Puerto Rican adults living on the mainland US have documented health disparities;however, little research has been conducted with this second largest Hispanic subgroup. Our long-term goal is to understand the complex interactions of diet and other behavioral and environmental factors, genetics, and psychosocial stress on the high and apparently increasing prevalence of cardiovascular disease (CVD) risk factors in Puerto Rican adults. As this group is rapidly growing, understanding the reasons for this risk is of great importance. Our initial funding period for the Boston Puerto Rican Center on Population Health and Health Disparities (BPR-CPHHD, 2003-08) focused on the role of stress on physical disability and cognitive decline, through physiological dysregulation or """"""""allostatic load."""""""" During that investigation, it became clear that risk factors for CVD were highly prevalent. These findings are in contrast to the commonly held belief that there is a Hispanic paradox?lower heart disease and mortality despite greater poverty. Importantly, the Puerto Rican population differs considerably in ancestral genetic history and in exposures to known risk factors from other Hispanic groups. They have unique dietary intake patterns, as well as social, cultural and environmental structures that contribute and affect reaction to stressors. During our initial funding period, we successfully assembled a cohort of 1450 Puerto Rican adults, aged 45-75 years at baseline, and have completed (to date) more than 900 two-year follow-up interviews?we are continuing, with the expectation of completing at least 1150. As this population is aging and growing rapidly, the high prevalence and apparent cohort effect of increased heart disease risk factors suggest that 1) this population has serious health disparities in heart disease risk factors and 2) heart disease will become an even greater problem for this group in the near future. Our overall aim for this renewal is, therefore, to extend follow-up and to measure and analyze relevant characteristics and CVD risk factors, and to add additional contextual and outcome measures for CVD risk in this established cohort of Puerto Rican adults, so that we may better understand the dynamics of these disparities. Our model follows the transdisciplinary """"""""cells to society"""""""" concept developed jointly with our partner CPHHDs during the initial funding period, with consideration of genetic variation in relation to longitudinal change in allostatic load and biochemical indicators of risk, to more concrete indicators of disease (ankle brachial index (ABI) and intima media thickness (IMT));with additional focus on social networks, neighborhood characteristics (physical space and access to food) and environment (air pollution) factors as social determinants of health. Finally, using community based participatory techniques, we will implement and test a multidimensional intervention that focuses on diet and exercise, but that also fully considers the social and physical environment to ensure success. With participation of our community partner. La Alianza Hispana, and the support of our administrative, biostatistics and laboratory cores, our team is efficiently poised to make significant contributions to understanding the factors that contribute to the apparent growing threat of heart disease in this highly disadvantaged group?while providing insights that may be useful to other vulnerable groups. The continuation of our cohort, with its rich constellation of measures, will allow us to unravel some of the complex etiologic interactions which contribute to CVD risk, so that effective interventions maybe implemented.

Public Health Relevance

This work takes the innovative and necessary approach of examining complex interactions of physiological measures, biological stress, and psychosocial evaluation on multiple levels to understand the causes of disproportionate health disparities in Puerto Ricans. The study will have a positive impact on the creation of policies that are appropriate Puerto Rican adults, the second largest Hispanic population in the US.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Specialized Center (P50)
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Special Emphasis Panel (ZCA1-SRLB-3 (J1))
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Kaufmann, Peter G
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Northeastern University
Other Health Professions
Schools of Allied Health Profes
United States
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Noel, Sabrina E; Arevalo, Sandra; Smith, Caren E et al. (2017) Genetic admixture and body composition in Puerto Rican adults from the Boston Puerto Rican Osteoporosis Study. J Bone Miner Metab 35:448-455
Sprague Martinez, Linda; Reisner, Ellin; Campbell, Maria et al. (2017) Participatory Democracy, Community Organizing and the Community Assessment of Freeway Exposure and Health (CAFEH) Partnership. Int J Environ Res Public Health 14:
Simon, Matthew C; Hudda, Neelakshi; Naumova, Elena N et al. (2017) Comparisons of Traffic-Related Ultrafine Particle Number Concentrations Measured in Two Urban Areas by Central, Residential, and Mobile Monitoring. Atmos Environ (1994) 169:113-127
Mattei, Josiemer; Sotos-Prieto, Mercedes; Bigornia, Sherman J et al. (2017) The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults. J Nutr 147:661-669
Dashti, Hassan S; Aslibekyan, Stella; Scheer, Frank A J L et al. (2016) Clock Genes Explain a Large Proportion of Phenotypic Variance in Systolic Blood Pressure and This Control Is Not Modified by Environmental Temperature. Am J Hypertens 29:132-40
Sotos-Prieto, M; Bhupathiraju, S N; Falcon, L M et al. (2016) Association between a Healthy Lifestyle Score and inflammatory markers among Puerto Rican adults. Nutr Metab Cardiovasc Dis 26:178-84
Smith, Caren E; Coltell, Oscar; SorlĂ­, Jose V et al. (2016) Associations of the MCM6-rs3754686 proxy for milk intake in Mediterranean and American populations with cardiovascular biomarkers, disease and mortality: Mendelian randomization. Sci Rep 6:33188
Mattei, Josiemer; Mendez, Jacqueline; Falcon, Luis M et al. (2016) Perceptions and Motivations to Prevent Heart Disease among Puerto Ricans. Am J Health Behav 40:322-31
Hohl, Sarah D; Thompson, Beti; Krok-Schoen, Jessica L et al. (2016) Characterizing Community Health Workers on Research Teams: Results From the Centers for Population Health and Health Disparities. Am J Public Health 106:664-70
Thornton, Rachel L J; Glover, Crystal M; Cené, Crystal W et al. (2016) Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff (Millwood) 35:1416-23

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