N512 Module 6 assignment: Hispanic populations and Lost Boys of Sudan refugee health paper, a full sample

One Label, Many Communities; One Journey, Lasting Needs: Hispanic Health in California, Texas, and Florida and the Health of the Lost Boys of Sudan

Student Name

Master of Science in Nursing Program, Aspen University

N512: Diverse Populations & Health Care

Instructor Name

Month Day, Year

One Label, Many Communities; One Journey, Lasting Needs: Hispanic Health in California, Texas, and Florida and the Health of the Lost Boys of Sudan

Nurses often learn about populations through broad categories, but categories can hide the differences that matter most for care. This paper examines two groups. Part 1 describes Hispanic populations in the three states where they are largest, including health problems, socioeconomic factors, cultural diversity, and barriers to care. Part 2 examines the Lost Boys of Sudan, young refugees whose health needs reflect years of war, flight, and camp life, and considers cultural factors and nursing resources for their care.

Part 1: Hispanic Populations in California, Texas, and Florida

The Hispanic population of the United States reached 62.1 million in the 2020 Census, 18.7 percent of the nation, and accounted for slightly more than half of the country's population growth over the previous decade (Jones et al., 2021). California, Texas, and Florida together are home to about half of all U.S. Latinos (Funk & Lopez, 2022), and the differences among these three states show why a single label is not enough.

Cultural Diversity Within One Label

Nationally, people of Mexican origin make up about 61.5 percent of Hispanics, followed by Puerto Ricans at 9.7 percent, with large Cuban, Salvadoran, Dominican, Guatemalan, and Colombian communities (Funk & Lopez, 2022). In California and Texas, most Hispanic residents are of Mexican origin, many from families present for generations, alongside growing Central American communities, some of whom speak Indigenous languages rather than Spanish. Florida's Hispanic population is more varied, with large Cuban, Puerto Rican, Colombian, and Venezuelan communities. Puerto Ricans are U.S. citizens by birth, and many Cuban Americans arrived under different immigration policies than other groups, which shapes access to insurance and benefits.

These differences affect care. Language preferences, religious practices, food traditions, and experiences with health systems in countries of origin vary widely. A nurse who knows only that a patient is "Hispanic" knows very little about what that patient needs.

Health Problems

Hispanics experience a mix of advantages and disadvantages. Velasco-Mondragon et al. (2016) note that cancer is now the leading cause of death among Hispanics, followed by cardiovascular disease and unintentional injuries. Diabetes and obesity are more common than among non-Hispanic white adults, and chronic liver disease and cervical cancer are notable concerns. At the same time, Hispanics often have longer life expectancy than would be predicted from their socioeconomic status, a pattern called the Hispanic mortality paradox, along with better-than-expected birth outcomes. The authors warn that rising obesity and diabetes may erode these advantages.

Health patterns differ by state and group. In the border regions of Texas and California, high rates of diabetes and obesity are major concerns, and in agricultural areas occupational injuries and heat illness affect farmworkers. In Florida, Puerto Rican residents have higher rates of asthma than other Hispanic groups, and older Cuban Americans carry a heavy burden of cardiovascular disease.

Socioeconomic Factors and Barriers

Socioeconomic factors shape health outcomes. Many Hispanic workers are employed in jobs without employer-sponsored insurance, such as agriculture, construction, and service work. Although the Affordable Care Act improved access, being uninsured or underinsured remains a major barrier (Velasco-Mondragon et al., 2016). Texas and Florida did not expand Medicaid, leaving many low-income adults without coverage, while California's expansion and state-funded programs have reached more residents, including some who are undocumented.

Other barriers include limited English proficiency for some, low health literacy, a shortage of Hispanic health care providers, limited cultural sensitivity among clinicians, and fear of immigration consequences in mixed-status families (Velasco-Mondragon et al., 2016). These barriers overlap, so a family may face cost, language, and fear at the same time.

Part 2: The Lost Boys of Sudan

During the second Sudanese civil war, which began in 1983, thousands of boys from southern Sudan, most of them Dinka and Nuer, were separated from their families when their villages were attacked. They walked hundreds of miles to refugee camps in Ethiopia and later to the Kakuma camp in Kenya, facing hunger, disease, and violence along the way. Around 2000 and 2001, several thousand were resettled in the United States, many through the Unaccompanied Refugee Minors Program. They became known as the Lost Boys of Sudan.

Communicable Diseases

Years in refugee camps with crowding, poor sanitation, and limited health care placed the Lost Boys at risk for communicable diseases. Tuberculosis, including latent infection, is a major concern for refugees from East Africa and requires screening and treatment after arrival. Intestinal parasites, including schistosomiasis and hookworm, are common, and malaria and hepatitis B were endemic in the regions where they lived. Screening for these infections, vaccination, and treatment of latent tuberculosis are standard parts of refugee health assessments in the United States. Nurses play a central role in completing screening and ensuring that treatment for latent tuberculosis, which lasts months, is finished.

Non-Communicable Diseases and Mental Health

Chronic malnutrition during childhood can cause short stature, anemia, and dental problems, and many refugees resettled from Africa later face rising rates of hypertension and diabetes as diets and activity change. Mental health is often the most significant long-term concern. In a study of 304 Sudanese minors about a year after resettlement, 20 percent had a diagnosis of post-traumatic stress disorder; those with PTSD had worse functional and behavioral health, and social isolation and a history of personal injury were associated with the diagnosis (Geltman et al., 2005). The same study found that the minors generally functioned well in school and in their activities, a sign of considerable resilience, but that emotional problems appeared in their home lives. A systematic review of refugees resettled in Western countries estimated that 9 percent of adults had PTSD, roughly ten times the rate in the general population (Fazel et al., 2005).

Cultural Considerations

Culturally, the Lost Boys come from societies in which identity is rooted in family, clan, and cattle-based livelihoods, and in which elders hold authority. Many became Christians in the camps. Separated from their families as children, many formed strong bonds with one another, and these peer relationships function as family. Mental health problems may be expressed through physical complaints or described in spiritual terms, and the stigma attached to mental illness can discourage seeking help. Nurses should ask about their understanding of illness, involve trusted peers or community leaders if the patient wishes, and use professional interpreters in Dinka or Nuer when needed, since English proficiency varies.

Nursing Resources

Nurses can connect Lost Boys and other refugees with resettlement agencies, which provide case management, employment help, and orientation. Community health centers and refugee clinics offer screening and primary care, often with interpreters. Mental health services that use trauma-informed care, and community organizations formed by South Sudanese Americans, provide culturally appropriate support. Social isolation was linked to PTSD in the Lost Boys study (Geltman et al., 2005), so connecting individuals with community networks may be as important as clinical treatment. Nurses can also help refugees understand how to navigate insurance and follow-up care. Many of the Lost Boys are now adults in their thirties and forties with families of their own, so primary care nurses may meet them for hypertension or diabetes rather than for refugee screening, and asking about their history remains relevant decades after arrival.

Conclusion

Hispanic populations in California, Texas, and Florida share a label but differ in origin, legal status, insurance access, and health patterns, so nurses must look beyond the category to the individual. The Lost Boys of Sudan carried the effects of war and camp life into their new lives, including infections that required screening, the long-term effects of malnutrition, and trauma that appeared years later in their homes. In both parts, culturally competent nursing depends on specific knowledge, careful assessment, and connections to community resources.

References

Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309-1314. https://doi.org/10.1016/S0140-6736(05)61027-6

Funk, C., & Lopez, M. H. (2022, June 14). A brief statistical portrait of U.S. Hispanics. Pew Research Center. https://www.pewresearch.org/science/2022/06/14/a-brief-statistical-portrait-of-u-s-hispanics/

Geltman, P. L., Grant-Knight, W., Mehta, S. D., Lloyd-Travaglini, C., Lustig, S., Landgraf, J. M., & Wise, P. H. (2005). The "lost boys of Sudan": Functional and behavioral health of unaccompanied refugee minors re-settled in the United States. Archives of Pediatrics & Adolescent Medicine, 159(6), 585-591. https://doi.org/10.1001/archpedi.159.6.585

Jones, N., Marks, R., Ramirez, R., & Ríos-Vargas, M. (2021, August 12). 2020 Census illuminates racial and ethnic composition of the country. U.S. Census Bureau. https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html

Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. A. (2016). Hispanic health in the USA: A scoping review of the literature. Public Health Reviews, 37, Article 31. https://doi.org/10.1186/s40985-016-0043-2