The State of Latino Child Health in Houston

Executive Summary

Latinos are the largest and most rapidly growing minority group in the United States. They also face unique institutional and systematic challenges that have significant consequences for their well-being. Latinos are more likely to report health-related challenges, including difficulties accessing health care, language barriers, and lower levels of health literacy.[1]

These challenges lead to a variety of negative health and educational outcomes for Latinos, including the increasing prevalence of chronic health conditions and the persistent school achievement gap. Research reports that Latinos face higher levels of diabetes, hypertension, and liver disease.[2] Further, Latino children are much less likely to graduate high school than non-Latino whites.[3] In Texas, Latinos now make up the largest population at 40.2% in 2022.[4] Also, in Texas, almost half of the population of children under the age of 18 are Latino, and nearly one in five Texas children live in poverty.[5] With Latino children being the most likely ethnic population to live in poverty, it is imperative to develop interventions that will reduce these gaps.

To address specific health and wellness disparities among the community as a whole, it is imperative that policymakers address issues faced by the expanding population of Latino children in particular, focusing on three key areas:

1. Obesity.
2. Mental health.
3. Kindergarten readiness.

Programs to Address Obesity Should Focus on Nutrition, Physical Activity, and Community

The health consequences associated with obesity are well known, and to mitigate the risks, it is crucial to address them early in childhood. Among Latino children in Houston, 34% are obese, compared to 26% nationwide.[6] Up to 50% of Latino children will develop Type 2 diabetes in their lifetime; 41% of Latino children around the country are currently diagnosed with the condition, which in the long term can result in lower health-related quality of life.[7] To address these high rates of chronic disease, policymakers should determine appropriate evidence-based measures to reduce obesity among Latino and other youths.

Programs to address child obesity should consider the socioeconomic influences that may lead to the disease. Indeed, obesity arises from a complex set of individual, community, and environmental factors, including poverty.[8] Nutritious foods are less common in low-income neighborhoods, making it more likely that children living in these neighborhoods will consume unhealthy foods and beverages.[9] The rate of children living below the poverty level in Houston is 29.7%, which is higher than the national level of 16%.[10] This relatively high rate of poverty makes obesity among Latino children an especially urgent matter for local policymakers and other community stakeholders.

Evidence demonstrates that within Latino communities, nutrition intervention alone is not sufficient to influence obesity rates. According to the Centers for Disease Control and Prevention (CDC), Latinos and Hispanics have the highest inactivity levels outside of work among all demographic groups. These rates are reflected in the child population as well. Indeed, Latino and Hispanic high school students are more likely to report that they are not physically active for at least 60 minutes on at least one day of the week. Several structural barriers contribute to this disparity in physical activity levels: Reduced access to community health-related programs, work schedules, and language barriers are all factors that impact the ability of Latino and Hispanic students’ access to exercise.

Community-based programs that incorporate nutrition education with exercise demonstrate success in decreasing body mass index (BMI), improving insulin sensitivity, and improving weight-specific quality of life metrics among Latino and Hispanic adolescents. Programs that focus on shared spaces and promote nutrition can foster a sense of community and provide an opportunity for culturally influenced interventions, which evidence demonstrates have been most effective in changing behaviors.

Such opportunities include the promotion of youth sports, which is lacking among Latino youth according to the CDC’s Youth Behavioral Risk Survey (YBRS), an annual survey of students across the country.[11] Among Latino and Hispanic students surveyed, 60.7% reported playing on zero sports teams, compared to 47.7% of non-Latino/Hispanic student respondents. For the highest chance of success, interventions to address obesity in youth require a multifaceted approach that incorporates nutrition, physical activity, and a key focus on community connectedness.

Mental Health Stakeholders Should Prioritize Cultural Competency

In the aftermath of the COVID-19 pandemic, there is little doubt that the United States is facing a mental health crisis. For adults, pandemic-related trauma and economic stress continue to exacerbate inequalities. Latino/Hispanic adults are more likely to report psychological distress compared to the general population. The pandemic undoubtedly impacted children as well. The Youth Risk Behavioral Survey found that 46.4% of Latino/Hispanic students felt “sad or hopeless almost every day for two weeks or more in a row” and that it stopped them from doing some usual activities, compared to 41.1% of all other students.[12] Latino/Hispanic middle-schoolers were significantly more likely to report that they seriously considered attempting suicide (20.4%) compared with non-Latino middle school students (22.3%).

Similarly, per the YRBS, Latino/Hispanic middle school students were more likely to report making plans to attempt suicide (15.1%) relative to non-Latino middle-schoolers (13.4%). Latino/Hispanic middle school students were also more likely to say that they tried to kill themselves (10%) compared to non-Latino middle school students (8.2%). These numbers clearly indicate that children are struggling. It is essential to address the mental health needs of all children, and as they face unique barriers, Latino children in particular need culturally competent care.

In addition to mental health disparities, Hispanic children are disproportionately more likely to suffer family economic hardship, parental separation or divorce, low maternal education, and paternal incarceration compared to whites.[13] Schools encounter severe difficulties in meeting the mental health needs of their students; in Texas, more than 98% of schools fail to meet the American School Counselor Association standard of providing at least one counselor for every 250 students.

Language barriers also compromise the ability of many Latino/Hispanic families to seek mental health care in Texas. Indeed, 80% of mental health care providers offer services only in English. Systems must adapt to not only meet the needs of children, but also to provide culturally competent and trauma-informed care. The disparities that Latino children face can exacerbate the impact of mental health struggles. Latino children who primarily speak Spanish may experience difficulty finding qualified Spanish-speaking providers, and even simply making appointments.

Programs that integrate mental health care into school systems, such as Texas Child Health Access, a telemedicine program, provide initial mental health services to children through schools, thereby eliminating transportation and technology barriers. Schools can serve as critical partners by helping provide mental health services to children. However, they should ensure they have taken necessary steps to address the unique needs of children in the rapidly growing Latino community.

Kindergarten Readiness Is Vital

The growth of the Latino population has profoundly influenced the demographic composition of the American education system. There are approximately 19 million Latino children in the United States, representing 25% of the nation's overall child population.[14] Across Houston, Hispanic children accounted for 52% of enrolled kindergarteners, compared to white (20%) and Black (17%) students.[15]

Research suggests that upon entering kindergarten, Latino children consistently fall behind their peers in academic school readiness, and that this gap continues into later grades.[16] Low-income Latino families in particular face significant barriers to school readiness.[17] These include, but are not limited to, lack of knowledge of kindergarten readiness, language barriers, lack of access to books at home, and limits on free time with children. It has been widely demonstrated that children who enter school ready for kindergarten are more likely to succeed academically over the long term. In Houston, the percentage of students achieving kindergarten readiness declined from 47.7% in 2018–19 to 46.5% in 2019–20.[18]

Although schools and other groups have made efforts to bridge academic gaps, research continues to underscore persistent challenges, particularly among Latino children. The decline in the percentage of students achieving kindergarten readiness in Houston serves as a reminder of the imperative to address systemic barriers and foster inclusivity in educational environments. As we move forward, educators, policymakers, and community stakeholders must work collaboratively to develop targeted interventions and ensure equitable access to resources, so that all children enter school ready to thrive academically and realize their full potential.

Conclusion

It is imperative for a society to invest in the health and well-being of all children. Latino children face unique stressors in obesity, access to mental health care, and kindergarten readiness, and in order to ensure all children in Houston have an equal opportunity to realize their best possible future, it is critical to reduce disparities in disease, mental health, and education. Through a collaborative, community-engaged approach, policymakers and other stakeholders can develop and implement to improve outcomes for Latinos and the broader Houston community.

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Notes

[1] Eduardo Velasco-Mondragon et al. “Hispanic Health in the USA: A Scoping Review of the Literature,” Public Health Reviews 37, no. 31 (December 2016), https://doi.org/10.1186/s40985-016-0043-2.

[2] Christina Cordero et al., “Diabetes Incidence Among Hispanic/Latino Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL),” Diabetes Care 45, no. 6 (June 2022): 1482–5, https://doi.org/10.2337/dc21-1543; Maurizio Bonacini et al., “Racial Differences in Prevalence and Severity of Non-Alcoholic Fatty Liver Disease,” World Journal of Hepatology 13, no. 7 (July 2021): 763–73, https://doi.org/10.4254/wjh.v13.i7.763.

[3] “Home Page,” National Center for Education Statistics (NCES), n.d., https://nces.ed.gov/.

[4] Ashley Lopez, “Latinos Are the Biggest Ethnic Group in Texas, but Their Political Power Lags Behind,” National Public Radio (NPR), August 15, 2023, https://www.npr.org/2023/08/15/1193747771/latino-political-power-texas#:~:text=According%20to%20the%20U.S.%20Census,reported%20by%20The%20Texas%20Tribune. 

[5] “Home Page,” Every Texan, n.d., https://everytexan.org/.

[6] Maribel Barragan et al., “Reducing Obesogenic Eating Behaviors in Hispanic Children through a Family-Based, Culturally-Tailored RCT: Abriendo Caminos,” International Journal of Environmental Research and Public Health 19, no. 4 (February 2022): 1917, https://doi.org/10.3390/ijerph19041917; Carolina Boyd, “Tackling Childhood Obesity in the Houston Area. Legacy Community Health,” Legacy Community Health, https://bit.ly/3Vcbow3.

[7] Christina Aguayo-Mazzucato et al., “Understanding the Growing Epidemic of Type 2 Diabetes in the Hispanic Population Living in the United States,” Diabetes/Metabolism Research and Reviews 35, no. 2 (February 2019), https://doi.org/10.1002/dmrr.3097.

[8] Shimels Hussein Mohammed et al., “Neighbourhood Socioeconomic Status and Overweight/Obesity: A Systematic Review and Meta-Analysis of Epidemiological Studies,” BMJ Open (September 2019), https://doi.org/10.1136/bmjopen-2018-028238.

[9] Lauren E. Au et al., “Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10–15 Years: The Healthy Communities Study,” The Journal of Nutrition 149, no. 9 (September 2019): 1642–50, https://doi.org/10.1093/jn/nxz108.

[10] “Children Living Below Poverty Level,” Houston State of Health, https://bit.ly/48YqRD4.

[11] “Explore Youth Risk Behavior Survey Questions - United States, 2021,” Centers for Disease Control and Prevention (CDC), http://yrbs-explorer.services.cdc.gov/.

[12] “Explore Youth Risk Behavior Survey Questions.”

[13] Xiaoyan Zhang and Shannon M. Monnat, “Racial/Ethnic Differences in Clusters of Adverse Childhood Experiences and Associations with Adolescent Mental Health,” SSM - Population Health 17 (March 2022), https://doi.org/10.1016/j.ssmph.2021.100997.

[14] “One in Four Children Nationwide Are Latino, with 6-to-12-Year-Olds Making Up Nearly 40 Percent of Latino Children,” Hispanic Research Center, September 27, 2023, https://www.hispanicresearchcenter.org/research-resources/one-in-four-children-nationwide-are-latino-with-6-to-12-year-olds-making-up-nearly-40-percent-of-latino-children/.

[15] “Early Childhood Education in Houston,” Understanding Houston, accessed March 7, 2024, https://www.understandinghouston.org/topic/education/early-childhood-education.

[16] Suzanne Hartman, Adam Winsler, and Louis Manfra. “Behavior Concerns among Low-Income, Ethnically and Linguistically Diverse Children in Child Care: Importance for School Readiness and Kindergarten Achievement,” Early Education and Development 28, no. 3 (September 2016): 255–73, https://doi.org/10.1080/10409289.2016.1222121.

[17] Jaime Peterson et al., “Parental Attitudes, Behaviors, and Barriers to School Readiness among Parents of Low-Income Latino Children,” International Journal of Environmental Research and Public Health 15, no. 2 (January 2018): 188, https://doi.org/10.3390/ijerph15020188.

[18] “Early Childhood Education in Houston.”

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