Residents Of Miami-Dade County Research Articles

Living with water: Evolving adaptation preferences under increasing sea-level rise in Miami-Dade County, FL, USA

Great uncertainty exists about household responses to intensifying sea-level rise and related flooding, especially about when residents may consider relocation. Understanding how preferences for in-situ adaptation versus climate mobility evolve through time across communities with varying capacities can help identify policy solutions suited to a range of community needs. We present an analysis of 40 interviews and 597 survey responses from residents of Miami-Dade County, FL, USA—an area of substantial and increasing flood-related risk where concerns related to climate mobilities are emerging. We integrate new flood hazard models depicting chronic inundation and 1%-annual-chance flooding with street-level detail under increasing sea-level rise, which when combined with the interview and survey data reveal the multiplicities of spatiotemporal risk. Overall, we find that up to 75% of all participating respondents have experienced precipitation-based flooding in recent years, and “new normal” experiences of inundation are already reshaping current decisions to move. However, up to 57% of survey respondents preferred in-situ adaptations over moving away, highlighting a need for society-wide commitments to long-term adaptation. Socioeconomic pressures dominated climate mobility considerations among interview and survey respondents, raising climate justice concerns over socially inequitable mobility outcomes. Examinations of differential climate mobility pressures and preferences for adaptation increase understanding of the transformations reshaping coastal communities today to guide more equitable societal adaptations in the future.

Abstract P3-12-08: Neighborhood disadvantage predicts worse breast cancer-specific survival

Abstract BackgroundAlthough advances in screening, detection, diagnosis, and treatment have reduced overall breast cancer mortality, well-documented socioeconomic and racial/ethnic disparities persist. The objective of this study was to utilize the area deprivation index (ADI), a compositive measure of neighborhood disadvantage, on breast cancer survival in South Florida, predominantly consisting of Miami-Dade County residents. The ADI is based on a measure created by the Health Resources & Services Administration (HRSA) over three decades ago, and has since been refined, adapted, and validated to the Census Block Group neighborhood level. The ADI score (1-10) includes factors from the domains of income/employment (e.g., median family income), education (e.g., % population >25 with <9 years of education), housing (e.g., % occupied housing without complete plumbing), and household characteristics (e.g., % single-parent households with children <18). MethodsPatients treated at our medical campus, comprised of both a safety-net hospital and an adjacent academic cancer center, with stage I-IV breast cancer from 2005-2017 were identified from our local tumor registry. Our main outcome of interest was breast cancer-specific survival (BCSS). The ADI was calculated for each patient at the census block group level using the University of Wisconsin Neighborhood Atlas (https://www.neighborhoodatlas.medicine.wisc.edu/mapping) and categorized into tertiles. Random effects frailty models were conducted, controlling for patient and tumor characteristics [grade, stage, receptor status (ER+/HER-, ER+/HER2+, ER-HER2+, ER-/HER2-)], and NCCN-guideline appropriate treatment. ResultsThe study population was 5,377 breast cancer patients with 55.5% being Hispanic, 27.0% being non-Hispanic White (NHW), and 17.5% being non-Hispanic Black (NHB). The distribution of NHB was highest in the most disadvantaged neighborhoods compared to NHW and Hispanics (p<0.001). In addition, more uninsured patients lived in the most disadvantaged neighborhoods compared to those with any type of insurance. After controlling for multiple covariates including comorbidities, race/ethnicity, insurance status, and tumor subtype, we found that those individuals living in the most disadvantaged neighborhoods (highest ADI tertile) had a significantly increased hazard of breast cancer specific death compared to those living in the most advantaged neighborhoods (T2: HR: 1.27 95% CI: 1.00, 1.63, p<0.05 and T3: HR: 1.5 95% CI 1.17, 1.91, p<0.05). ConclusionThis study is the first to evaluate BCSS through the lens of the ADI, a composite measure of neighborhood advantage and disadvantage using census block group data reflective of social determinants of health domains spanning income, education, employment, and housing quality. Our study suggests that breast cancer survival disparities are partly influenced by neighborhood disadvantage. Even when accounting for sociodemographics, tumor characteristics, and NCCN-guideline appropriate treatment, survival disparities remained, suggesting potential social and environmental factors impacting survival. To address these disparities, effective interventions are. needed that account for the social and environmental contexts in which cancer patients live and are treated. Table: ADI (Tertiles) and Breast Cancer-Specific SurvivalHR (95% CI)Area Deprivation Index (vs. most advantaged)ADI Tertile 21.27 (1.00, 1.63)ADI Tertile 3 (more disadvantaged)1.50 (1.17, 1.91)Race (vs. NHW)Hispanic0.94 (0.72, 1.22)NHB1.71 (1.27, 2.31)Age1.02 (1.01, 1.02)Insurance (vs. Private)Government1.49 (1.19, 1.86)Insurance, NOS0.97 (0.62, 1.51)Uninsured1.15 (0.87, 1.52)Unknown1.19 (0.78, 1.82)Receptor Status (vs. ER+/HER2-)ER+/HER2+1.40 (1.06, 1.86)ER-/HER2-2.11 (1.70, 2.60)ER-/HER2+1.20 (0.85, 1.69)Unknown0.88 (0.51, 1.51)Body Mass Index (vs. Normal Weight (18.5 – 24.9)Underweight (Less than 18.5)1.40 (0.72, 2.72)Overweight (25.0 – 29.9)0.70 (0.56, 0.88)Obese (> 29.9)0.79 (0.63, 0.98)Hypertension0.84 (0.67, 1.03)Diabetes Mellitus1.02 (0.74, 1.40)NCCN-guideline concordant Treatment0.84 (0.75, 0.94) Citation Format: Neha Goel, Seraphina Choi, Sina Yadegarynia, Kristin Rojas, Susan Kesmodel, Erin Kobetz, Ashly Westrick. Neighborhood disadvantage predicts worse breast cancer-specific survival [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-08.

For Better or Worse: an Assessment of the 'Linked Lives' Concept and the Race-Based Effects of Partner Stress on Self-Rated Health Among Older Adults.

The purpose of this study was to assess the utility of the life course framework concept of "linked lives" for examining the effects of partner stress on self-rated health among older adult populations. Data were derived from a partner-dyad study of Miami-Dade County residents and their significant others. We limited our analysis to respondents ages 60 or older (n = 409). Regression analyses revealed that greater levels of personally experienced major life events were associated with worse self-rated health. However, the association between a significant other's stress exposure and one's own self-rated health was only statistically significant among Black respondents. Extending prior study indicating that Black Americans tend to have worse self-rated health later in life relative to other racial groups, these findings demonstrate the utility of the linked lives concept for furthering an understanding of racial disparities in health based upon loved ones' stressful experiences.

Abstract P5-13-03: The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital

Abstract Background: There are disparities in breast cancer (BC) diagnosis. Black and Hispanic women have a lower rate of screening mammography while the uninsured are less likely to seek medical care even if a palpable mass is found in the breast. Jackson Memorial Hospital is the Safety-Net Hospital that serves the 2.5 million residents of Miami-Dade County which is the most populous county in the State of Florida. The Affordable Care Act (ACA) was signed into law on March 3, 2010 and the goal was to increase the number of insured individuals. In January 2011, it was mandated that health insurance providers cover the cost of screening mammograms. The decision to expand Medicaid was left to the individual states. Florida did not expand Medicaid coverage. Prior to the implementation of the ACA it was estimated that 25-35% of the residents of Miami-Dade County were uninsured or underinsured. By January 2017, more than 1.3 million Floridians had signed up for health insurance through the ACA. Currently almost one in five Americans receiving health coverage via Healthcare.gov or the Spanish language version, CuidadodeSalud.gov, resides in Florida. South Florida is home to the eight congressional districts with the highest concentrations of ACA enrollees in the US. The top 38 zip codes for ACA sign-ups in Florida are in South Florida. We postulated that evaluating the number of patients diagnosed, the stage at which they are diagnosed and the type of insurance used for the period of time 6 years before (2007-2012) and 4 years after the implementation of the ACA (2014-2017) should give a picture of the effect of the ACA on breast cancer diagnosis in an underserved population. Methods: A retrospective review of patients diagnosed with invasive and in situ breast cancer at the Breast Diagnostic Center at Jackson Memorial Hospital between 1/1/2007 – 12/31/2017 was approved by the University of Miami IRB. We collected data including: age, stage at diagnosis and type of insurance. In keeping with other similar studies, the year 2013 was excluded since it was a transition period. The trends were compared using ANOVA and chi-squared tests. Results: A total of 2155 patients were analyzed. The absolute number of patients with stage 0 seen every year remained stable (30 per year) throughout the time period. The percentage of patients with Stage 0 increased from 12.5% to 16.02% (p=0.049).Both the absolute number and percentage of patients with stage IV decreased, from 15 to 8 patients per year (6.42% to 4.12% (p=0.016)). The total number of patients diagnosed yearly with breast cancer decreased from 233 to 186 (p= 0.005). The absolute number and percentage of insured patients increased from 75 to 126 patients per year (23.5% to 38.3% (p= 0.02)). Conclusions: Fewer patients were diagnosed with breast cancer at the safety net hospital in Miami-Dade County after the initiation of the ACA. More patients had insurance and there was a stage shift towards lower stage at presentation. Availability of insurance to residents of Miami-Dade County decreased the burden on the safety net hospital and resulted in the diagnosis of lower stage breast cancer. Citation Format: Sandoval Leon AC, Ghanta S, Richardson A, Kesmodel S, Hurley J. The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-03.

The effect of park renovation on civic trust: a survey experiment approach

ABSTRACTWhile urban planners often cite public park revitalization as a means of improving community civic trust, there is limited research that verifies this practice. To address this gap, this study utilizes a survey experiment with Miami-Dade County residents living near a park undergoing renovation. The study finds that informing people about the renovation can increase civic trust relative to not informing them. The benefits of this research are twofold: the survey experiment methodology serves as a cost-effective means of comparing design elements while the findings confirm and extend conventional wisdom regarding the effect of park revitalization on civic trust.

The social meaning of Spanish in Miami: Dialect perceptions and implications for socioeconomic class, income, and employment

In this study, we investigate the ways in which three national-origin varieties of Spanish commonly heard in metropolitan Miami—Cuban, Colombian, and Peninsular—are conceptualized by young adult residents of Miami-Dade County in terms of implicit perception. Further, we test whether or not perceptions about Spanish can predict social outcomes in the domains of labor, employment, and income. Three male residents of Miami were asked to read a text in their home variety of Spanish. All men were college educated in their respective countries of origin (Cuba, Colombia, and Spain) and are professionally employed in Miami. For each voice heard, participants were given background information about the speaker, including the parents’ country of origin. In some cases, the parents’ national-origin label matched the country of origin of the speaker (Speaker: Cuba, Origin-label: Cuba), but in other cases, the background information and voices were mismatched (Speaker: Cuba, Origin-label: Spain). This manipulation allows us to separate the perceptions based on the elements of the speech signal from the provided social information. Participants were asked to rate the voice/background permutations on five-point Likert-scales for a range of personal characteristics. Data were analyzed for significance using a three (dialect) X four (label) within-subjects ANOVA with a series of specific statistical contrasts. Our analyses of these judgments showed three kinds of significant effects: (1) main effects of language variety, (2) main effects of the background label, and (3) interaction effects. Overall, we find that adolescent Latin@s in Miami-Dade exhibit divergent perceptions of national-origin varieties of Spanish and that they use sociolinguistic differences to make predictive judgments about nonlinguistic, social attributes related to socioeconomic class, including family wealth, personal income, and profession.

Host outdoor exposure variability affects the transmission and spread of Zika virus: Insights for epidemic control.

BackgroundZika virus transmission dynamics in urban environments follow a complex spatiotemporal pattern that appears unpredictable and barely related to high mosquito density areas. In this context, human activity patterns likely have a major role in Zika transmission dynamics. This paper examines the effect of host variability in the amount of time spent outdoors on Zika epidemiology in an urban environment.Methodology/Principal findingsFirst, we performed a survey on time spent outdoors by residents of Miami-Dade County, Florida. Second, we analyzed both the survey and previously published national data on outdoors time in the U.S. to provide estimates of the distribution of the time spent outdoors. Third, we performed a computational modeling evaluation of Zika transmission dynamics, based on the time spent outdoors by each person. Our analysis reveals a strong heterogeneity of the host population in terms of time spent outdoors–data are well captured by skewed gamma distributions. Our model-based evaluation shows that in a heterogeneous population, Zika would cause a lower number of infections than in a more homogenous host population (up to 4-fold differences), but, at the same time, the epidemic would spread much faster. We estimated that in highly heterogeneous host populations the timing of the implementation of vector control measures is the major factor for limiting the number of Zika infections.Conclusions/SignificanceOur findings highlight the need of considering host variability in exposure time for managing mosquito-borne infections and call for the revision of the triggers for vector control strategies, which should integrate mosquito density data and human outdoor activity patterns in specific areas.

Abstract C27: Breast cancer presentation in a cohort of Afro-American women and Afro-Caribbean women diagnosed at University of Miami/Jackson Memorial Hospital

Abstract Background: It is documented that socioeconomic factors, such as lack of access to health care and inadequate treatment after diagnosis contribute to disparities in breast cancer, but these factors alone do not explain breast cancer disparities. Several studies suggest that several other factors, such as environmental, biological and behavioral factors may play a significant role in the observed disparities in breast cancer outcomes in women in minorities. In this study we compare Afro-Caribbean (AC) women born in the Caribbean and living in the United States and Afro-American (AA) women born and living in the United States, with a diagnosis of breast cancer in order to evaluate the effect of immigration and place of residency. Methods: We conducted a retrospective chart review study of black women of AA and AC origin diagnosed with breast cancer at University of Miami/Jackson Memorial Hospital between 2005 and 2015 (n = 745). For each of the groups, we collected demographic data including age, body mass index (BMI), menopausal state, and TNM stage, receptor expression of estrogen and progesterone, Her-2/neu expression, gravidity and parity. Continuous data were analyzed using independent samples t-tests when parametric and using Wilcoxon-Mann-Whitney tests when non-parametric; categorical and binary data were analyzed using Chi-squared tests. Results: We analyzed data from 745 black female patients: AA (n = 281) AC (n = 422). Place of birth was not available for 42 women. Mean age was 54.9 and 53.7 in AC and AA women, respectively. AA women had higher BMI (32.1 vs 29.8, p = 0.0001), lower proportion of HER2 positive breast cancer (12% vs 19%, p = 0.027) and more children (3.1 vs 2.8, p = 0.023) than AC. There was no difference in age (54.9 vs 53.7), premenopausal status (33% vs 31%), stage 3 or 4 (38% vs 37%), ER+ (63% vs 62%) or triple negative breast cancer (27% vs 31%) in AC compared with AA women (Table 1). Conclusion: Jackson Memorial Hospital is a Safety-Net hospital for the 2.4 million residents of Miami-Dade County. The average age of our cohort was 54 years, ER 63% positive, Stage 3 was 27% and triple negative breast cancer was 29%. Compared to SEER data, our patients developed breast cancer one decade earlier, had a higher rate of triple negative breast cancer and higher stage at presentation. This was not affected by immigration status although the AC women were thinner and had fewer children. Table 1.ACAAAAUSA(UM/JMH)(UM/JMH)(SEER)(SEER)Age55545863Age <50y29%35%25.7%18.3%Stage 3 or 438%37%19.3%12.8%ER+63%62%73%84%Her-2+19%12%19.7%16.1%Triple Negative27%31%11.9%5.5% Citation Format: Rochelle Marill, Keren Braithwaite, Jorge Monge, Diana Byrnes, Sophia George, Judith Hurley. Breast cancer presentation in a cohort of Afro-American women and Afro-Caribbean women diagnosed at University of Miami/Jackson Memorial Hospital. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C27.

Strategies to Improve HIV Testing in African Americans

Only 17% of Miami-Dade County residents are African American, yet this population accounts for 59% of the county's HIV-related mortality. The Centers for Disease Control and Prevention recommend annual testing for persons at increased risk for HIV, but 40% of African Americans have never been tested. OraQuick® (OraSure Technologies, Inc., Bethlehem, PA), the first US Food and Drug Administration-approved home-based HIV rapid test (HBHRT), has the potential to increase testing rates; however, there are concerns about HBHRT in vulnerable populations. We conducted focus groups in an underserved Miami neighborhood to obtain community input regarding HBHRT as a potential mechanism to increase HIV testing in African Americans. We queried HIV knowledge, attitudes toward research, and preferred intervention methods. Several HIV misconceptions were identified, and participants expressed support for HIV research and introducing HBHRT into the community by culturally appropriate individuals trained to provide support. We concluded that community health workers paired with HBHRT were a promising strategy to increase HIV testing in this population.

Barriers to Colorectal Cancer Screening Among Miami-Dade County Residents

Barriers to Colorectal Cancer Screening Among Miami-Dade County Residents

Depressive symptoms and bodily pain: the role of physical disability and social stress

This study evaluates the bi-directional association between depressive symptoms and bodily pain, and examines the role of physical disability and perceived social stress in the depression-pain relationship. Data are employed from a two-wave panel study of Miami-Dade county residents (n = 1,459) that includes a substantial over-sampling of individuals who identify as physically-disabled. Findings indicate that the bi-directional relationship between depression and pain is similar for those with and without a physical disability. Results also demonstrate that stress exposure, specifically recent life events and daily discrimination, partially mediated the relationship between prior levels of depression and changes in pain. Directions for future research and the need for a more comprehensive model of health incorporating physical, psychological, and social factors are discussed.

Interview with a Quality Leader

Dr. Paul Gluck, MD, FACOG, has held many leadership positions. He served as the president/chair of the William A. Little OB/GYN Society, the Miami OB/GYN Society, the Florida OB/GYN Society, the Baptist Health Foundation, the Health Council of south Florida, the Florida Section of the American College of OB/ GYN (ACOG), National Patient Safety Foundation, as well as the Dade County Medical Association. He is currently ACOG assistant secretary and serves on their Executive Committee. Dr. Gluck has an interest in access to healthcare. For his work in establishing a prenatal clinic in an area of critical need he received ACOG president's Service Award and Humanitarian of the Year Award from the South Florida Perinatal Network. He led the Florida initiative to promote depression screening and treatment in women recognized by the Wyeth National Section Award. He co-chaired the Governance Committee of the Mayor's Task Force charged with solving the problem of providing care for the over 450,000 uninsured residents of Miami-Dade County.

Physical Limitations and Depressive Symptoms: Exploring the Nature of the Association

Although evidence suggests that physical disability and depression may be reciprocally related, questions of causality versus spuriousness and the direction of causality remain to be confidently answered. This study considered the hypothesis of reciprocal influence; the possibility of spuriousness in relation to pain, stress, and lifetime major depression; and the possible mediating effects of pain and social stress. We analyzed data from a two-wave panel study of Miami-Dade County residents (n = 1,455) that included a substantial oversampling of individuals reporting a physical disability. Results indicated that, although prior levels of physical limitations predicted changes in depressive symptoms, there was no evidence of the reverse association. Results also indicated that part of the association between prior physical limitations and changes in depressive symptoms was explained by intervening level of pain and, to a lesser extent, by the day-to-day experience of discrimination. Much of whatever causation may be involved in the linkage between physical limitations and depressive symptomatology flows from limitations to depression rather than in the reverse direction. Results also make clear that this linkage is not an artifact of shared associations with pain, social stress, or lifetime major depression.

Short-Term Impact Evaluation of a Social Marketing Campaign to Prevent Syphilis Among Men Who Have Sex With Men

We carried out an independent short-term impact evaluation of a social marketing campaign designed to reduce syphilis infections among men who have sex with men in south Florida in 2004. Venue-based surveys were conducted shortly after the campaign began and 6 months later to assess changes in exposure to campaign materials, awareness, knowledge about syphilis, perceptions of risk, sexual behavior, clinic visits, and testing and treatment for syphilis among participants. Exposure to social marketing campaign materials increased from 18.0% at baseline to 36.5% at follow-up (P< .001). Awareness of syphilis and perceptions of risk increased among Broward County residents but not among Miami-Dade County residents. Risky sexual practices and patterns of recreational drug use did not change. No significant increases in knowledge, clinic visits, or testing or treatment for syphilis among participants were detected over the 6-month study period. None of the campaign objectives were fully met. The interventions were insufficient to produce a significant impact among men who have sex with men in south Florida.

Comparison of Stage at Diagnosis of Melanoma Among Hispanic, Black, and White Patients in Miami-Dade County, Florida

To compare stage at diagnosis of melanoma between non-Hispanic white, non-Hispanic black, and Hispanic patients. Retrospective analysis. Melanoma cases reported to the Florida Cancer Data System, with known stage and race/ethnicity information, for residents of Miami-Dade County, Florida, from 1997 to 2002. Those diagnosed as having melanoma according to the Florida Cancer Data System. Stage of melanoma at diagnosis. Of the 1690 melanoma cases reported with both stage and race/ethnicity information, 1176 (70%) were among non-Hispanic white patients, 485 (29%) were among Hispanic patients of any race, and 29 (2%) were among non-Hispanic black patients. Late-stage (regional and distant) diagnosis was more common among Hispanic (26%) and non-Hispanic black patients (52%) compared with non-Hispanic white patients (16%) (P < .001). Advanced stage of melanoma diagnosis among Hispanic and black patients suggests suboptimal secondary prevention efforts in minority populations.

Planning for long-term care: concept, definition, and measurement.

This study explores the development and testing of an instrument to measure long-term-care planning behavior. Researchers operationalized proposed constructs and response styles as statements in a questionnaire. A telephone survey involved 150 randomly selected residents of Miami-Dade County, Florida who were between the ages of 55 and 70. Responses underwent exploratory and confirmatory factor analyses and reliability testing. The trimmed long-term-care planning instrument of 23 items had five subscales with high internal reliability (coefficients >.70), a comparative fit index of.987, and a root mean square error of approximation of.050. Responses involved making choices about housing, readiness to use help from family and friends, maintaining one's health, saving and investing money, and not accepting the need to ask for help. Future research of long-term-care planning behaviors can use the instrument. Practitioners may use the instrument as a diagnostic inventory, alone or in combination with personalized educational interventions aimed at increasing awareness of and planning for future dependency and long-term-care assistance.

Latino Naming Practices of Small-Town Businesses in Rural Southern Florida

This article examines naming practices of Latino grocery stores and restaurants in an eighteen-county area of southern Florida. Business names denote cultural affinity and personal whims, and, like other forms of Latino cultural expression, they are drawn from cultural roots of owners and clientele to connote flavor and pride of Latino identity. Unlike other art or literary forms, however, business names reflect a commercial accommodation to techniques and strategies of marketing more than a defiance of mainstream culture or statement of cultural resistance to Anglo society. Their choices are strongly influenced by places and experiences that reflect Latino culture outside local area rather than locales of current residence within southern Florida. (Transmigrant business, farm workers, naming practices and sociocultural identity, population expansion and settlement, southern Florida) ********** Discussing shifting ethnicities that accompany process of globalization, Hall (1991:42) calls identity the ground of action, suggesting that way one identifies is what will most influence one's behavior. Rouse (1992) provides additional discussion on what this might mean for Latino immigrants, for whom, he argues, an alternative framework is needed. He suggests that Latino immigrants maintain interests and commitment to family and town from which they came at same time that they develop another way of viewing world through their experience in a new environment. He calls views from these dual experiences bifocality. This article extends work of these two authors, first by considering expressions of identity in naming practices for grocery stores and restaurants, and then by expanding community of interest beyond migrant laborers to entrepreneurial class within Latino population. To do this assumes that individuals who engage in entrepreneurial activities (specifically establishment and management of a business) may include men and women with backgrounds similar to their clientele. By way of a statistical analysis, I examine formulation of immigrants as members of multiple communities (Chavez 1994) by testing influence of place and experience on naming practices for grocery stores and restaurants. The context for this inquiry is process of Latinoization in areas of southern Florida, chosen for rapid growth of Latino population within southeastern United States and that part of Florida. Increases in Latino and Latino-origin Caribbean people within southeastern United States are similar to processes of Latinoization in other areas of country, notably California, where persons of Mexican ancestry predominate in many towns and small cities (Allensworth and Rochin 1998). At one time, Chicago had largest concentration of persons of Mexican ancestry living outside southwest (de Lourdes Villar 1994), but this has changed. Latinos are increasingly found in metropolitan areas, such as Washington, D.C. (Pessar 1995), and New York City (Sontag 1998) in northeast, or small towns and cities in midwest, such as Garden City, Kansas (Stull, Broadway, and Erickson 1992). Another area of country that draws large numbers of Latinos is southern Florida. The term rural is to be used with caution. Three counties of interest in this article (Palm Beach, Miami-Dade, and Hillsborough) have sparsely populated portions that are devoted to highly productive agriculture, but also have metropolitan urban areas (West Palm Beach, Miami, and Tampa, respectively) for which counties are better known. Residents of Miami-Dade County, for example, distinguish South Dade as southern, agricultural portion of county from northern (Miami) portion (Bryan, pers. comm.; also Greiner et al. 1992:69n). Unlike phenomenon of past decades of concentrated numbers of a single national origin that settle in one region or area (Allensworth and Rochin 1998), several national origins comprise Latino population in counties of southern Florida. …