failed to recognize that calling 911 was the appropriate first response to heart attack and stroke. In contrast an earlier study , revealed about one in ten Hispanic women did not know to call 911 as a first response to either a heart attack or stroke, while
another study reported that approximately one in eight African-American men answered incorrectly about calling 911 in response to someone having symptoms. Since not being transported by ambulance to the acute care setting is a risk factor for delayed treatment, measures to encourage Hispanic men to access emergency care by calling 911 would likely yield benefit. Finally, the analysis revealed a substantial gap in knowledge of heart attack and stroke symptom knowledge among U.S. Hispanic men. U.S. adult Hispanic men earning low scores on composite heart attack and stroke knowledge questions were more likely to be less educated, to have deferred medical care because of cost, to not have an identified health care provider and to be uninsured. Earlier studies indicated that this was true also for Hispanic women , although a lower income in Hispanic women was also a significant predictor of low heart attack and stroke symptom knowledge. The relationship between living in low income households and low heart attack and stroke symptom knowledge is consistent with earlier studies for both African-American men and AfricanAmerican women. Several potential limitations to this study should be noted. First, the survey is based on telephone derived data and may be skewed if those who did not participate were less likely to recognize symptoms. For example, persons of lower socioeconomic status may have been excluded because of poorer phone access. Since lower socioeconomic status correlates with lower symptom awareness, our findings could underestimate knowledge or the gap between lower socioeconomic status and other Hispanic men. However, the fact that the vast majority of Americans live in households with phones minimizes this bias. A second limitation is that the survey consists of close ended questions and this may result in an overestimation of knowledge. A differently formatted survey might have yielded different results. Third, Hispanic immigrants newly arrived to the U.S. may not be willing to participate in a phone survey if they feared their immigration status could be jeopardized—introducing a selection bias. On the positive side, a strength of the study is the large number of individuals surveyed yielding a nationally representative sample. In conclusion, these findings support the value of analyzing the differences within a population group and that there is a gap in symptom awareness for stroke and heart attack among Hispanic men compared to other population groups in the US. As the results revealed 69% of the sample had at least a high school education, 59.5% had health insurance and 55% of the sample had an identified health care provider. However, the multivariate analysis of the group shows there were significant within-group differences. Targeting educational efforts toward older
(C55 years) Hispanic men with less than a high school education, those who do not have an identified health care provider or health insurance, and who were deferring health care because of cost would perhaps be ways to improve the outcome of acute vascular events among the Hispanic adult male population. By educating this group of U.S. Hispanic men on signs and symptoms of heart attack and stroke and knowing how to seek care, the public health status could be improved. Early intervention could potentially improve morbidity and mortality outcomes leading to less public health care costs such as long term rehabilitation, Medicare and Medicaid support and social security disability costs