Relationships of nativity and length of residence in the U.S. with favorable cardiovascular health among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Individuals with favorable levels of all readily measured major CVD risk factors (low CV risk) during middle age incur lower cardiovascular morbidity and mortality, lower all-cause mortality, and lower Medicare costs at older ages compared to adults with one or more unfavorable CVD risk factors. Studies on predictors of low CV risk in Hispanics/Latinos have focused solely on Mexican-Americans. The objective of this study was to use data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; enrolled 2008 to 2011) to assess relationships of nativity and length of residence in the US, a commonly used proxy for acculturation, with low CV risk (not currently smoking; no diabetes; untreated total cholesterol 1 heritage. We also tested whether associations varied by Hispanic/Latino background. Women living in the US<10 years were 1.96 (95% confidence interval: 1.37, 2.80) times more likely to be low CV risk than US-born women after adjusting for sociodemographic characteristics, diet, physical activity, and self-reported experiences of ethnic discrimination. Findings varied in men by Hispanic/Latino background, but length of residence was largely unrelated to low CV risk. These findings highlight the role acculturative processes play in shaping cardiovascular health in Hispanics/Latinos

Levels of Participants Satisfaction with Initial Contact and Examination Visit: The Hispanic Community Health Study/ Study of Latinos (HCHS /SOL)

Objective: This study examined perceived satisfaction among Hispanic/Latino individuals who participated in a baseline examination for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large cohort study of 16,415 adults living in four selected communities. Method: An estimated 22% (n= 3,584) of participants completed a questionnaire regarding satisfaction with staff attention, the overall experience during the study examination, and the influence of the informed consent digital video disc (DVD). Results: The majority of participants who completed the questionnaire expressed overall satisfaction with the study. Most participants reported that staff were friendly, courteous and respectful and study test procedures were clearly explained. Participants who preferred to complete the interview in Spanish felt that the informed consent DVD positively influenced their ability to make an informed decision to enroll in the study. Participants who preferred to complete the interview in English tended to report that the baseline examination was longer than expected compared with participants who completed the interview in Spanish. Conclusion: Results demonstrate that culturally and linguistically trained staff and the use of the study’s informed consent DVD were effective in explaining study procedures and positively influenced decisions to participate in the HCHS/SOL study. These results can inform recruitment and enrollment strategies for future participation of minority groups into longitudinal cohort studies. Ethn Dis. 2016;26(3):435-442; doi:10.18865/ed.26.3.435 </p

Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/ Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18–74 years at time of recruitment, from four US metropolitan areas, between March 2008 to June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights, and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking was associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention

Macronutrient Intake, Diagnosis Status, and Glycemic Control Among US Hispanics/Latinos With Diabetes

CONTEXT: Diet modification is a mainstay of diabetes management. US Hispanics/Latinos are disproportionately affected by diabetes, but few studies have examined dietary intake among US Hispanics/Latinos with diabetes, and little is known regarding the influence of diabetes awareness on dietary intake. OBJECTIVE: We evaluated macronutrient intake and its associations with diabetes awareness and glycemic control among US Hispanics/Latinos with diabetes. PARTICIPANTS: This analysis included 3310 diabetic adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011). MAIN OUTCOME MEASURES: Diabetes was defined as diagnosed (based on medical history or antihyperglycemic medication use) or undiagnosed diabetes (based on fasting glucose ≥ 126 mg/dL, glycated hemoglobin [HbA1c] ≥ 6.5%, or 2 h glucose ≥ 200 mg/dL in the absence of a physician diagnosis). Dietary intake was assessed using two 24-hour recalls. RESULTS: Among Hispanic/Latino adults with diabetes, 21.2%, 55.7%, and 71.2% met the American Diabetes Association recommendations for fiber (≥14 g per 1000 kcal), saturated fat (<10% of total energy), and cholesterol intake (<300 mg), respectively. Compared with those with undiagnosed diabetes, people with diagnosed diabetes consumed less carbohydrate (50.3 vs 52.4% of total energy; P = .017), total sugar (19.1 vs 21.5% of total energy; P = .002), added sugar (9.8 vs 12.1% of total energy; P < .001), and more total fat (30.7 vs 29.3% of total energy; P = .048) and monounsaturated fat (11.5 vs 10.7% of total energy; P = .021). Association between diabetes awareness and low total and added sugar intake was observed in individuals of Mexican and Puerto Rican background but not in other groups (P for interaction < .05). Among people with diagnosed diabetes, those with HbA1c of 7% or greater consumed more total fat, saturated fat, and cholesterol than those with HbA1c less than 7% (all P < .05). CONCLUSIONS: Among US Hispanics/Latinos with diabetes, fiber intake is low, and diabetes awareness is associated with reduced carbohydrate and sugar intake and increased monounsaturated fat intake. Sugar intake may require special attention in certain Hispanic/Latino background groups

Perceived discrimination and cancer screening behaviors in US Hispanics: the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Perceived discrimination has been associated with lower adherence to cancer screening guidelines. We examined whether perceived discrimination was associated with adherence to breast, cervical, colorectal, and prostate cancer screening guidelines in US Hispanic/Latino adults

Psychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

ABSTRACT OF THE DISSERTATIONPsychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)byRebeca Espinoza Giacinto Doctor of Philosophy in Public Health (Global Health)University of California, San Diego, 2016San Diego State University, 2016Professor Gregory A. Talavera, ChairBackground: Individuals with uncontrolled diabetes are at higher risk for developing cardiovascular disease, dyslipidemia, hypertension and retinopathy. While there is evidence for poor diabetes management among high risk populations, such as Hispanic/Latinos, specific self-care and lifestyle practices that influence glycemic regulation remain poorly understood.Aims: This dissertation will examine psychosocial, sociocultural, and biobehavioral correlates of glycemic control among diverse Hispanic/Latinos with diabetes in the US through the following aims: (1) to examine psychosocial and sociocultural correlates of glycemic status; (2) to examine the role of sleep duration and glycemic status; and (3) to examine the reported use of conventional and complimentary medicine and types of care accessed and its related influence on glycemic regulation status.Methods: Chapters 2-4 employ data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data were collected as part of the HCHS/SOL study which included 16,415 self-identified Hispanic/Latinos ages 18-75 recruited between March 2008 and June 2011. Analyses for the current study involved a subset of individuals with diabetes. Results: As presented in Chapter 2, older age, shorter duration of US residence, annual doctor visits, and better dietary quality were independently associated with improved glycemic control. No other variables, including those for psychosocial and sociocultural factors, were significantly associated with glycemic control. As presented in Chapter 3, individuals with long sleep duration (&gt;9 hrs.) had suboptimal glycemic control status, compared to those who reported average sleep duration (6&lt; 9hrs.). As described in Chapter 4, individuals with poor glycemic status were more likely to report being prescribed diabetes medication as well as reporting concomitant use of diabetes medication and botanical/herbal use compared to those who reported use of neither prescribed diabetes medications or supplement use.Conclusion: Addressing social and structural barriers such as routine care, particularly among younger Hispanic/Latinos and those with longer residence in the US may aid in improving glycemic control status and preventing complications related to suboptimal diabetes management. Further research is needed to examine acculturative processes and glycemic control which may offer greater insights into specific correlates of diabetes management among ethnically diverse Hispanic/Latinos in the US

Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013

Objective.To assess prostate cancer (PC) mortality in Mexico from 1980 to 2013, according to the state marginalization level. Materials and methods. Using age-adjusted rates in men ≥ 40 years old, we estimated trends and agecohort-period effects of PC mortality from 1980-2013 according to state marginalization status by using a joinpoint regression model and a Poisson regression model proposed by Holford. Results. The PC mortality risk has increased nationwide at a constant rate (2% annually) during the past 13 years. The highest annual increase was observed among states with very high (4.4%) and high (7.7%) marginalization rates. In contrast, states with very low levels of marginaliza- tion showed a significant reduction of 1.5% per year. The main changes were observed in the 1945-1950 birth year cohorts. Conclusions. Differences in PC mortality across regions of Mexico may reflect differences in the timing of the diagnosis and treatment of PC. DOI: http://dx.doi.org/10.21149/spm.v58i2.778

Associations of Lipid Levels and Cognition: Findings from the Hispanic Community Health Study/Study of Latinos

ObjectiveHispanics/Latinos in the United States are less aware of their cholesterol levels and have a higher burden of associated adverse cardiovascular and cerebrovascular outcomes than non-Latino whites. Investigations of the associations between cholesterol levels and cognition in this population have often occurred within the context of metabolic syndrome and are limited to select lipids despite the fact that triglycerides (TGs) may be more relevant to the health of Hispanics/Latinos.MethodsBaseline data from the Hispanic Community Health Study/Study of Latinos, collected from 2008 to 2011, was used to investigate the associations of lipid levels (i.e., TG, total cholesterol, TC; low-density and high-density lipoprotein cholesterol, LDL-C and HDL-C) with cognition (i.e., learning, memory, verbal fluency, and digit symbol substitution, DSS), adjusting for relevant confounders.ResultsIn 7413 participants ages 45 to 74&nbsp;years from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds, separate, fully adjusted linear regression models revealed that TG levels were inversely associated with DSS performance; however, this relationship was no longer significant once additional cardiovascular disease risk factors were added to the model (p = .06). TC and LDL-C levels (separately) were positively associated with learning and verbal fluency regardless of adjustments (p-values &lt; .05). Separate analyses investigating the effect modification by background and sex revealed a particularly robust association between TC levels and DSS performance for Puerto Ricans and Central Americans (albeit in opposite directions) and an inverse relationship between TG levels and DSS performance for women (p-values &lt; .02).ConclusionsIt is important to consider individual lipid levels and demographic characteristics when investigating associations between cholesterol levels and cognition in Hispanics/Latinos

Evaluating Two Evidence-Based Intervention Strategies to Promote CRC Screening Among Latino Adults in a Primary Care Setting

Regular use of colorectal cancer screening can reduce incidence and mortality, but participation rates remain low among low-income, Spanish-speaking Latino adults. We conducted two distinct pilot studies testing the implementation of evidence-based interventions to promote fecal immunochemical test (FIT) screening among Latinos aged 50-75&nbsp;years who were not up-to-date with CRC screening (n&nbsp;=&nbsp;200) at a large Federally Qualified Health Center (FQHC) in San Diego, CA. One pilot focused on an opportunistic clinic visit "in-reach" intervention including a 30-min session with a patient navigator, review of an educational "flip-chart," and a take-home FIT kit with instructions. The second pilot was a system-level "outreach" intervention consisting of mailed materials (i.e., FIT kit, culturally and linguistically tailored instructions, and a pre-paid return envelope). Both received follow-up calls to promote screening completion and referrals for additional screening and treatment if needed. The primary outcome was FIT kit completion and return within 3&nbsp;months assessed through electronic medical records. The in-reach pilot consisted of mostly insured (85%), women (82%), and Spanish-speaking (88%) patients. The outreach pilot consisted of mostly of Spanish-speaking (73%) women (64%), half of which were insured (50%). At a 3-month follow-up, screening completion was 76% for in-reach and 19% for outreach. These data demonstrate that evidence-based strategies to promote CRC screening can be implemented successfully within FQHCs, but implementation (particularly of mailed outreach) may require setting and population-specific optimization. Patient, provider, and healthcare system related implementation approaches and lessons learned from this study may be implemented in other primary care settings

Body Mass of U.S. Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): How Do Diet Quality and Sedentary Time Relate?

Little evidence exists on diet quality- and sedentary time-related differences in body mass index (BMI) among immigrant and nonimmigrant Hispanics/Latinos with different lengths of U.S. residence. A total of 13,962 (80.2% foreign-born) Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants aged 18 to 60 from four U.S. cities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) underwent standardized interviews and fasting blood tests. Diet quality was total Alternative Healthy Eating Index score. Sedentary time was number of <100 counts/minute over 3 to 6 days. BMI was examined using regression models adjusted for age, income, Hispanic/Latino background, HCHS/SOL site, and tobacco use. Two three-way interactions (diet or sedentary time length of residence sex) were tested to examine health behavior-related differences in BMI among immigrant and nonimmigrant males and females. The diet length of residence sex interaction was significant ( b = .005, 95% confidence interval [−.003, .008]). For a 10-unit Alternative Healthy Eating Index difference, the BMI difference was greater among immigrant females in the United States longer (0 years = .84 kg/m2; 10 years = 1.64 kg/m2). Diet-related obesity prevention efforts may start soon after migration, particularly for immigrant women