneconomy org report hispanicspending power 2021 3 Noe Bustamante L Lopez M H Krogstad J M 2020 U S Hispanic population surpassed 60 million in 2019 but growth has slowed Pew Research Center https www pewresearch org fact tank 2020 07 07 u s hispan ic population surpassed 60 million in 2019 but growth has slo wed text Latinos 20accounted 20for 20about 20half changed 20over 20t he 20past 20decade 4 Krogstad J M amp Noe Bustamante L 2021 Facts about US Latinos for national Hispanic heritage month Pew Research Center https www pewresearch org fact tank 2021 09 09 key factsabout u s latinos for national hispanic heritage month 5 United States Census Bureau USCB 2019 2018 American community survey single year 6 Patten E 2016 The nation s Latino population is defined by its youth Pew Research Center https www pewresearch org hispanic 2016 04 20 the nations latino population is defined by its youth 7 Schaeffer K 2019 The most common age among whites in U S is 58 more than double that of racial and ethnic minorities Policy Commons https policycommons net artifacts 616675 the most common age among whites in us 1597362 8 United States Census Bureau USCB 2018 Hispanic population to reach 111 million by 2060 Infographic https www census gov library visualizations 2018 comm hisp anic projected pop html References 11 New American Economy Research Fund 2020 Power of the purse The contributions of Hispanic Americans https research newamericaneconomy org report hispanic am ericans 2019 12 Dubina K 2021 Hispanics in the labor force 5 facts The United States Department of Labor Blog https blog dol gov 2021 09 15 hispanics in the labor force5 facts text 29 20million reach 2035 9 20million 20i n 202030 13 U S Bureau of Labor Statistics 2020a Labor force characteristics by race and ethnicity 2020 BLS Reports https www bls gov opub reports race and ethnicity 2020 ho me htm 14 Womanable 2016 The 2016 state of women owned businesses report Commissioned by American Express OPEN A summary of important trends 2007 2016 1 10 http bondstreet com content userfiles 2016_State_of_Women Owned_Businesses_Executive_Report pdf 15 Stanford Graduate School of Business 2020 2020 Research report State of Latino entrepreneurship Latino Entrepreneurship initiative https www gsb stanford edu sites default files publication pdf report 2020 state of latino entrepreneurship pdf 16 Treisman R 2021 Key facts about the US Latino population to kick off Hispanic heritage 17 National Center for Education Statistics 2021 Research roundup NCES celebrates Hispanic heritage month NCES Blog https nces ed gov blogs nces post research roundup nces ce lebrates hispanic heritage month 55

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Latino Community Strengths and Needs Report 18 Krogstad J M 2020 Hispanics have accounted for more han half the US population growth since 2010 Pew Research Center https www pewresearch org fact tank 2020 07 10 hispanicshave accounted for more than half of total u s population gro wth since 2010 19 NALEO Educational Fund 2022 Report North Carolina s Latino population has grown nearly 40 percent over last decade 1 3 https naleo org wp content uploads 2022 01 1_18_2022__NEF_Release_ _NC_Profile_Release_ _Final pdf 20 Rosenthal J 2021 Hispanic heritage month 2021 North Carolina Department of Commerce https www nccommerce com blog 2021 10 12 hispanic heri tage month 2021 21 U S Bureau of Labor Statistics 2020b 2020 Annual averages household dara tables for employment and earnings https www bls gov cps cps_aa2020 htm 22 U S Department of Health and Human Services Office of Minority Health 2021 Profile Hispanic Latino Americans https minorityhealth hhs gov omh browse aspx lvl 3 amp lv lid 64 text Health 3A 20According 20to 20Census 20Bureau and 2078 4 20years 20for 20men 23 One Charlotte Health Alliance 2021 Summary data for state North Carolina 2022 Demographics https www oneclthealth org demographicdata 24 American Community Survey 2019 Educational attainment in North Carolina Federal Reserve Bank of Richmond https www richmondfed org media RichmondFedOrg resear ch regional_economy reports special_reports pdf educational_ attainment_nc pdf 25 Centers for Disease Control and Prevention CDC 2022a Childhood obesity facts Prevalence of childhood obesity in the United States Overweight and Obesity https www cdc gov obesity data childhood html 26 Dominguez K Penman Aguilar A Chang M H Moonesinghe R Castellanos T Rodriguez Lainz A Schieber R 2015 Vital signs leading causes of death prevalence of diseases and risk factors and use of health services among Hispanics in the United States 2009 2013 Morbidity and Mortality Weekly Report 64 17 469 References Camino Research Institute 27 Centers for Disease Control and Prevention CDC 2015 Vital signs Hispanic health https www cdc gov vitalsigns hispanic health index html 28 Substance Abuse And Mental Health Services Administration SAMHSA 2019 2019 National survey on drug use and health Hispanics US Department of Health and Human Services https www samhsa gov data sites default files reports rpt31101 2019NSDUH Hispanic Hispanic 202019 20NSDUH pdf 29 Substance Abuse And Mental Health Services Administration SAMHSA 2022 2020 NSDUH detailed tables U S Department of Health and Human Services SAMHSA National Survey on Drug Use and Health https www samhsa gov data report 2020 nsduh detailed tables 30 National Alliance on Mental Illness 2022 Hispanic Latinx https www nami org Your Journey Identity and Cultural Dimensi ons Hispanic Latinx 31 Gould E Perez D Wilson V 2020 Latinx workers particularly women face devastating job losses in the COVID 19 recession Economic Policy Institute https www epi org publication latinx workers covid 32 Centers for Disease Control and Prevention CDC 2022b Risk for COVID 19 infection hospitalization and death by race ethnicity COVID 19 https www cdc gov coronavirus 2019 ncov covid data investig ations discovery hospitalization death by race ethnicity html 33 Revens K E Caro L 2021 The Impact of COVID 19 on Latino Communities in the Greater 34 North Carolina Institute Of Medicine 2003 NC Latino health 2003 A report from the Latino Health Task Force North Carolina Institute of Medicine in collaboration with El Pueblo Inc i 134 https nciom org wp content uploads 2017 08 Latinofullreport pdf 35 Gill H amp White J 2016 Hispanic community needs assessment for El V nculo Hispanio The Hispanic liaison The Latino migration project University of North Carolina at Chapel Hill https migration unc edu wp content uploads sites 2 2019 10 Summary Report English Hispanic Community Assessment for EV H pdf 36 The UNC Charlotte Urban Institute 2006 Mecklenburg County Latino community needs assessment i 73 https ui charlotte edu story mecklenburg county latinocommunity needs assessment 56

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Latino Community Strengths and Needs Report 37 Wallerstein N Duran B Oetzel J G amp Minkler M Eds 2017 Community based participatory research for health Advancing social and health equity John Wiley Sons 38 Revens K E Gutierrez D Paul R Reynolds A D Price R DeHaven M J 2021 Social support and religiosity as contributing factors to resilience and mental wellbeing in Latino immigrants A community based participatory research study Journal of Immigrant and Minority Health 23 5 904 916 https doi org 10 1007 s10903 021 01179 7 39 Rios Casas F Ryan D Perez G Maurer S Tran A N Rao D Ornelas I J 2020 Se vale llorar y se vale re r Latina immigrants coping strategies for maintaining mental health in the face of immigration related stressors Journal of Racial and Ethnic Health Disparities 7 5 937 948 https doi org 10 1007 s40615 020 00717 7 40 Curtin A Martins D C amp Schwartz Barcott D 2019 Coping with mental health issues among older Hispanic adults Geriatric nursing 40 2 123 128 https doi org 10 1016 j gerinurse 2018 07 003 41 Evans S Levy J Miller Gonzalez J VInes M Gir n A S Walejko G Bates N Garcia Trejo Y 2019 2020 Census barriers attitudes and motivators study CBAMS focus group final report United States Census Bureau https www2 census gov programs surveys decennial 2020 pr ogram management final analysis reports 2020 report cbamsfocus group pdf 42 Camino Church n d Camino church Homepage https www caminochurch com 43 Camino Health Center n d Camino Clinic https caminohealthcenter com clinic Camino Research Institute 48 Salimi Y Shahandeh K Malekafzali H Loori N Kheiltash A Jamshidi E Frouzan A S amp Majdzadeh R 2012 Is community based participatory research CBPR useful A systematic review on papers in a decade Int J Prev Med 3 6 386 93 49 Fuger K L 2014 2013 Greater Kansas City Hispanic needs assessment UMKC Institute for Human Development I C 17 https www mattierhodes org wp content uploads 2014 11 Hisp anic Needs Assessment 2013 2014_Optimized pdf 50 El Centro de la Raza 2017 2017 Community needs assessment Community based participatory research 1 18 https www elcentrodelaraza org wp content uploads 2020 02 2017 Community Needs Assessment FINAL pdf 51 Corona R Gonzalez T Cohen Robert Edwards C Edmonds T 2009 Richmond Latino needs assessment A community university partnership to identify health concerns and service needs for Latino youth Journal of Community Health 34 3 195 201 http doi org 10 1007 s10900 008 9140 6 52 Ojeda L Flores L Y Meza R R Morales A 2011 Culturally competent qualitative research with Latino immigrants Hispanic Journal of Behavioral Sciences 33 2 184 203 http doi org 10 1177 0739986311402626 53 Fugard A amp Potts H 2015 Supporting thinking on sample sizes for thematic analyses A quantitative tool International Journal of Social Research Methodology https doi org 10 1080 13645579 2015 1005453 54 Guest G Namey E McKenna K 2017 How many focus groups are enough Building an evidence base for nonprobability sample sizes Field Methods 29 1 3 22 http doi org 10 1177 1525822X16639015 44 Camino Arriba n d Camino Arriba https arriba org 45 Camino Research Institute CRI n d Survey Camino Health Center https caminohealthcenter com survey 46 United States Census Bureau USCB 2020a Quick facts Mecklenburg county North Carolina https www census gov quickfacts fact table mecklenburgcoun tynorthcarolina POP010220 47 Scarinci I C Garces Palacio I C amp Partridge E E 2007 An examination of acceptability of HPV vaccination among African American women and Latina immigrants Journal of Women s Health 16 8 1224 1233 https doi org 10 1089 jwh 2006 0175 References 55 Galvin R 2015 How many interviews are enough Do qualitative interviews in building energy consumption research produce reliable knowledge Journal of Building Engineering 1 1 12 https doi org 10 1016 j jobe 2014 12 001 56 Beebe J 1995 Basic concepts and techniques of rapid appraisal Human organization 54 1 42 51 https doi org 10 17730 humo 54 1 k84tv883mr2756l3 57 Harris K J Jerome N W amp Fawcett S B 1997 Rapid assessment procedures a review and critique Human Organization 56 3 375 378 58 Johnson G A Vindrola Padros C 2017 Rapid qualitative research methods during complex health emergencies a systematic review of the literature Social Science Medicine 189 63 75 https doi org 10 1016 j socscimed 2017 07 029 57

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Latino Community Strengths and Needs Report Camino Research Institute 59 Valdivieso Mora E Peet C L Garnier Villarreal M Salazar Villanea M Johnson D K 2016 A systematic review of the relationship between familism and mental health outcomes in Latino population Frontiers in psychology 7 1632 https doi org 10 3389 fpsyg 2016 01632 69 Mecklenburg County Government 2022 2019 2021 Local Mecklenburg Behavioral Risk Factor Surveillance Survey BRFSS 60 Patr n O E 2021 Precarious familismo among Latinas os xs Toward a critical theoretical framework centering queer communities Journal of Social and Personal Relationships 38 3 1085 1102 https doi org 10 1177 0265407520971049 71 Data USA 2019 Mecklenburg County North Carolina 61 Sabogal F Mar n G Otero Sabogal R Mar n B V Perez Stable E J 1987 Hispanic familism and acculturation What changes and what doesn t Hispanic journal of behavioral sciences 9 4 397 412 https doi org 10 1177 07399863870094003 62 United States Census Bureau USCB 2020b American community survey 2015 2019 5 year data release https www census gov newsroom press kits 2020 acs 5year html 63 Khattar R Roque L Vela J 2022 Latino workers continue to experience a shortage of good jobs The Center for American Progress https www americanprogress org article latino workers continu e to experience a shortage of good jobs 64 Centers for Disease Control and Prevention CDC 2022c Oral health conditions https www cdc gov oralhealth conditions index html text Poor 20oral 20health 20is 20associated consuming 20sug ary 20foods 20and 20beverages 65 Centers for Disease Control and Prevention CDC 2020a Keep an eye on your vision health Vision health initiative https www cdc gov visionhealth resources features keep eye o n vision health html 66 Centers for Disease Control and Prevention CDC 2020b Behavioral risk factor surveillance system https www cdc gov brfss index html 67 Centers for Disease Control and Prevention CDC 2020c Health of Hispanic or Latino population National Center for Health Statistics https www cdc gov nchs fastats hispanic health htm 68 Mecklenburg County Government 2019 2019 Community health assessment https schs dph ncdhhs gov units ldas cha2019 Mecklenburg 20CHA 202019 pdf References 70 United States Census Bureau USCB 2021 Quick facts Mecklenburg county North Carolina 72 Early J O Burke Winkelmann S amp Joshi A 2016 On the front lines of prevention Promotores de Salud and their role in improving primary care for Latina women families and communities Global Journal of Health Education and Promotion 17 2 58 86 http dx doi org 10 18666 GJHEP 2016 V17 I2 7130 73 Krogstad J M amp Lopez M H 2017 Use of Spanish declines among Latinos in major US metros Pew Research Center https www pewresearch org fact tank 2017 10 31 use of spanish declines a mong latinos in major u s metros 74 Lutz A 2008 Negotiating home language Spanish maintenance and loss in Latino families Latino a Research Review 6 37 64 https surface syr edu cgi viewcontent cgi article 1001 amp context soc 75 Lopez M H Krogstad J M amp Flores A 2018 Most Hispanic parents speak Spanish to their children but this is less the case in later immigrant generations Pew Research Center https www pewresearch org fact tank 2018 04 02 most hispanic parents spe ak spanish to their children but this is less the case in later immigrant generati ons 76 Pew Research Center 2004 Assimilation and language 77 McShane C 2020 Charlotte region s Hispanic population grows at a rapid pace UNC Charlotte Urban Institute https ui charlotte edu story charlotte regions hispanicpopulation grows rapid pace 78 Marin G amp Marin B V 1991 Research with Hispanic populations Sage Publications Inc https psycnet apa org record 1991 97676 000 79 Torres V N Williams E C Ceballos R M Donovan D M Duran B Ornelas I J 2020 Participant engagement in a community based participatory research study to reduce alcohol use among Latino immigrant men Health Education Research 35 6 627 636 https doi org 10 1093 her cyaa039 80 Shedlin M G Decena C U Mangadu T amp Martinez A 2011 Research participant recruitment in Hispanic communities Lessons learned Journal of Immigrant and Minority Health 13 2 352 360 http doi org10 1007 s10903 009 9292 1 81 Shore N 2007 Community based participatory research and the ethics review process Journal of Empirical Research on Human Research Ethics 2 1 31 41 http doi org 10 1525 JERHRE 2007 2 1 31 58

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Camino Research Institute Latino Community Strengths and Needs Report APPENDIX A 2019 2021 Local Mecklenburg Behavioral Risk Factor Surveillance System The Behavioral Risk Factor Surveillance System BRFSS is a state based system of health surveys that collects information on health risk behaviors preventive health practices and health care access primarily related to chronic diseasse and injury In 2014 the Mecklenburg County Health Department began collecting local data using questions from the CDC BRFSS survey to provide a more accurate picture of health behaviors in our community In the table below are 2019 2021 3 year estimates selected health indicators percentages by total population gender and race ethnicity among adults aged 18 and older in Mecklenburg County Selected Health Indicators for Hispanics Latinos in Mecklenburg County Local Mecklenburg BRFSS 2019 2021 Race Ethnicity Mecklenburg County White Black Hispanic Latino 13 6 11 7 16 4 9 6 66 35 60 37 76 34 69 33 31 20 23 13 42 27 36 40 Diabetes 10 8 14 8 Cardiovascular Disease High Blood Pressure 6 30 5 28 9 39 4 22 High Cholesterol 30 33 29 25 36 45 30 20 Mental Health Not Good 8 Days in the last 30 days 16 16 18 12 Depressive Disorder 20 22 19 13 Does not have Health Insurance 17 7 16 60 Does not have a Personal Doctor Could not See Doctor Because of Cost 23 14 18 9 20 15 49 30 Could not See Dentist Because of Cost 22 15 25 36 Behavioral Health Risks Smoking Current E Cig Use Some Days and Everyday Overweight Obesity Overweight Obesity No Physical Activity Chronic Conditions Immunizations Had Flu Vaccine Mental Health Health Care Access Appendix A 59

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Latino Community Strengths and Needs Report Camino Research Institute APPENDIX B How is Camino Helping Camino lives out our mission to Equip people to live healthy hopeful and productive lives through a plethora of services that were created specifically for Latino communities Camino s services help bridge gaps in healthcare food insecurity and economic and educational opportunities through Camino Health Center Arriba Camino Church Camino University Camino Health Center CHC provides holistic bilingual health services that are delivered by multicultural staff bridging language and culture gaps CHC also utilizes a low cost membership model to reduce barriers related to cost and insurance allowing us to serve uninsured and undocumented Latinos who may otherwise be left without medical care In fact 99 of those who utilize Camino s primary care services are Spanish speaking Latino immigrants who are uninsured CHC includes four primary service areas Camino Clinic Camino Vida the Food Farmacy and Camino Contigo Camino Clinic is the medical home to over 4 000 uninsured Latino immigrant patients and their families Camino Vida is a health and wellness program that assists patients of Camino Clinic in managing chronic conditions like high blood pressure type 2 diabetes and high cholesterol through lifestyle changes Camino Vida provides health education nutrition education and cooking demonstrations and the opportunity to engage in personal training sessions in a medically integrated wellness center The Food Farmacy provides free food assistance to families in need In 2021 the Food Farmacy served 9 342 people The Food Farmacy aids in reducing food insecurity with those who lack a disposable income by providing a reliable place for nutrition during difficult times Camino Contigo provides bilingual behavioral health services to adults and children These services include individual and group therapy social navigation and peer support Social navigators ensure we are providing a holistic approach to care and are instrumental in ensuring patients are connected to all the services they need both at Camino and externally for the services we do not currently provide Without CHC these services would be nearly impossible for our patients to access Arriba provides employment and education opportunities to Latino families to increase upward mobility Services include employment training and readiness programs connection to job opportunities educational classes English as a Second Language and Promotores de Salud and entrepreneurship education and training Arriba also helps prepare individuals for employment assisting with resume building mock interviews and dressing for interviews Additionally Arriba provides job fairs and workshops on various topics like recertifying credentials from other countries and basics on filing taxes and how to build credit Arriba was established in 2021 and has already served over 800 people Camino Church is a bilingual multicultural nondenominational church that equips everyone to live in the freedom that comes from an everyday relationship with God Although Camino Church and Camino s nonprofit operate separately all entities share a common location values and vision to help Latino communities Integration between and across all services helps expand our reach in the community and allows us to not only meet the physical mental and social needs of those we serve but the spiritual as well Camino Church provides a number of services including bible studies prayer groups and Circles Given the centrality of faith and church in the lives of most Latinos Camino Church is a crucial component of what we do All entities work together to engage in community outreach and provide many of our services in a mobile fashion allowing us to reach those who are unable to come to us Camino University provides theological training and practical experience to the Latino community through educational programs Camino University also provides continuing education activities to professionals to help improve social service and mental healthcare service delivery for immigrant and ethnic minority communities In addition Camino University provides training for community outreach ensuring all volunteers and faith leaders are equipped to meet holistic needs of Latino community members Camino University was established in 2022 and will begin program offerings in the fall of 2022 Appendix B 60

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Latino Community Strengths and Needs Report Camino Research Institute APPENDIX B All of Camino s services are informed by data collected by CRI We believe those we serve should have the opportunity to provide input and be involved in the process of developing and implementing programs and services All staff who assist with the development and delivery of services are representative of those we serve ensuring cultural competence and community relevance We also use CBPR to conduct research with Latino communities allowing us to directly ask them what they actually want and need in ways that are culturally sensitive We then use that data to inform the development and implementation of programs and services For example as a result of this data we are actively exploring the best approach to the addition of dental and vision services at Camino Clinic Additionally Arriba has secured partnerships with Central Piedmont Community College and the Ecuadorian American Chamber of Commerce of the Southeast of the US to provide additional ESL classes and entrepreneurship training respectively Camino is also in the planning phases of identifying specific neighborhoods throughout the state that would benefit from our services We plan to fully embed ourselves within neighborhoods going a step beyond providing mobile services by building trust and social support networks Each neighborhood would have a community navigator who serves a dual role as a social navigator and faith leader This individual will be the central point of contact for Latino families in that area ensuring their physical mental social and spiritual needs are being met To better serve areas outside of Mecklenburg County data collection on the Latino Community Strength and Needs Assessment will continue across the state and be used to inform Camino s community outreach efforts This data will also be shared with the organizations and churches who are already working in those areas and have the trust of the Latino communities living there Appendix B 61

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