Hispanics in the United States According to the 2013 U.S. Census Bureau population estimate, there are roughly 54 million Hispanics living in the United States, which represents 16.9% of the total U.S. population. In 2012, among Hispanic subgroups Mexicans ranked the largest at 64.3%, followed by Central and South Americans (14.9%), Puerto Ricans (9.4%), and Cubans (3.7%); U.S. Census Bureau, 2012).

By mid-July 2013, 55% of Hispanics were living in California, Florida, and Texas. In 2012, about 33% of Hispanics were under age 18 in comparison to almost 20% of non-Hispanic whites (Office of Minority Health, 2014a). Nearly two thirds (65%) of all U.S. Hispanics age 5 and older either speak only English at home or speak English very well (Motel & Patten, 2012).

Hispanics tend to highly value the family. Families are very close, broadly defined, and emotionally and financially supportive. This characteristic is referred to as familismo. The eldest male is typically the authority figure, and gender roles are traditional. Important decisions are made by the whole family, not the individual, because they tend to have a collectivist type of social structure. Respect (respeto) is fundamental to communication and relationships. Elders are shown respect, and they are viewed as authority figures within the community. Elders are trusted and often provide child care for the grandchildren (Rhode Island Department of Health, n.d.).

Hispanics place higher value on individuals as opposed to institutions. They tend to trust and cooperate with individuals they know personally, and many dislike impersonal and formal structures. Hispanic customers may identify a health care worker by name rather than by job title or institution. In a professional situation, many Hispanics expect to be addressed formally (e.g., Mrs. Martinez), but also personally (e.g., How are your children?). The length of the social interaction is often viewed to be less important than the quality (Rhode Island Department of Health, n.d.).

Hispanics tend to avoid conflict and criticism and prefer smooth social relations based on politeness and respect (Rhode Island Department of Health, n.d.). Overt disagreement is not considered appropriate behavior. Many Hispanics are characterized by warm, friendly, and affectionate relationships. Personal space is close and frequently shared with family members or close friends. Many Hispanics, particularly if they were not raised in the United States, may avoid direct eye

contact with authority figures or in awkward situations. Many will nod affirmatively but not necessarily mean agreement. Silence may mean failure to understand and embarrassment about asking or disagreeing.

The family is considered a reliable source of health information. The family also is influential in health-seeking behaviors. They generally have a fatalistic worldview and an external locus of control, and this influences their help-seeking behaviors as well. There also is a belief that poor health is the fault of the individual and hence illness is a punishment from God. Expressing negative feelings is impolite, and people from this cultural group may not complain when health