Is It Language? Family Ties? Plumbing the Mystery of the Hispanic Paradox

Is It Language? Family Ties? Plumbing the Mystery of the Hispanic Paradox

In early December 2021, I was seeing a physical therapist for a shoulder injury. During one of my visits, the therapist was alternating between me and another patient on an adjacent bed, who had a knee replacement. While the therapist worked on the other patient’s leg, stretching it and bending the knee, I eavesdropped on their conversation.

The patient was in pain, anxious to complete the hard part of the therapy. The therapist was encouraging him to keep working. At one point the patient expressed a desire to quit. The therapist responded “Te queda una semanita más.” This translates to “You have a short week left.” The patient agreed to continue.

By adding the suffix “ita” to the word “semana,” – or week – the therapist offered the patient a perspective on how much therapy remained in a way that sounded shorter, even though it was still a full week.

This ability to minimize or exaggerate a situation by simply adding a suffix is one feature of the Spanish language that could contribute to a striking resilience in health that researchers have documented in Hispanic populations in the United States, called the “Hispanic Paradox.”

As a Hispanic quantitative psychologist, I have been involved in research on stress and cardiovascular health at the University of Miami since 1988. More recently, I joined the Hispanic Community Health Study/Study of Latinos as an investigator. This observational study of over 16,000 adults documents the health of Hispanics of various backgrounds in four urban communities in the U.S.

Unraveling the Hispanic Paradox

Happy latin family enjoy lunch outdoor at home on patio - Grandparents, parents and children lauging and hugging each other.About 30 years ago, researchers reported that Hispanics in the United States lived longer and had lower rates of heart disease than their non-Hispanic white counterparts. This is despite having high prevalence of risk factors for heart disease, such as obesity and diabetes, and experiencing stress from discrimination and low wages.

Heart disease killed 696,962 persons in the U.S. last year. The causes involve interactions between genetics and environmental factors such as smoking, leading a sedentary lifestyle and consuming a high fat diet. These behaviors contribute to heart disease and stroke.

Stress also contributes to heart disease. How people react to that stress is important, too. The extent to which our language facilitates how we process our emotions in response to stress may therefore be important in heart disease. For that reason, the Spanish language may offer an advantage. Having lived a bilingual life, I believe this to be true.

This seeming paradox between Hispanics’ higher health risk yet lower overall rate of heart disease came to be called the Hispanic Paradox. Prior to the COVID-19 pandemic, Hispanics lived on average three years longer than their white counterparts, according to the Centers for Disease Control and Prevention.

The cause of this resilience has been a topic of interest to researchers for decades. They have proposed explanations from statistical bias to bean consumption to cultural values such as “familismo,” the notion that the Hispanic culture places family over the individual.

Family ties alone can’t explain the Hispanic Paradox

I became intrigued by this phenomenon when I joined the Hispanic Community Health Study in 2008. My first attempt at finding an explanation for the Hispanic Paradox led me to investigate whether the family unit might offer some protection against early life stress.

In that work, I estimated the prevalence of adverse childhood experiences in Hispanics in the U.S. If the family was a source of resilience, I expected to find low rates of experiences of abuse, neglect or family dysfunction. But to my surprise, the prevalence of these adverse events was actually quite high in those populations. In fact, 77% of the target population reported experiencing at least one adverse childhood event, and about 29% reported experiencing four or more before the age of 18.

That led me to the realization that the source of the resilience seen in the Hispanic Paradox did not necessarily come from the safety net of family.

Exploring how culture could contribute

I next turned my attention to other cultural resources such as social support and optimism, factors that may buffer the impact of stress.
The Conversation

Is the Hispanic culture more optimistic than the American culture? Having an optimistic view can help people think about stress as being temporary and manageable. Optimism can make a person feel they can cope with stress.

I came across a paper on the positivity of human language. The researchers had developed a “happy index” that they applied to measure the number of positive words in a variety of sources from several different languages. They analyzed books, newspapers, music lyrics and tweets, for instance.

A figure in the paper showed the distribution of the happy index across sources and languages. The result was startling. The sources with the highest happy index ratings were those in Spanish!

Once I identified the Spanish language as a focus, the pieces began falling into place. I relied on linguistic analyses to examine the role of language in emotion. A current theory of emotion describes how people need language in order for their brains to construct emotions. Research shows that emotions influence how blood pressure and heart rate react to and recover from stress. And our reactions and recovery from stress play a central role in the development of heart disease.

In other words, the rich and positive emotion lexicon of the Spanish language may not only influence culture over time, but also influence our emotional reaction to stress.

The contribution of verbs

However, it may not only be the positive words that are contributing to better cardiovascular health in Hispanic populations. There are other features of the language that facilitate emotional expression.

Take, for example, the two forms of the verb “to be.” In English, we simply “are.” But in Spanish, we can be a certain way temporarily – “estar” – or more permanently, “ser.” This comes in handy when considering negative situations. In English I could be overweight. In Spanish I can be permanently overweight, which translates to “ser gorda,” or I could be temporarily overweight, or “estar gorda.” The latter is transient and entertains the possibility of change, which can itself encourage motivation towards change.

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Spanish is one romance language that makes use of the subjunctive form of verbs. The subjunctive expresses hypothetical situations, wishes and possibilities. For instance, consider the “magical realism” of the Colombian author Gabriel García Márquez. His use of the subjunctive facilitated the possibility of alternative realities.

The Spanish language’s ability to minimize and exaggerate by the simple addition of a suffix also increases the range of emotions and perceptions. This is how the therapist in the example helped his patient persevere through a difficult phase of therapy.

While English is the language of science – precise and succinct – my hunch is that the flowery nature of Spanish contributes to a culture that supports emotional expression. In doing so, it can help its speakers manage the responses to stress.

DUSON Launches New Center Focused on Latino Adolescent, Family Health

DUSON Launches New Center Focused on Latino Adolescent, Family Health

Latinos are the largest and youngest racial minority group in the U.S. – representing roughly a quarter of all people younger than 30 years old.

Duke University School of Nursing’s new Center for Latino Adolescent and Family Health (CLAFH) serves to engage in the health care of the Latino community by addressing the inequities facing it and by promoting the overall wellbeing of Latino youth and their families.

The Center was founded by its director Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, AAHIVS, FAAN, dean, Duke School of Nursing, and vice chancellor for nursing affairs, Duke University, with a mission to reduce health inequities and promote overall wellbeing among Latino adolescents and their families. CLAFH accomplishes that mission through its four key thematic areas:

  • Meaningfully engages the Latino community to identify, understand and collaboratively address the underlying drivers of health and social inequities.
  • Strengthening the role of families in supporting adolescent and young adult health and life opportunities through the development and evaluation of family-based interventions.
  • Developing and evaluating innovative, nurse-driven models of health care delivery that improve access to and utilization of prevention and treatment services in underserved communities.
  • Promoting the scale-up of evidence-based interventions in underserved communities to drive real-world impact, locally and nationally.

CLAFH has several current research projects in progress, including:

  • The Nurse Community-Family Partnership (NCFP) Program: Increasing COVID-19 Testing in Underserved Communities
    • As part of NIH’s Rapid Acceleration of Diagnostics in Underserved Communities (RADx-UP) initiative, CLAFH has been conducting this randomized controlled trial to see how effective NCFP is at increasing COVID-19 testing, vaccination and mitigation behaviors and reducing secondary sequelae among families in structurally disadvantaged communities.
  • Families Talking Together Plus (FTT+)
    • FTT+ is a remotely delivered, parent-based intervention that CLAFH has been analyzing to check the effectiveness of FTT+ at delaying sexual debut and informing correct and consistent condom use in youth who are sexually active.
  • Exploring Father-Son Relationships to Promote Adolescent Life Opportunities
    • The objective of this mixed-methods study is to learn more about how the father-son relationship can impact adolescent male academic/economic, social and behavioral resilience in the context of large-scale societal events.
  • Research Focused on Latino Sexual Health
    • Two central areas of CLAFH’s research are investigating Latino sexual health disparities and developing interventions to prevent STIs and unplanned pregnancies.
  • Latino-Focused Global Research
    • CLAFH’s work includes research, educational partnerships and service in Mexico and the Spanish-speaking Caribbean.

CLAFH offers research opportunities to Duke University students and welcomes collaborations with researchers and research institutions that are interested in projects related to Latino health and social welfare disparities.

CLAFH also houses the Latinx Comprehensive Development of Empowered Leaders Against AIDS Institute [DILES (Tell Them) Institute]), a year-long program for fellows wanting to end the HIV epidemic for Latino men. Throughout the program, participants will be instilled with leadership skills to assist them in guiding substantial change in their communities. The application process will open later this fall.

Associates in Research Adam Benzekri and Marco Thimm-Kaiser join Ramos as members of CLAFH’s core team, in addition to María de Lourdes Rosas López, CLAFH’s primary collaborator in Mexico and an Universidad Popular Autónoma del Estado de Puebla professor.

For more information, visit the CLAFH website, or email the team.

Why FNPs are Becoming the Indispensable Health Care Providers in Latinx Communities

Why FNPs are Becoming the Indispensable Health Care Providers in Latinx Communities

Family nurse practitioners (FNPs) are needed now more than ever, especially in our fast-growing-but-underserved Latinx communities.

Latinx patients disproportionately report not having a usual source of healthcare and face challenges when trying to find a provider. They are also more likely to live in a community that is experiencing a provider shortage, so they often seek out care in community health centers.

FNPs are more likely to work in these health centers and can ensure Latinx families have access to the care they need.

Dedicated to Diversity and Inclusion

In Arlington County, home of Marymount University’s physical campus, Latinx residents comprise 20-25 percent of the population, the largest concentration in the state. Marymount University’s student population reflects the local demographic, with 25 percent of its undergraduate students identifying as Latinx or Hispanic.

Marymount is dedicated to the idea that diversity is a shared value lived by students, faculty, and staff. Those efforts were recognized when they were named the first Hispanic-Serving Institution (HSI) in Virginia.

Marymount also supports its Latinx students through a recent initiative called ¡Avanzamos! (“Moving Forward Together”), which ensures campus-wide programs and student-success efforts include issues that impact their Latinx student population. ¡Avanzamos! is part of a larger effort to promote diversity and inclusion entitled, “You Belong Here,” which brings together students, faculty, and staff who understand the challenges and needs associated with discrimination and inclusion.

Explore Marymount University’s Online FNP Programs

The time has never been better for nurses who want to complete a Family Nurse Practitioner program. Marymount’s online nursing programs prepare nurses for a career as an FNP, allowing them to help underserved populations across the country, including Latinx communities.

Marymount offers several FNP programs for nurses with various levels of education.

For BSN-prepared nurses, Marymount’s online DNP-FNP program teaches skills needed to be a nurse leader who not only offers compassionate care but improves patient outcomes by providing the best patient care across multiple populations in a complex, ever-changing environment.

Marymount’s CCNE-accredited online MSN-FNP program, also designed for nurses with a BSN, utilizes a curriculum strongly focused on ethics and evidence-informed care. Learn from practicing FNPs who are experts in their field and translate theoretical knowledge from the sciences and humanities into the delivery of advanced nursing care to diverse populations.

Marymount’s FNP post-master’s online certification prepares nurses who already have an MSN degree to build on existing knowledge to optimize patient care and be at the forefront of the ever-changing healthcare landscape.

Marymount’s online FNP programs offer a unique opportunity to balance work and school, achieve career goals, and obtain the knowledge and skills needed to sit for the AANP or ANCC family nurse practitioner certification exam after graduation.

To ensure all students can concentrate fully on working and studying, Marymount’s Clinical Placement Team coordinates all aspects of the clinical placement process to ensure the successful completion of clinicals at a placement site within a reasonable distance to the student’s home.

For answers to frequently asked questions and to learn more about Marymount’s online FNP programs, visit Marymount’s BSN to DNP-FNP, BSN to MSN-FNP, or post-master’s FNP certificate program pages.

National Survey Shows Hispanic Mothers Want Support for their Infant Feeding Choices

National Survey Shows Hispanic Mothers Want Support for their Infant Feeding Choices

Hispanic mothers want to continue making their own infant feeding decisions and they want unrestricted access to infant feeding information, according to a recent national survey. The new survey also shows that Hispanic mothers in the United States do not agree with hospital or government policy that limits their access to educational information on infant formula and samples during their hospital stay.

The nationally representative survey of mothers with children under 12 months was conducted by the bipartisan team of Greenberg Quinlan Rosner Research (GQRR) and Public Opinion Strategies (POS) and sampled opinions of more than 1,000 moms (210 of which identified as Hispanic).

“Hispanic mothers are telling us that they want to feel supported by hospitals and health care providers whether they choose to breastfeed or formula feed,” says Anna Greenberg, Senior Vice President at GQRR. “Being fully informed is important to moms and they trust hospitals to not restrict their access to infant feeding information and formula samples.”


Key Findings

  • 62% of Hispanic mothers have already decided how to feed their babies before entering the hospital
  • 79% of Hispanic mothers get infant feeding information from their doctors and nurses
  • Hispanic moms reported not being able to produce enough breast milk, having to go back to work or school, and the cost of a breast pump as the three biggest barriers to feeding their baby breast milk
  • 93% of Hispanic mothers said restricting the use of formula in the hospital would not have changed their decision on whether or not to breastfeed or how long they breastfed
  • 91% of Hispanic mothers approve of hospitals giving out hospital discharge bags with infant formula samples and 83% said they used the samples they were given
  • 72% of Hispanic mothers opposed hospital policies that restrict hospital discharge bags with infant feeding information and infant formula samples and 82% opposed government restrictions on hospitals hospital discharge bags

“The National Association of Hispanic Nurses (NAHN) believes that breastfeeding is the ideal infant feeding choice. However, we also believe it’s important that moms receive information on both breastfeeding and infant formula,” says Jose Alejandro, President of NAHN. “According to the new survey, only 55% of Hispanic moms polled reported receiving educational material on infant formula. Hispanic mothers that do not receive information on safe preparation and use of formula may be at a disadvantage.”

When asked what actions could help increase breastfeeding in the United States, 24% of Hispanic mothers said, “guaranteeing paid maternity leave or longer maternity leave” and 28% of Hispanic mothers who received health and nutrition assistance through Women, Infants, and Children (WIC) said, “providing more support from health care professionals after mothers leave the hospital, including home visits following birth.” Hispanic moms also said they would like more breastfeeding support in the workplace.

“These are areas where health care providers, the government, and employers could do more to support Hispanic mothers to increase breastfeeding initiation and duration rates,” Alejandro adds.

Hispanic mothers identified a number of other barriers that either prevented them from initiating or continuing breastfeeding—the most common of which include the inability to produce enough milk and problems associated with breastfeeding (e.g., sore or cracked nipples, engorged or leaking breasts, breasts infected or abscessed).

“Many Hispanic mothers want to breastfeed,” states Greenberg, “but oftentimes they realize that when it’s time to go back to work, continuing to exclusively breastfeed and maintain their milk supply can be difficult without adequate support.”

For more information, contact Celia Trigo Besore, MBA, CAE, Executive Director & CEO, National Association of Hispanic Nurses, [email protected].

Una nueva herramienta móvil

The Spanish-language version of the all-purpose government portal is now even more accessible at A mobile version was released earlier this year, aimed at some of the most active portable Web users, Hispanics.

Through the mobile version’s website,, Spanish-speaking users can access current news and search for government information on their smart phones.

The Pew Internet and American Life Project recently reported that Hispanics are not only some of the most active users of Web-enabled cell phones, but also use their mobile devices to a fuller extent than other populations.

Topics on the site include employment news, government benefits, and health recalls. The mobile version of GobiernoUSA. gov also facilitates filing taxes for free and monitoring changes in airport security, among other things. The content has been modified for mobile devices with stripped-down text and fewer images for faster loading and easier reading.

Helpful sister sites of include, the Federal Citizen Information Center, and, the Spanish language version of the federal Consumer Action Website.