Hispanics and Diabetes

April 20, 2006

Transcript:

José Cardenas:
Good evening. I'm José Cardenas. Welcome to Horizonte. Illegal immigration continues to be one of the country's top issues. What does it take for people to become a legal United States immigrant? A look at the process needed to come here legally. And it's a disease that effects more than 20 million people in the United States, and its cause continues to be a mystery. We'll talk about diabetes research and programs, plus how to manage the disease. More on all this, next, on Horizonte.

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José Cardenas:
Diabetes among Hispanics is a serious health challenge because of the increased prevalence of diabetes in this population. According to the American diabetes association, Mexican Americans, the largest Hispanic-Latino subgroup, are 1.7 times as likely to have diabetes as non-Hispanics. With us tonight to talk about this disease is Cecilia Chapman, president of About Lifestyle Ink, and a registered dietitian, certified diabetes educator and a Lifestyle counselor. Also here is Maria Portela, epidemiological study director for the Translational Genomics Research Institute. Cecilia, Maria, thank you both for joining us on Horizonte. Cecilia, you have a lot of titles, all of them have something to do with diabetes and other diseases that effect the Hispanic population. Tell us a little bit more about your background.

Cecilia Chapman:
I'm a diabetes educator. I just became a diabetes educator last year. I was very interested in becoming an expert in this area because I am seeing it so much in the population that I serve here, the Hispanic population, especially the Mexican American population.

José Cardenas:
And you serve that population principally through- you have a contract, as I understand it, with Saint Vincent De Paul?

Cecilia Chapman:
Right. I work with a free medical clinic and I coordinate with another person, Yolanda. We're both coordinators of the diabetes program there and we also do the prevention for the people that are pre-diabetic. And we're actually starting a new program with the kids, the children that are very high risk of developing diabetes at a very young age.

José Cardenas:
Now, in the introduction we talked about the fact that Hispanics are 1.7 times more likely, certainly at least the Mexican American Hispanic population, than others to develop diabetes. What else can you tell us about diabetes and how it affects that subgroup?

Cecilia Chapman:
Well, diabetes is devastating for the population, for anybody that has diabetes. But in this population it's very difficult because there are many barriers to getting management for the disease. Right now at the clinic we see patients that are the working poor. They might be working two or three jobs at once but they don't have enough money to buy insurance. And their company does not provide any insurance. So they're looking around to find out what kind of services there are out there. And there's not many.

José Cardenas:
Now, what are we seeing by way of transition-- certainly been a lot of discussion in the newspapers, the magazines about obesity becoming a bigger problem and that's related to diabetes. Is the incidence of diabetes increasing as well?

Cecilia Chapman:
Oh you bet. Diabetes and obesity are very closely linked together. One of the interesting things that we also see with the new immigrants coming into the United States especially from Mexico is that within the first year that they come in they tend to gain about 30 pounds, which is amazing. And it's the lifestyle that is being changed. They're not walking as much. They're not exercising as much. And now they're eating differently than what they were eating in their home country.

José Cardenas:
Well, Maria, you're here with TGEN, Translational Genomics Research Institute. Does the point that Cecilia just made…does this suggest this is not a genetics problem or gene related or what do we have going on here?

Maria Portela:
There are certainly many studies that are trying to look and figure out the genetic basis, if there is any, of diabetes. And although our relationship most certainly be present due to the fact that Hispanics and African-Americans suffer disproportionably higher rates of diabetes than all the populations, the relationship is not understood yet. However, the environmental basis of diabetes is definitely very important. This can be accounted by the fact that a hundred years ago, the prevalence of diabetes was virtually inexistent. Nowadays the occurrence of diabetes is skyrocketing, specifically among the Hispanic community. We have seen the prevalence among Hispanics is almost three times as higher than the prevalence nationwide.

José Cardenas:
And when we say Type 2 diabetes, what are we referring to?

Maria Portela:
We're referring to the high blood glucose levels that are associated with a later onset of the disease.

José Cardenas:
Tell us about the TGEN study that's been going on for a while. Give us a little bit of background and tell us where it is right now.

Maria Portela:
This is actually the second year that we've been involved with Avondale. During the first year we conducted a baseline epidemiological study. And this was basically a detailed survey that included all sorts of questions about health behaviors, health histories, family histories and just specific dietary habits, physical activity. This survey shed a lot of light into many things that were thought of maybe before but now we have validated. For example, people are not engaging in physical activity as much as they should. They're not eating many fruits and vegetables. The appearance of diabetes is outstandingly high among this population. There's a lot of high blood cholesterol levels, there's a lot of hypertension and there's a lot of people that have hypertension or high blood pressure, have diabetes but don't know it. And these are the scariest things that we have.

José Cardenas:
Have you seen the same thing that Cecilia was talking about, which is that recent immigrants who, despite perhaps the poverty that has compelled them to come to the United States actually had a healthier lifestyle there than they are here in the United States?

Maria Portela:
Our survey could not really tap into those specific questions. But what we have seen, though, is that over 76% of our participants are foreign-born. And they are not engaging in enough physical activity, or at least not enough because over 80% of them are overweight or obese, which is certainly a higher incidence than the one that you find in Mexico city.

José Cardenas:
Now, why the focus on Avondale?

Maria Portela:
Well, we chose Avondale because of several things. Number one, this is basically epidemiological study and Avondale is a manageable size. They have a very interesting demographics. 50% of Avondale is Hispanic according to the Arizona Department of Health Services, community profile, and Avondale had already implemented an interesting program called "The healthy Avondale program" and the healthy people 2010 program, which tends to basically promote healthier lifestyles and decrease the incidence of chronic diseases in populations. So instead of just getting information from people we actually wanted to have the opportunity to provide some free services and to refer people for free programs. Free education classes, free fitness classes, health services, refer them to physicians or healthcare providers so that in case they actually do want to acquire a new, healthier lifestyle they have the opportunity to do so.

José Cardenas:
And I think this ties into a point you made before we went on the air, Cecilia, which is that this is a very preventable disease.

Cecilia Chapman:
Yes, it is. One of the reasons I say that is because if you take into consideration the way your selections and the meals you make and selections of the drinks you drink and also include some activity into your life, this can prevent you to gain all this extra weight and stay healthier in your life. And simple things like eating healthier.

José Cardenas:
And how are you communicating that? What is Saint Vincent's doing? I know you have some other partners we want to talk about in a moment. But what are you doing to alert people to these possibilities?

Cecilia Chapman:
One of the interesting things that happened at Saint Vincent is that we started about 5 years ago doing a diabetes program. Because they have several patients, coming in and they were being treated by medical doctors, giving them medications. But about 50% of these patients were getting better. The director, Janice hurdle, knew that they needed more than just medication. They needed more than medication. They needed an education program. And this is where I came into-- myself and Yolanda, came in and developed a program to educate how to take care of their diabetes. The meals that they needed to be making and eating, the exercise they needed to include in their life, how to take medication, how to monitor their blood sugar with a monitor that needs to be checked every day. Things like that. There were a series of eight classes. But in the meantime we were also seeing patients that were very prone to getting diabetes. In other words, pre-diabetics. The doctor there, medical doctor Oral Baker who just retired recently, really noticed this and said these patients that are coming in with pre-diabetes will be back. And we need to do something. It is our moral obligation to do something with these patients. And we feel very passionate about doing this. So we started another program called the "every little step counts." This program-- and we weren't even sure if anybody would come because they weren't going to get a diagnosis of diabetes. They were about to get it and we didn't know when. A year, ten years from now.

José Cardenas:
It's a little harder to convince people to do something.

Cecilia Chapman:
Yes, because you don't have it. Are they really going to have it? So we actually did a pilot study and found out that when they started coming to the classes and they agreed, because they are very interested in having a healthy life, even though they could not see themselves as being, you know, unhealthy at the time?

José Cardenas:
They were responsive.

Cecilia Chapman:
They were responsive. They wanted to learn.

José Cardenas:
And you've got something else coming up, both of you do, in the next few days. And we've got about a minute and a half left. An expo involving a couple of your other partners?

Cecilia Chapman:
Yeah, a diabetes expo. This is going to be Saturday the 22nd. It starts at 8:30 to 3:00. And I'm going to be at the booth, a freestyle meter booth with a glucerna shakes and bars. And I want everybody to come--

José Cardenas:
And the meter is a monitoring device?

Cecilia Chapman:
Yes, I'm monitoring to check your blood sugar, which is very important to control your blood sugar. And they can come and do demonstrations. We're also going to give samples of the glucerna shakes and bars and we're also going to do some workshops. I'm going to be in charge of giving some presentations on diabetes and how to control it.

José Cardenas:
Where does this all take place?

Cecilia Chapman:
This is going to be at the diabetes expo at the Phoenix Convention Center downtown.

José Cardenas:
And then Maria, you have something coming up, healthy Avondale. Tell us about that.

Maria Portela:
This upcoming Friday the healthy Avondale symposium. This Friday it's going to take place at the Avondale city hall. There'll be several experts giving talks about how you can make small changes in your life, in your daily life, in order to live healthier. And participants, the reservation is free and they'll get all sorts of literature and things to jump-start a healthy life.

José Cardenas:
Well we wish you both good luck on both of these events and we thank you very much for joining us on Horizonte.

Maria Portela:
Thank you for having us.

Cecilia Chapman:
Thank you for having us.

José Cardenas:
Again the Phoenix diabetes expo will be this Saturday, April 22 from 8:30 to 3 in the afternoon at the Phoenix Civic Plaza. Immigration. Lately there has been a lot of attention focused on illegal immigration. But did you know there are approximately 1 million new legal immigrants to the United States each year? People may wonder why undocumented immigrants don't use the legal process to come here. As Larry Lemmons tells us, it can take a long time to become an American citizen regardless of where you are from.

Diane Brennan:
The White House is not disputing the disclosure that president Bush gave the go ahead to a leak of prewar Iraq intelligence.

Larry Lemmons:
Diane Brennan anchors the news at KTAR. She's worked at the station for nearly four years. She's also categorized as a permanent resident. A Canadian at birth, she has a green card now and wants to become an American citizen.

Diane Brennan:
My green card is good for 12 years. But I would. I would like to become a citizen here. I love the country. I'd like to vote and would like to do a few other things. I want to apply in amazing race and you actually have to be a citizen to do. So I'm like, I'm there.

Larry Lemmons:
All kidding aside, the subject of citizenship has been no joke to Brennan.

Diane Brennan:
The experience was definitely a nightmare. From what I was told what would happen in the process was completely different than what I actually had to do. At the time-- I've been in the states for nine years. For example, there was a lot of miscommunication. I'd speak with one person at immigration they'd say file this form. I would speak with another one and they would say, no, that was wrong. I don't know who told you that. Fill out this form. My documents were lost. I.N.S. had lost them so I had to reapply and pay the fine again. My green card they actually sent to the wrong address and I had to wait a year until a certain date to be able to contact them and say, what happened to my green card. So I had to wait a year. And the whole time it was lost. I wasn't allowed to call earlier to find out. I had to wait a whole year. Then I had to reapply again and pay the other forms even though I sent them the address change. So it was very frustrating.

Larry Lemmons:
The most common misconception we may have about legal immigration is that it's a relatively easy and quick process. We think about the images of the immigrants on Ellis Island, the immigration process was much easier back then. Not so much today.

Jeanne Kent:
Okay.
Well, let's try and do it the easy way. First thing someone has to do is immigrate to the United States as a lawful, permanent resident. And generally there are two ways to do that: either through a family-based petition or employment-based petition. And obviously a family-based petition means someone that's already here in the United States either as a lawful permanent resident themselves or U.S. citizens can file a petition to immigrate that person to the United States. And with the employer petition, a similar process in that an employer files a petition looking for someone that has a special work skill that's needed and maybe there aren't enough Americans that have that skill and they'll immigrate the person. Once the person gets here to the United States, generally they have to be a permanent resident and be here for five years before they can qualify to file for citizenship. There are certain exceptions for military personnel and for spouses of U.S. citizens. They only have to wait three years. So once they are ready, they have put their time in, then they can file an application for citizenship or naturalization, we call it. And to do that, they fill out an application. They can submit it to their service center. They go through fingerprinting and security checks. They come to the office for an interview that covers the items that are in their application. They also have to take an English and civics test. And assuming everything goes well with that and they pass their interview then they're scheduled for a ceremony. So that's the process in a nutshell. Of course, it sounds easier than it really is. Depending on the person.

Larry Lemmons:
There are other ways to come into the country legally without becoming a citizen. There are work visas and other possibilities. But if you are intent on being a citizen it will take you longer if you are from China, Mexico, India or the Philippines. That's because there's so much of a backlog from those countries of people wanting to become citizens.

Jeanne Kent:
There's four different preference categories for those visa numbers. And the categories can get quite large so the backlog in certain categories can be quite years long. So for people like China and the Philippines is used often as an example someone that's a brother or sister living in the Philippines has about a 20-year wait.

Larry Lemmons:
Congress sets the rules as to what preferences and question as are in place. The quota for country puts citizens or larger countries at a disadvantage because they are all under the same quota based on worldwide immigration. And the rules can change quite often over the years.

Diane Brennan:
Well, first with the different administration coming in the immigration laws change. At one point in my life I tried to seal if I was eligible and I wasn't. Then four years later the rules changed and that's when I found out that my mother could get her U.S. citizenship and she could sponsor me for a green card. So that was the first step. And I chose that visa because I was eligible for it. I could also come down on a NAFTA agreement, North American Free Trade Agreement, but it's a year visa you have to renew every year and it's up to the border guards whether or not to renew it. So basically your life is in a border guard's hands whether he says yes or no. So I wanted a permanent visa.

Larry Lemmons:
Brennan's next step is to take the citizenship test. That will take another year. She says being an immigrant helps her understand why people want to come to the United States.

Diane Brennan:
So I can understand the desire of the Mexican people to want to come here and do better. I pretty much came for the same reason. I went as far as I could in my field that if was trying to do in Canada. So in order to better myself and want a better future for myself I wanted to come to the U.S. because I was allowed to do that. So I can relate to what they want to do.

Jeanne Kent:
When I'm at a naturalization ceremony and see the emotion in the person's eyes that just became a citizen, you really have to see it. It makes you feel so good about being a citizen of the United States, how lucky we are.

José Cardenas:
Joining us now to talk more about the legal immigration process is Emilia Bañuelos, immigration attorney. Emilia, it's good to have you back on Horizonte.

Emilia Bañuelos:
A pleasure being here.

José Cardenas:
A lot of discussion these days about proposed changes in the immigration process, McCain-Kennedy bill, senator Kyl has his proposals, Sensenbrenner, but has there been much change over the last five years in the existing laws?

Emilia Bañuelos:
Basically the changes started in 1986 with the legalization that they passed in 1986. They passed IRA IRA. Which was more of an enforcement based bill. That was in 2006. So the last big immigration reform was in 1996. But prior to that was in 1986 bill. Which was when that gave legalization to people who had been here for five years and also people who had some kind of work employment in agriculture.

José Cardenas: Legalization meant it gave them legal resident status that they could then apply for citizenship?

Emilia Bañuelos:
Right they were allowed to be temporary residents and permanent legal residents after awhile. After five years they were able to apply for citizenship.

José Cardenas:
And then what happened in 1996?

Emilia Bañuelos:
1996 they had the immigration reform act, which was basically didn't do anything for-- to allow people to apply. Basically it created punishments in defining the aggravated felonies, making more people deportable from the United States. It also barred people from being able to come to the United States or live in the United States if they had lived here unlawfully. So it dramatically changed the immigration laws.

José Cardenas:
So it got harder.

Emilia Bañuelos:
It definitely got more difficult. One of the reasons why there's so much chaos right now in our immigration system is basically based on the 1996 bill.

José Cardenas:
Well, the suggestion-- and you hear this in the immigration debates is-- well, these people should go home and then come back through the normal process. But how difficult is that?

Emilia Bañuelos:
The process right now for some people, even if you're married to a United States citizen, it is impossible for you to be able to go through the process. Because there is no process to be able to-- if you enter the country illegally as a result of the 1996 law, if you enter the country illegally and you didn't file anything before 2001, even if you're married to a United States citizen there is no way that you could obtain a green card in the United States. You are barred for 10-years from being able to apply for anything, even though you're the spouse or the child of a United States citizen.

José Cardenas:
Well, let's say that I'm living in Nogales, Sonora.

Emilia Bañuelos:
Right.

José Cardenas:
And I meet and I marry a woman from Nogales, Arizona.

Emilia Bañuelos:
Okay.

José Cardenas:
And I want to come to the United States and begin the process. How long would it take?

Emilia Bañuelos:
You're a United States citizen or illegal resident?

José Cardenas:
No, I'm a Mexican resident and met my wife and got married in Mexico.

Emilia Bañuelos:
And you have no United States citizen son who is over 21 or parent who is a United States citizen. You're not-

José Cardenas:
My wife is my connection who is a citizen.

Emilia Bañuelos:
She's your wife who is a United States citizen. Basically she would be able to apply for you if you enter the country legally.

José Cardenas:
How long will that process take?

Emilia Bañuelos:
That process right now, they're very quick if you're married to a United States citizen and enter the country legally. And that process right now is taking about six months.

José Cardenas:
And if I don't have that connection, how long does it take a Mexican national living in Mexico who wants to come here, wants to go through the process of legally, how long would it take for them to come to the United States?

Emilia Bañuelos:
You either have to have a petition base, which is a U.S. citizen, or an employer based petition to be able to come to the United States. Now or else there's no way that you're coming to the United States.

José Cardenas:
And I understand on the employer-based petitions there are only a certain limited number of those that are available? Is that right?

Emilia Bañuelos:
Right. Both for family based and employment based. Now employment based you have to have some kind of skill and have to show there is no U.S. legal resident available for that position. You have to not only certify that the position is unique and there's nobody else who could do that same position in the United States. And so basically if both family base is controlled and also the employment based, there's a limit on how many people can come in annually.

José Cardenas:
How about for agriculture? A lot of people from Mexico come for that. Is there a system?

Emilia Bañuelos:
There's a process you can apply for special permits to come in. Basically most of the companies that have actually gone through that process, it's not working because it takes too long to get those. By the time they get those permissions, either the-- it's only seasonal. It has to be only seasonal for a short period of time. For a lot of times these employers need workers now for a short season. They just can't go through all the periodic-- it takes a lot of time for these petitions and it costs money for these petitions.

José Cardenas:
And we've had some employer representatives on the shows said that the number of legally available spots is too limited. It wouldn't meet their needs even if they were able to fill it.

Emilia Bañuelos:
In some cases it's 5,000, in some cases 10,000 nationwide.

José Cardenas:
Let me ask you a question about the pending legislation. You have the McCain-Kennedy bill, Senator Kyl's proposal, Sensenbrenner. Of those do any of them deal with the situation of how people can come over more easily, especially the ones that say go home and then come back legally. Is there any provision to make that easier?

Emilia Bañuelos:
The only provision that kind of goes over is the McCain-Kennedy provision is basically the only one that deals with those who are here already and how to go ahead and in a future process. Basically the way the law is right now, with the different bars and the different way that you're not eligible for status, that is going to deeply impact future legislation hasn't take mean account all the different bars that they made in 1996. But the only provision that would have a mechanism-- because basically to try to-- you have to create a comprehensive immigration package. That's not just a one size fits all. That's what the problem is they have to have three or four different components have to be within that comprehensive immigration package in order for this to work. You have to deal with the people who are here already in the United States. You have to deal with the people who are wanting to come to the United States. Most companies are going to apply for only people that they already have established a relationship with. You're not going to apply for someone out in the blue.

José Cardenas:
We have to end the discussion there, Emilia, but thanks again for joining us on Horizonte.

Emilia Bañuelos:
It's a pleasure.

José Cardenas:
That's all tonight for Horizonte. We'll be back next Thursday night talking to one of the filmmakers of the national PBS series "the American dream." I'm José Cardenas. For all of us here at Horizonte, have a good evening.

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