U5D1-28 - Determine and Analze the Steps for the Case Study Project. Please follow all instructions and Reading material provided.

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What social and political biases must the agency recognize? How can the agency overcome the biases that it is likely to face? What information does the agency likely need to become aware of biases in the community? From whom

should the agency collect information about biases and attitudes?

Vignette 2: Teenage Pregnancy Prevention

A small town along the Texas-Mexico border has experienced an alarming number of pregnancies among unmarried teenagers. Over 40% of teenage girls aged 17–19 years have at least one child, and over 90% of these are unmarried. Planned Parenthood of Dallas has decided to seek funding for the implementation of a school-based sex education curriculum to be introduced in social science classes.

1. What social and political biases must the agency recognize? 2. How can the agency overcome the biases that it is likely to face? 3. What information does the agency likely need to become aware of biases in the community? From whom

should the agency collect information about biases and attitudes?

Economic Factors Describe in detail a human service program that you feel needs to be developed to address a specific social

problem or need (e.g., delinquency in African American youth). Also describe in detail the following:

1. The agency that would be ideal for seeking funds for this program 2. What past experience the agency should have in-house in doing needs assessments 3. What background the agency should have in dealing with this topic 4. If the agency does not have past history with this type of programming, whether or not it should apply for

funding for it and, if it does apply, how it should proceed 5. What type of personnel the agency should reflect in its application 6. What level of experience the principal investigator and co-investigator should have

Three

Social, Gender, and Cultural Considerations “Margie, what happened? Why do you have that dreadful look on your face? Don’t scare me! You know we have to put that grant proposal together for the diabetes and obesity prevention program that we desperately need to keep our staff employed, since there were so many cuts in our other public health programs. This is our last shot for doing so before we have to lay people off. Didn’t you find high diabetes and obesity rates based on county-wide data in our just-completed needs assessment?”

Margie replies, “Tom, how can this be? We found low rates of diabetes of obesity in our community. Yes, I said low rates! I just don’t get it. The health foundation informed us we would get the funding if we just provided supporting data showing the need. Do you remember, they were begging us to take the money as soon as we provided them with the data because they said that they and other health providers are paying way too much for treatment once people get diabetes and are obese? But with these data we’ll never get the funding.”

“Margie, what proportion of respondents in our study were minorities?” “Tom, that was the other weird thing, only 15% of our sample were cultural minority members, and

75% were female. That’s right, only 15% in a community that the Census says is 76% minority. How do

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B

you figure that? But that information isn’t as important as the other findings on diabetes and obesity. What should we do, Tom?”

ut Margie in this vignette is so wrong! Statistics on cultural minority members in her sample are very important, if not critical, because they tell whether the sample used is representative of the population or

not. Why do you think the findings are so different than expected? Did the data collectors discriminate against minorities and just not bother to include them? Or does it matter, since the agency will not get the funding sought?

This chapter focuses on the challenge of reflecting diversity correctly in samples for needs assessments and of securing valid and reliable information from diverse communities. Books on needs assessments or even on research methods often steer clear of discussing diversity. They may discuss making sure you have a representative sample from a statistical standpoint: “All members you draw from a population must have an equal chance of being selected in the sample.” However, rarely do those who conduct needs assessments have access to an entire population from which to draw a sample—something we call a probability random sample. We shall later discuss various methods that are likely to lead to representative samples. However, in this chapter we shall discuss different ways that we can measure the diversity of a community in ways that are relevant to human service agencies that need information on their communities. The chapter is meant to be practical and illuminating for those involved in conducting needs assessments in diverse communities.

The Diversity Challenge When we hear the term diversity, we may immediately think of cultural diversity—people of various cultures, ethnicities, and countries of origin. However, diversity means more than cultural diversity. People differ in many important ways that bear on human services—life experiences, the family they come from, gender, age, education, and income to name a few. The reason we are concerned with diversity is that findings from needs assessments show that people differ in their needs based on various demographic characteristics. The reason we sometimes fail to discuss diversity in needs assessments is that doing so means expending time and resources. For example, paying attention to diversity requires first devoting sufficient time to consider the ways in which people differ that are relevant to the purpose of needs assessments. This requires planning for the data to be collected, and it requires time to interpret findings with respect to diversity after the data are collected and analyzed. Moreover, few have training in understanding the importance of diversity and therefore take the time to consider the variables that may make sense when conducting a study. Being a member of any diverse group does not give you special qualifications or automatically make you aware of or sensitive to diversity issues.

Sadly, ignorance or the complexity inherent in diversity often leads us simply to ignore it, wishing that somehow it will either go away or manifest on its own once the data are collected. However, neither of these things happen—diversity does not just show up by itself. A serious consideration of diversity requires a careful consideration of the specific variables believed to be important sources of variability. Variables are elements, characteristics, features, or factors that vary and change. For example, age changes, and one age is different from another.

In this chapter we will review various demographic variables that make up the concept of socioeconomic status (SES) and then consider measures of culture. While in conducting needs assessments, understanding and measuring diversity are important, not all demographic variables are always important or relevant for each assessment. What is prudent is to carefully consider the variables mentioned in the chapter and others found in the literature in light of the purpose of the assessment and the variability found in the targeted population.

Social Diversity Rather than starting with cultural diversity, let us first consider various social and economic variables that the literature suggests are tied to social, behavioral, and health problems. The variables we will review are important not just for suggesting differences in needs but for describing the communities that are of concern to agencies. They also serve as a check on whether the data collected from a needs assessment are reflective of the community one wishes to learn more about.

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As we consider variables denoting diversity, it is important to consider how social scientists who conduct needs assessments commonly use the various demographic variables. Need in needs assessments can be assessed by directly asking respondents about their perception of need for any program or service (e.g., “Do you need a mental health service to help you with your depression?”). Or need can be assessed by measuring a condition that clearly signifies a need for services (e.g., using a standardized measure that measures depression). For example, if rates of depression are high in a community, then we take that to indicate a need for treatment services for depression in the community. These differences should be kept in mind as we review variables denoting diversity.

Age One of the most common variables included in any study is age. Research studies consistently demonstrate

the importance of age in relationship to social and health indicators and concerns (see, e.g., Vondras, Powless, Olson, Wheeler, & Snudden, 2005). Studies have shown that age is linked to such concerns as substance use, crime/delinquency, suicidal ideation, obesity, heart disease, diabetes, pulmonary diseases, and depression and other mental health problems. In some cases, rates are lower with age (e.g., drug use), and in other cases, rates are higher with age (e.g., heart disease or cancer). Needs assessments should always include a question on age. Age questions can be categorical:

Age (mark one): ___ 0–5 ___ 6–11 ___ 12–19 ___ 20–39 ___ 40–59 ___ 60+

Or the question can simply ask for the age as a number. The question below requires respondents to have clear writing skills, since they have to write out their age:

What is your age? (years): _________ Sometimes you may want a more exact response and so will ask respondents for their exact age:

Categorical questions are useful when you believe that respondents would feel uncomfortable giving you their exact age and when you know you will only need categorical data. For example, studies may simply want to analyze the needs of minors versus those of adults. However, if you gather years or dates of birth, you can still create categories after the data are collected. Also, when you collect numerical data, you can derive averages, an impossibility with categorical data. Furthermore, categorical questions do not lend themselves to some statistical analyses. For example, it is difficult to look at the correlation or link between age and substance use using categorical data.

Why ask for the complete date of birth rather than just the year? The advantage of obtaining the actual birth date is that you can convert it into years or months. The more specific the information you collect on age, the more you can do with it. Complete birth dates become particularly relevant when the survey inquires about young children; for example, specific month cutoff points are important for entry into school. On the other hand, respondents may consider a question on exact date of birth too invasive, and such a question may result in high nonresponse rates.

Urban/Rural/Suburban The US Census Bureau has two classifications for urban: Urban Areas (UAs) of 50,000 or more people and

Urban Clusters (UCs) of at least 2,500 and less than 50,000 people. A commonly accepted definition of an urban

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area is one with a population of at least 2,500. Rural areas are considered all population areas not included in an urban area. Less precisely, a suburb is a metropolitan location just outside of a central city area.

More research has been done on urban/rural differences and less on suburbs. Research on rural/urban dichotomies has pointed to the importance of this variable to outcomes such as physical health, mental health, and substance use (see, e.g., Galea & Vlahov, 2005; Loue & Quill, 2001; Van de Poel, O’Donnell, & Van Doorslaer, 2007). Some findings show urban areas have more problems (e.g., use of heroin), and other findings show urban areas having fewer problems (e.g., alcohol abuse). Clearly, most rural areas have less access to social, physical health, and mental health services than urban areas. However, the dichotomy between urban and rural can also suggest that different cultures emerge based on more or less contact with others, which can lead to differences in worldviews and behavioral differences.

Questions for measuring rural/urban differences may ask individuals for their full address, their ZIP code, or the name of their city or town. Below are some examples of ways in which the rural/urban dichotomy can be measured.

Full Address Question

Please provide us with the address where you currently live:

ZIP Code Only Question

Please write in the ZIP code where you currently reside: ___ ___ ___ ___ ___

City/Town Question

Please write the name of the city or town and county in which you currently live:

Name of City/Town County

Education Education has been linked to a broad array of social and health outcomes, including stress, heart disease, and

substance use (see, e.g., Beatty, Kamarck, Matthews, & Shiffman, 2011; Hagger-Johnson, Mõttus, Craig, Starr, & Deary, 2012; Karriker-Jaffe, 2011, Kershaw Mezuk, Abdou, Rafferty, & Jackson, 2010). It is said that education is less a direct causal factor of health-related outcomes than it is a mediating factor tied to such things as stress-coping styles (Kershaw et al.). However, education is more commonly associated with income (see, e.g., Saad, Sue, Zane, & Cho, 2012) and therefore has been used as a proxy for income. There are several ways of measuring education. In the 2012 American Community Survey, the Census Bureau (2012) inquired about education as follows:

What is the highest degree or level of school this person has COMPLETED? Mark (X) ONE box.

___ No schooling completed ___ Regular high school diploma ___ Some college credit, but less than 1 year of college credit ___ Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA) ___ Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD) ___ Doctorate degree (for example: PhD, EdD)

Another, simpler question is this one:

Which of these educational levels have you COMPLETED?

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(Mark One) ____ Did not attend school. ____ Elementary (Grades 1–6) ____ Middle School or Junior High (Grades 7–8) ____ High School (Grades 9–12) ____ Community College ____ 4-Year College or University ____ Master’s or Doctorate Degree

The advantage of using an existing question, like the one used by the Census Bureau, is that you can make a direct comparison between what you find in your needs assessment with what has been found nationally or regionally. Sometimes municipalities or counties do their own surveys or know of researchers who have. In these cases, you can find existing data that can be used for comparison purposes or to augment the information you gather from your needs assessment.

Income Questions on income are important because the responses are a direct measure of resources that individuals

and families have, and resources have been shown to be an important correlate of a variety of social, behavioral, and health outcomes (see, e.g., Chaloupka, 1999; Riley & Milbank Memorial Fund, 2008). There are various ways to inquire about income. The question can ask the respondent about his or her individual income or earnings:

What was total amount that you earned during the past 12 months? $____________

However, most agencies are interested in household income, because it is typically more reflective of the economic environment in which the individual and his or her family live. Here is a question that asks about household income:

Write the total amount that all members of your household earned over the past 12 months (before taxes): $ ______________

Research organizations like the US Census Bureau realize that it is important to be precise when creating questions. Otherwise, respondents become confused and frustrated. For example, when attempting to answer the question above, a respondent might wonder whether it is asking about the previous calendar year. Hence, the US Census Bureau includes a note that says, “The ‘past 12 months’ is the period from today’s date one year ago up through today” (US Census Bureau, 2012).

Regardless of whether you collect individual or household income, you might provide respondents with income categories to choose from. Here is an example:

Starting with today’s date, what is your current family or household income for the past 12 months before taxes? (Check One)

____ Less than $30,000 ____ $30,000–$49,999 ____ $50,000–$74,999 ____ $75,000–$99,999 ____ $100,000 or More ____ I do not know.

Offering respondents categories makes it easier for respondents to answer and reduces respondent concerns about privacy because they are not giving exact amounts. The above example also allows respondents to indicate that they do not know. This reduces false reporting that may occur when respondents really do not

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know. This is particularly the case with younger members of families who are not heads of household and thus do not manage household income.

One possible problem with the above question has to do with the categories themselves. The categories appear to be most relevant to middle-class households, since the amounts are generally high. According to the 2010 Census, the median household income for American families was $49,445 (US Census Bureau, 2011b). Thus, over half of all Americans would mark off only the first two choices. For most agencies conducting needs assessments, the communities of focus are lower income, and therefore it would make sense to offer categories that reflect and differentiate among lower income levels. Here’s a question that does this:

Starting with today’s date, what is your current family or household income for the past 12 months before taxes? (Check One)

____ Less than $10,000 ____ $10,000–$19,999 ____ $20,000–$29,999 ____ $30,000–$39,999 ____ $40,000–$49,999 ____ $50,000–$59,999 ____ $60,000 or More ____ I do not know.

Interestingly, research has shown that the validity of responses to questions about income increases when questions ask about income for the past calendar year, as opposed to the previous 12 months (Duncan & Petersen, 2001). Duncan and Petersen suggest the following question (p. 252):

What was the total combined income of all members of this family in 1999? Please include money from jobs, net income from business, farm or rent, pensions, dividends, welfare, social security payments and any other money income received by you or any other family member.

$_________ IN [YEAR]

To aid respondents who either cannot remember or feel they would rather not give an exact amount, Duncan and Petersen add the following series of questions to the one above (2001, p. 252). They report research that suggests a significant reduction in missing responses when this series of questions is used.

IF YOU DON’T KNOW OR REFUSED:

(answer each with yes or no)

Yes/No _____ Would it amount to $30,000 or more? _____ IF YES: Would it amount to $50,000 or more? _____ IF YES: Would it amount to $75,000 or more? _____ IF NO: Would it amount to $40,000 or more? _____ IF NO: Would it amount to $15,000 or more? _____ IF YES: Would it amount to $20,000 or more? _____ IF NO: Would it amount to $10,000 or more?

What determines the appropriate income information to collect for any needs assessment is the focus or purpose of the study and the planned statistical analyses. A question on income should be a part of most needs assessments, particularly if respondents are adults. Categorical income questions are appropriate if income neither is a concern nor will be needed for detailed analysis (e.g., correlation of income with other variables). However, detailed information on income should be collected if this variable will be an important focus. Having

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total household income as a numerical value will allow you to conduct correlation and parametric analyses (this will be discussed in Chapter 6).

One final point is that collecting household income information from youth is, as mentioned earlier, more challenging, since they often do not know the answers to such questions. For children and youth, qualifying for participation in programs to receive free or reduced lunches has been used to arrive at a dichotomous variable suggesting low or not-low income (see, e.g., Howard et al., 2011). Alternatively, some studies have used the average education of parents as a proxy for socioeconomic measures (Johnston, O’Malley, Bachman, & Schulenberg, 2011). In general, measures of family income are difficult to obtain from minors.

Gender Women have higher rates of use of human services than do men (Salisbury, Van Voorhis, & Spiropoulos,

2009). Females have lower rates of substance abuse compared to males (Johnston et al., 2011). Men are more likely to die from cancer than are women (Cook, McGlynn, Devesa, Freedman, & Anderson, 2011). Boys are more likely to be incarcerated, but females are more likely to need mental health treatment than males (Currin, Hayslip, & Temple, 2011). These are but just some of the ways in which males and females differ relevant to needs assessment. Clearly, needs assessments should take gender into consideration.

Let us clarify the difference between gender and sex. A focus on sex differences means that the attention is on biological difference. For example, testosterone levels differ between men and women, and this difference is said to be based on sex. Gender differences pertain to sociocultural or behavioral variables. For example, males are more likely to drink more alcohol than women, and this phenomenon is more likely to be due to sociocultural differences than to biological differences. Therefore, social and behavioral needs assessments will more likely use the term gender, while medical studies more likely use the term sex.

Questions used in needs assessments relating to sex or gender tend to be straightforward. Differences lie mainly in the use of male/female versus men/women or boys/girls. The terms male and female may be preferred, since they are widely understood. They also avoid confusion on the part of very young adults who may not yet see themselves as men or women and thus may not understand whether the survey pertains to them. A common question used in studies is this:

Please tell us your sex: (mark one) ___ Male ___ Female

Many agencies conducting needs assessments collect information on gender or sex from their respondents. However, they fail to examine if in fact there are differences in needs or concerns between males and females. Research suggests that needs differ between males and females on a variety of topics. Therefore, it is always important to examine differences between gender groups.

Marital Status and Household Size Other common demographic variables that are important to consider when conducting needs assessments are

marital status and size of household. Here is a common question used to determine marital status:

Please tell us your marital status (mark one) ____ Now married ____ Widowed ____ Divorced ____ Separated ____ Never married

Regarding size of household, a common question is this:

Including you, how many live in your household? (please write in the number): _________

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Another way of asking the same question is as follows:

Number in Your Household/Family Including Yourself (please write in): ________

Culture The United States is one of the most culturally diverse industrialized countries in the world. The 2010 census

showed that a little over a third of the US population identifies as an ethnic or a racial minority (US Census Bureau, 2011a). The United States is a country of immigrants, with most of the population having roots in countries and regions throughout the world. Historically, the United States has had waves of immigration from various countries, and these immigrants have settled in different parts of the United States. For example, many of the early immigrants during the colonial period were from England, and they settled in the Northeast. Then during the 19th century, waves of Irish and Italian immigrants joined existing immigrants and settled in the Northeast and in the Midwest. Also during the colonial period, French and Spanish immigrants settled in the South. During the 19th century, the lure of gold and land caused many immigrants to settle in the West. From the 19th century to the present, Hispanic immigrants, the largest group being from Mexico, have increased their presence in the Southwest. This history of immigration has resulted in the United States being one of the most culturally diverse countries in the Western world.

Clearly, this diversity influences cultural practices and celebrations throughout the country. For example, St. Patrick’s Day is celebrated by many Americans of Irish descent, Greek festivals by Greek Americans, Cinco de Mayo by Mexican Americans, Mardi Gras by French Americans, Octoberfest by German Americans, and so on. And, indeed, Americans of all background participate in these celebrations. Unfortunately, the cultural backgrounds of many groups are closely linked to varying levels of income and education. This has led to the recognition that perhaps US ethnic and racial groups are disproportionately affected by social and health problems because of disparities in income and access to quality education. The National Institutes of Health (NIH) has determined empirically that members of minority groups, including ethnic and racial groups, have historically experienced and continue to experience social and “health disparities” (Ruffin, 2011). According to the Centers for Disease Control (CDC), health disparities are defined as

preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations (CDC, 2008).

Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources. (CDC, 2011)

Studies show that racial and ethnic minorities differ significantly in health, social, and economic experiences and outcomes. Research, for example, suggests that there are striking disparities in illness and death among African Americans, Hispanics, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, and underserved groups such as disadvantaged rural Whites. According to a report by Woolf, Johnson, Fryer, Rust, and Satcher (2004), differential mortality rates between African Americans and Whites from 1991 to 2000 suggest that 880,000 more African Americans died during this period than would be the case if all factors were equal. The same report points to disparities in health insurance rates and living environments and access to fewer health care facilities and health care professionals among other minority groups, including Hispanics, Asians, and American Indians. In general, minority communities experience disproportionately elevated rates of poverty, low rates of education, and elevated rates of diseases such as diabetes, kidney disease, heart disease, and cancer (Satcher, 2005).

These disparities in health, income, and social conditions have caused the NIH to require that all federally funded researchers include adequate numbers of ethnic and racial minorities within their research study samples. According to the NIH, a minority group is “a readily identifiable subset of the U.S. population that is distinguished by racial, ethnic, and/or cultural heritage” (NIH, 2001, § IV.E.1). NIH policies require that NIH-

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funded researchers incorporate within their studies salient members of ethnic and racial groups, which include the following:

Hispanic or Latino—a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term “Spanish origin” can also be used in addition to “Hispanic or Latino.”

Not Hispanic or Latino

The following definitions apply for racial categories.

American Indian or Alaska Native—a person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliations or community attachment.

Asian—a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. (Note: Individuals from the Philippine Islands have been recorded as Pacific Islanders in previous data collection strategies.)

Black or African American—a person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African American.”

Native Hawaiian or Other Pacific Islander—a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Majority Group

White— a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

The NIH starts with the premise that these ethnic and racial categories are important and that researchers are expected to include adequate samples of each within their studies, unless there are compelling reasons for not doing so. These reasons can include the nonexistence or scarce existence of populations in one’s geographic area of interest or a scientific need to focus exclusively on one or more specific groups, possibly because other groups are not afflicted by the condition or problem in question. It is also recognized that at times a specific subgroup or subgroups from within these racial or ethnic categories may merit special focus and attention. Below are examples of two research projects, one that may be justified in focusing solely on individuals of a particular ethnic group and particular national origins and another that must include members of all ethnic groups represented in the wider population:

Example 1. A researcher in California wants to study posttraumatic stress disorder (PTSD) in Central American Hispanics because he suspects these individuals suffered high rates of exposure to violence in their countries of origin. The focus of the study is on persons with particular experiences related to their ethnicity and national origin. Thus, the study may be justified in excluding persons from other groups.

Example 2. A researcher seeks funding from the NIH to conduct an epidemiological study on rates of exposure to violence in California populations. This researcher will be expected to have a plan for including all ethnic and racial groups and to include enough members of each in the study sample to make meaningful statements on exposure to violence among these various ethnic and racial groups, since they make up significant proportions of the California population.

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The first example may be justified, or it may not. The NIH may respond that comparative rates of other groups may be critical to understanding the relative problem of PTSD among Central American immigrants.

The point is that there needs to be clear planning for cultural group representation in needs assessments. Human service agencies need to be aware of the cultural diversity and presence of specific cultural groups within their catchment area. Agencies need to avail themselves of existing data sources, such as census data, that will inform them with respect to diversity in their geographic area of interest.

In recent years, the US Census Bureau has made tremendous strides in making its data available to the public and to health and human service agencies. Through its website, the Census Bureau now provides the latest population estimates for most regions in the country. Go to the Census Bureau’s website (www.census.gov), choose the “Data” tab, and select “American FactFinder.” From there, you can get population characteristics based on “Topics,” “Geographies,” “Race and Ethnic Groups,” or “Industry Codes.” The last criterion provides business and manufacturing information. Each of these tabs allows the user to focus a search on population characteristics down to the block level using various databases, such as that of the decennial census (collected every 10 years on the entire US population), American Community Survey (collected every year and aggregated at 3- and 5-year intervals from samples of the population), and Current Population Survey (collected annually for population and labor force data).

Often cities or counties have Census Data Centers that regularly receive data from the US Census Bureau, conduct their own analyses, and produce demographic or population reports that focus on populations in their region. For example, in San Diego County the San Diego Association of Governments (SANDAG) is a Census Data Center, and this office regularly produces reports that utilize Census Bureau data and sometimes conducts its own population surveys. Before undertaking a needs assessment, know what tools are available to help you understand the diversity of your population.

Race and Ethnicity There are various ways to ask questions about race and ethnicity. The choice of questions and wording will

depend on the diversity in the population of focus. The Census Bureau collects information about a person’s race and Hispanic origin, and historically some respondents have experienced confusion regarding the best way to answer these questions. One of the most challenging questions is that on race: What is your race? For many who feel they are members of the majority group and are not a member of a minority group, checking off the response option White is easy enough, if that is an option among others like Black, Asian, American Indian, and Other. But how would a typical Hispanic answer this question? As the Census Bureau has learned, most Hispanics have problems answering the race question because the standard categories do not encompass their sense of race, so they end up checking off the last option offered to them, Some Other Race. Race, ethnicity, and minority status are all social and societal constructs that have little biologic or genetic basis, but they are considered real nonetheless. Race is a real concept to the extent that people believe in it and react to it themselves or as though others do.

The terms used in questions that inquire about race or ethnicity are important. For the 2010 census, the US Census Bureau asked a question on Hispanic origin first before posing a question on race. Below are the questions used for Hispanic origin and for race:

Is this person of Hispanic, Latino, or Spanish origin? No, not of Hispanic, Latino, or Spanish origin

Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin—Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

What is this person’s race? Mark one or more boxes.

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White

Black, African Am., or Negro

American Indian or Alaska Native—Print name of enrolled or principal tribe.

Asian Indian

Chinese

Filipino

Other Asian—Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. Japanese

Korean

Vietnamese

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander—Print race, for example, Fijian, Tongan, and so on.

Some other race—Print race.

A related, but different question comes from the CDC and is administered in person by interviewers (CDC NCHS, 2011). However, it can be adapted for use in a self-administered questionnaire. The numbers next to responses are arbitrary coded numbers assigned to the specific responses:

Do you/Does [ALIAS] consider [yourself/himself/herself] to be Hispanic or Latino?

1 Yes 2 No 7 Refused 9 Don’t know Where did your [ALIAS’s] ancestors come from? * Read if necessary. Puerto Rican Cuban/Cuban American Dominican (Republic) Mexican Mexican American Central or South American Other Latin American Other Hispanic/Latino

What race or races: Do you/Does [ALIAS] consider [yourself/himself/herself] to be? Please select 1 or more of these categories.

* Enter all that apply. 01 White

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02 Black/African American 03 Indian (American) 04 Alaska Native 05 Native Hawaiian 06 Guamanian 07 Samoan 08 Other Pacific Islander 09 Asian Indian 10 Chinese 11 Filipino 12 Japanese 13 Korean 14 Vietnamese 15 Other Asian 16 Some other race 97 Refused 99 Don’t know

These questions serve as examples of race and Hispanic origin questions that are extensive but that can be reduced to focus on the particular cultural groups present in any given community.

Acculturation A final cultural variable to consider is the concept of acculturation, which refers to the extent to which

individuals are influenced or are changed culturally, socially, and psychologically as a result of the interaction and exchange between two or more cultures (see, e.g., Sam & Berry, 2010). Acculturation has been shown to be tied to health issues, behavioral issues, and educational outcomes (see, e.g., Barrera, Toobert, Strycker, & Osuna, 2012; Kim, 2007; Suinn, 2010). Hence, it appears to be an important concept to include in needs assessments. The problem is that most measures of acculturation are designed for specific ethnic or cultural groups. For example, a frequently used measure is Cuellar, Arnold, and Maldonado’s (1995) Acculturation Rating Scale for Mexican Americans–II (ARSMA–II). Another measure for Mexican Americans is Mendoza’s (1989) Cultural Life Style Inventory. For Asian Americans, the Suinn-Lew Asian Self-Identity Acculturation Scale has been used extensively (Suinn, Ahuna, & Khoo, 1992).

While there are multiethnic scales (e.g., Stephenson, 2000), only one is available that can be responded to by various minority members, as well as nonminority members. It is called the Pan-Acculturation Scale, or the “PAN Scale” (Soriano, Ho, Yeh, McCabe, & Hough, 2012). This measure is included in Appendix B. Respondents’ use their sense of American culture as a frame of reference to answer a series of up to 23 questions, and they compare their sense of American culture to their awareness of the culture in their background that is different from American culture. This measure has been validated using an existing validated acculturation measure by Mendoza (1989). The measure can be used unidimensionally to measure acculturation (high/low on American culture), and it can also be used to measure enculturation or affinity to one’s culture other than American culture.

Acculturation is relevant in needs assessments when there are high proportions of cultural minority groups and when there is a need to know more about the extent to which minority groups are similar to or different from nonminority groups. Measures of acculturation can be used to describe the minority population and its sense of closeness to American culture. They can also be used to assess the relationship between acculturation and social problems, physical health concerns, and mental health problems such as depression, PTSD, and alienation. Comprehensive reviews on the concept of acculturation are available from Levy (2004) and Yoon, Langrehr, and Ong (2011).

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Conclusion In this chapter we considered the diversity that is found in communities of interest to human service agencies. Various variables were reviewed that are considered important in the human services area. This diversity needs to be considered when planning to conduct needs assessments. Human service agencies need to determine for themselves the extent to which any of the various variables considered here are more or less important and relevant to them. It is clear that demographic, social, and cultural diversity are tied to varying levels of human service needs. Understanding a community’s diversity is critical to assessing its likely social and health service needs. Needs assessments are important for collecting information about the needs and concerns of communities. Before embarking on the collection of needs, agencies do well to first develop demographic profiles of their communities. The US Census Bureau has made it easier for agencies to do that through its website. By using American FactFinder, human service agencies can develop comprehensive demographic profiles of their communities down to the block level. These community profiles are critical first steps in planning for needs assessments.

Exercise Since the devastation of hurricane Katrina in 2005, New Orleans has made great strides toward rebuilding its infrastructure and addressing the social and health needs of its population. A city-wide needs assessment is planned to determine the social, economic, and educational needs of the population. In preparation for this needs assessment, use American FactFinder at www.census.gov to access American Community Survey (ACS) and 2010 Census data to develop a social, demographic, and cultural profile of the community.

Provide the following information on the city of New Orleans:

Total population:

Income levels of residents:

Age characteristics of residents:

Gender characteristics of residents: