Data Book

A Report to the Communities
Hispanic Community 

Health Study

Study of Latinos

Data Book

A Report to the Communities

NIH Publication No. 13-7951

September 2013
Table of Contents

I. Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

II. Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

III. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Study Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

How To Read This Data Book – A Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Definition of Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Description of Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

IV. Field Center Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Bronx Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Chicago Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Miami Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

San Diego Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

V. Description of Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Participants by Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Participants by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Participants by Education and Income levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Participants by Preferred Language Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Participants by Place of Birth and Time Living in the United States . . . . . . . . . . . . . . . . . . . . .18

VI. Disease Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Coronary Heart Disease and Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
VII. Risk Factors for Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . 28

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Prediabetes and Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Symptoms of Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Anxiety Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Sleep Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Multiple Risk Factors for Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

VIII. Lifestyle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

IX. Awareness, Treatment, and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Awareness, Treatment, and Control of Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Awareness, Treatment, and Control of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

X. Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Types of Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

XI. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

XII. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4 hchs/sol data book: a report to the communities 
 section i: preface 5

I. Preface

We are pleased to present a summary of medical research results of the Hispanic Community Health Study/Study of Latinos 

to the communities and participants from the largest health study of Hispanic/Latino populations in the United States. This 

study seeks to understand the health issues affecting Hispanic/Latino groups in the United States and includes research on 

many diseases and conditions of particular importance to the Hispanic/Latino communities. 

The participants in this study have understood the value of research on the causes of health conditions to improve the 

lives of Hispanics/Latinos in particular and all Americans in general. They have contributed many hours participating in a 

clinical evaluation, responding to many questions about their health status and engaging in other measures after they left 

the field center. The success of this study is due to their dedication and contribution of time and effort. The sponsoring 

organizations at the National Institutes of Health, the universities and researchers involved in this study, and all who will 

benefit from this research thank the participants for their commitment.

This report provides data from the first examination of participants who attended the Hispanic Community Health Study/

Study of Latinos. It highlights health areas that are having a positive impact in these communities and those that need 

greater attention to improve lives. All who have made this study possible deserve the Nation’s thanks.

Gary H. Gibbons, M.D.

Director

National Heart, Lung, and Blood Institute

National Institutes of Health
6 hchs/sol data book: a report to the communities 

II. Acknowledgments

Special appreciation is extended to the participants who contributed their time and effort and to the extraordinary staff 

who conducted the study. A list of staff can be seen at http://www.cscc.unc.edu/hchs/

Investigators contributing to this report:

Abreu, Maria de los Angeles, MPA, CCPR

University of North Carolina at Chapel Hill

Arredondo, Elva, PhD

San Diego State University

Avilés–Santa, Larissa, MD, MPH

National Heart, Lung, and Blood Institute, NIH

Barr, R. Graham, MD, DrPH

Columbia University 

Beck, James, PhD

University of North Carolina at Chapel Hill

Birnbaum–Weitzman, Orit, PhD 

University of Miami

Buelna, Christina, MA 

San Diego State University

Cai, Jianwen, PhD

University of North Carolina at Chapel Hill

Castañeda, Sheila F., PhD 

San Diego State University

Cruickshanks, Karen J., PhD 

University of Wisconsin 

Daviglus, Martha, L., MD, PhD 

University of Illinois, Chicago; Northwestern University 

Giachello, Aida, PhD

Northwestern University

González, Sara, PhD 

Albert Einstein College of Medicine

Heiss, Gerardo, MD, PhD

University of North Carolina at Chapel Hill

Isasi, Carmen, MD, PhD 

Albert Einstein College of Medicine

Kaplan, Robert, PhD

Albert Einstein College of Medicine

Redline, Susan, MD, MPH 

The Brigham & Women's Hospital

Rodríguez, Bárbara, MS(c) 

San Diego State University

Sanchez, Carlos, MD

University of Illinois, Chicago

Schneiderman, Neil, PhD

University of Miami

Siega–Riz, Anna Maria, PhD, RD, LDN 

University of North Carolina at Chapel Hill

Silsbee, Lorraine, MHS 

National Heart, Lung, and Blood Institute, NIH
 section ii: acknowledgments 7

Smoller, Sylvia, PhD 

Albert Einstein College of Medicine

Sorlie, Paul, PhD 

National Heart, Lung, and Blood Institute, NIH

Sotres, Daniela, DrPH 

University of North Carolina at Chapel Hill

Talavera, Ana, MPH

San Diego State University

Talavera, Gregory A., MD, MPH 

San Diego State University

Wilkins, Tania M., MS

University of North Carolina at Chapel Hill

Youngblood, Marston, MA, MPH

University of North Carolina at Chapel Hill

funding acknowledgment

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a collaborative study supported by contracts 

from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01–HC65233), 

University of Miami (N01–HC65234), Albert Einstein College of Medicine (N01–HC65235), Northwestern University 

(N01–HC65236), and San Diego State University (N01–HC65237). The following Institutes/Centers/Offices contributed 

to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Deafness and Other Communication 

Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney 

Diseases, National Institute on Minority Health and Health Disparities, National Institute of Neurological Disorders and 

Stroke, NIH Office of Dietary Supplements.

editorial acknowledgment

With thanks to Nancy Eng, NHLBI
8 hchs/sol data book: a report to the communities 

III. Introduction

study description 

The Hispanic Community Health Study/Study of Latinos 

(HCHS/SOL), which began in 2006, is a comprehensive 

longitudinal multicenter community–based cohort study of 

Hispanic/Latino populations in the United States. Between 

2008 and 2011, 16,415 U.S. Hispanic/Latino adults were 

recruited from a random sample of households in four 

communities located in the Bronx, Chicago, Miami, and 

San Diego, and they underwent a baseline clinic 

examination. Each community had more than 4,000 

participants from diverse Hispanic/Latino backgrounds 

who self–identified as Cuban, Dominican, Puerto Rican, 

Mexican, Central American, or South American and were 

of diverse socioeconomic groups. They were selected to be 

representative of the target population in each community 

rather than the entire U.S. population. Study participants 

were selected to obtain approximately one–third between 

18–44 years of age and two–thirds between 45–74 years of 

age (Lavange et al., 2010; Sorlie et al., 2010).

The goals of the study are to identify risk factors that 

may have a protective or harmful role in the development 

of cardiovascular disease in Hispanics/Latinos and to 

evaluate the role of acculturation in the prevalence and 

development of risk factors and disease. Study participants 

underwent an extensive clinic examination to determine 

baseline cardiovascular prevalence and to identify potential 

risk and protective factors. The baseline examination was 

administered in English or Spanish based on the participant’s 

preference. Baseline questionnaires included information 

on personal and family health, acculturation (including 

language and cultural food preferences), physical activity, 

diet, sleep, occupation, and other personal characteristics. 

Clinical assessments included hearing, vision, and dental 

exams, and many types of blood tests. Physical activity and 

sleep were assessed by use of measurement devices that 

participants took home with them. After the clinic visit, 

participants were followed regularly by telephone calls to 

track important health events (Sorlie et al., 2010). 

how to read this data book – a guide

This page is a guide on how to understand the numbers 

and charts included in this book. Questions about health 

status were asked of all participants. The percentage of 

persons who responded that they had a disease, condition, 

or behavior relevant to this research is presented in charts 

for different groups by age, sex, background, or community. 

In this Data Book, percentages and averages for health 

outcomes were calculated for sex, age, and background 

groups. All percentages and averages are “weighted” to 

account for how households and people were sampled 

to be comparable to the 2010 U.S. Census population. 

All percentages and averages were also age–adjusted so 

that comparisons between sexes and among background 

groups could be compared equally. Age–adjustment was 

done because substantial differences exist in age among 

above: Study recruiter, San Diego

photo by larissa avilés-santa
 section iii: introduction 9

backgrounds. For example, Cubans are, on average, older 

and Mexicans are, on average, younger. The only un–

weighted estimates appear in Section V (Description of 

Participants), where numbers of participants represent 

the actual counts of participants in each group. 

definition of groups 

Age: 18 to 44 years, 45 to 64 years, and 65 to 74 years.

Sex: men and women.

Hispanic/Latino background group: Central American, 

Cuban, Dominican, Mexican, Puerto Rican, and South 

American.

Community: Bronx, Chicago, Miami, and San Diego. 

description of charts

Chart 1: Percent of Participants by Level of Education (Pie Chart Example)

The title describes the chart as the percentage of 

participants with different levels of education in 

different colors. 

These numbers show the percentage of participants 

in each education group. For example, in this chart, 33 

percent of the participants (orange area) had less than 

a high school education.

The legend shows different colors for different groups. 

In this chart, these colors are levels of education. 

Chart 2: Number of Participants by Background – Chicago (Bar Chart Example)

This title describes the chart as the number of 

participants by background in Chicago.

This number shows the number of participants by 

background. In Chicago, 2,409 participants were of 

Mexican background.

The legend shows different groups by age, sex, 

background or community. In this chart, the 

background groups are shown.

Less Than 

High School High School Grad Some College College Degree

33%

27%

23%

16%

0

500

1000

1500

2000

2500

3000

South

American

Puerto

Rican

Central Cuban Dominican Mexican

 American

418

2,409

27

770

374 25
10 hchs/sol data book: a report to the communities 

IV. Field Center 

Descriptions

bronx field center

The Bronx Field Center is located in Bronx, New York, 

which is one of five boroughs of New York City. New York 

City's Hispanic/Latino population grew by 8.1 percent in 

the past decade, reaching 2,336,076 in 2010. Hispanics/

Latinos now account for 28.6 percent of the overall New 

York City population (New York City Department of City 

Planning [NYCDCP], 2011). The Bronx has one of the 

highest concentrations of Hispanic/Latino persons in any 

U.S. urban area—over half of the 1.4 million residents of 

the Bronx are of Hispanic/Latino background (NYCDCP, 

2011).

Puerto Ricans are the largest Hispanic/Latino background 

group in the Bronx, followed by Dominicans, Mexicans, and 

Central and South Americans. While the Bronx Hispanic 

population has tended to concentrate in the southern and 

western portions of the borough, the greatest population 

gains over recent years in the Hispanic/Latino population 

were in neighborhoods outside these areas (NYCDCP, 

2011).

The Bronx has played an important role in shaping 

Hispanic/Latino history in the United States. Sonia 

Sotomayor, who in 2009 became the first person of 

Hispanic/Latino heritage to serve on the U.S. Supreme 

Court, was born and raised in the Bronx. Dr. Helen 

Rodriguez–Trias, a public health and human rights activist 

who was the first Latina to head the American Public 

Health Association, was on the faculty of Albert Einstein 

College of Medicine in the Bronx. The Bronx also 

popularized both salsa and hip–hop music.

top to bottom: Fordham Road; Bronx-Manhattan 

skyline; Fordham Plaza
 section iv: field center descriptions 11

A Bronx Participant

“I started this program in 2008, I am participating until now, 2013. I believe this 

study is very important so that they could find solutions for the sickness of the 

Spanish people, and at the same time they can prevent all the sickness such as 

diabetes, high blood pressure, obesity, and more. I congratulate the people that 

created the program, it's very important. Thank you very much!”

chicago field center

In 2010, nearly 2.7 million people were living in Chicago 

and 29 percent were of Hispanic/Latino background 

(U.S. Census Bureau, 2010). Chicago has the third largest 

concentration of Mexicans/Mexican-Americans in the 

United States and the second largest concentration of 

Puerto Ricans. Although the vast majority of Hispanics/

Latinos (74 percent) living in Chicago are Mexicans/

Mexican-Americans, many other ethnic groups, including 

individuals from Central and South America and the 

Caribbean (Ready & Brown–Gort, 2005), also reside here.

Participants were recruited from six Chicago communities 

(Albany Park, Belmont–Cragin, Hermosa, Humboldt Park, 

Irving Park, and Logan Square) located on the north/

northwest side of the city. These communities reflect the 

diversity of Hispanics/Latinos in terms of socioeconomic 

status, national origins and backgrounds, language use, 

and immigration status. These are vibrant communities 

with high concentrations of businesses (e.g., ethnic food 

restaurants and bodegas/tiendas de abarrotes), botánicas 

(folk medicine pharmacies), and a diversity of other 

establishments. Devotion to religious practices and an 

emphasis on family ties are prevalent, with individuals 

frequently living in an extended family system where 

many generations (grandparents, parents, and siblings) 

live together on different levels of a multi–unit building. 

The Hispanic/Latino communities of Chicago are well 

organized and have a tradition of caring and problem–

solving leaders who have established health, human 

services, and educational organizations and community 

coalitions to respond to community needs. In addition, the 

Hispanic/Latino communities in Chicago are rich in 

culture and arts. Ethnic pride and nationalism are photos by larissa avilés-santa

left to right: Mural on a private residence; Chicago skyline; East end of Paseo Boricua, Humboldt Park photos by larissa avilés-santa
12 hchs/sol data book: a report to the communities 

expressed through public murals at almost every corner of 

the Hispanic/Latino neighborhoods in the city. These 

murals tell stories of social justice (or injustice), political 

struggles, or religious beliefs and practices and serve to 

inspire all members of the diverse communities from 

which Chicago HCHS/SOL participants were recruited.

miami field center

In 2010, more than 2.5 million people were living in Miami–

Dade County, located in southeastern Florida. Within the 

county, 51 percent of the residents are foreign born and 

64 percent report speaking Spanish at home (U.S. Census 

Bureau, 2010). The percent of persons of Hispanic/Latino 

background has continued to increase over the past decade 

and today accounts for 65 percent of the population (U.S.

Census Bureau, 2010).

Participants in the Miami Field Center were recruited from 

Miami, Hialeah, and Coral Gables. Miami is the largest 

community with almost 400,000 residents of which 70 

percent are of Hispanic/Latino background (U.S. Census 

Bureau, 2010). The city of Hialeah has 225,000 residents 

with 95 percent of them Hispanic/Latino, and the city 

of Coral Gables has 47,000 residents with 54 percent 

Hispanic/Latino (U.S. Census Bureau, 2010). In each of 

these areas, the majority background group is Cuban, with 

the next being Central American. These communities 

represent a diversity of education and income. 

A Chicago Participant

“The study is superb and I enjoyed my visit to the clinic.”

photo by larissa avilés-santa

clockwise from top left: Mosaic tiles in 

Maximo Gomez/Domino Park; City of Hialeah 

entrance; Miami Freedom Tower Building
 section iv: field center descriptions 13

san diego field center

San Diego is California’s most southern city and is located 

next to the northern border of Mexico. San Diego is the 

birthplace of California and home to a rich multicultural 

heritage. The San Diego–Tijuana bordercrossing is the 

busiest in the world (Becker & Armendariz, 2012), which 

makes it a unique and vibrant bi–national community. 

According to the 2010 Census, around one–fourth of San 

Diegans are Mexican or Mexican American (U.S. Census 

Bureau, 2010).

Recruitment of the San Diego HCHS/SOL participants 

focused on communities that have higher concentrations 

of Hispanic/Latino residents than other regions in San 

Diego. San Diego is locally known as “the South Bay” 

and includes the communities of San Ysidro, Chula Vista, 

National City, Imperial Beach, and Bonita. 

Mexico’s influence on San Diego County is cultural, 

political, spiritual, and economic. Culturally, Mexican 

influences can be found in local artwork in murals at 

college campuses and Chicano Park. Politically, community 

property and water rights were based on Spanish and 

Mexican traditions that considered water a community 

resource to be divided as the community decided. 

photo by larissa avilés-santa

clockwise from top left: Third Avenue, Chula Vista; San Diego trolley; Murals in Chicano Park

Miami has played a unique role in the history of 

immigration in the United States. In the 1960s, substantial 

immigration occurred from Cuba to the Miami area in 

three waves and included many persons who were well 

educated or who had high skill levels. In 1980, another 

wave of Cuban immigration occurred followed more 

recently by immigration from Central and South 

America. The Freedom Tower in Miami was the “Ellis 

Island” of Florida and stands today as a memory of the 

waves of immigration. The Spanish language is spoken 

by more persons in Miami than in any other U.S. city. Little 

Havana, a neighborhood in Miami, once almost exclusively 

the residence of Cubans, now has immigrants from other 

Latin American countries. It is still the center of social, 

cultural and political activity for Cubans (Wikipedia, 

Miami).

A Miami Participant

“This is an excellent study because many people need to know 

about our health, and this was a good opportunity given to us.”
Bronx

Miami

Chicago

San Diego

14 hchs/sol data book: a report to the communities 

Spiritually, the Mexican religious traditions are evident in 

San Diego churches that celebrate Día de Guadalupe and 

La Posada. San Diego is home to the first Church in 

California, the Mission Basilica San Diego de Alcala, which 

was founded in 1769. Economically, Mexican labor plays a 

major role in the development and maintenance of San 

Diego’s agricultural economy. The influence of Mexican 

culture is undeniable and continues to shape the 

development of San Diego (Kucher, 2010). 

A San Diego Participant

“The program was very good and I feel that what I did will be 

very useful for future generations. Thank you very much.”

Field Center Locations
0

500

1000

1500

2000

Central American Cuban Dominican Mexican Puerto Rican South American

219 208

1,380

1,837

45 187

0

750

1500

2250

3000

Central American Cuban Dominican Mexican Puerto Rican South American

418

2,409

770

374

25 27

 section v: description of participants 15

V. Description of 

Participants

participants by background

Background was determined by participants’ self–report of heritage or descent. The very few participants who described 

their background as mixed/other or who didn’t describe a specific background are not shown.

Chart 3: Number of Participants by Background – Bronx

Chart 4: Number of Participants by Background – Chicago

In the Bronx Field Center, most 

participants are of Puerto Rican 

background, followed by those of 

Dominican background.

In the Chicago Field Center, 

most participants are of Mexican 

background, followed by those of 

Puerto Rican, Central American and 

South American background.
0

1500

3000

4500

6000

Men Women

Age 18-44 Age 45-64 Age 65–74

2,900

3,801

3,179

5,203

501

831

0

750

1500

2250

3000

Central American Cuban Dominican Mexican Puerto Rican South American

1,034

2,269

468

64 38 82

0

1000

2000

3000

4000

Central American Cuban Dominican Mexican Puerto Rican South American

61 9 2

3,817

39 43

16 hchs/sol data book: a report to the communities 

Chart 5: Number of Participants by Background – Miami

In the Miami Field Center, 

most participants are of Cuban 

background, followed by those 

of Central American and South 

American background.

In the San Diego Field Center, the 

vast majority of participants are of 

Mexican background.

In the study, 6,701 participants are 

in the 18 to 44 age group, 8,382 are 

in the 45 to 64 age group, and 1,332 

are in the 65 to 74 age group.

Sixty percent of the participants are 

women and 40 percent are men.

Chart 6: Number of Participants by Background – San Diego

Chart 7: Number of Participants by Age and Sex
$20,000

or Less

$20,001–

$50,000

$50,001

or More Unknown

42%

36%

12%

10%

Less Than 

High School High School Grad Some College College Degree

33%

27%

23%

16%

 section v: description of participants 17

Forty–two percent of the 

participants have a yearly household 

income of $20,000 or less.

Chart 9: Percent of Participants by Yearly Household Income

participants by education and income levels

Participants reported their highest level of education. Education levels were grouped into four categories: less than high 

school, high school graduate, some college, and college degree or more. 

Participants reported their annual household income. They were grouped into four categories: $20,000 or less, $20,001 

to $50,000, $50,001 or more, and unknown. A small number of participants did not provide information on annual 

income and are included in the unknown group. 

Chart 8: Percent of Participants by Level of Education

Most participants completed 

some high school or graduated 

from high school. Sixteen percent 

graduated from college with a 

degree, and another 23 percent 

attended at least some college. 

Thirty–three percent have less 

than a high school education.
Spanish English

76%

24%

Not Born 

in the U.S.

Born

in U.S.

79%

21%

18 hchs/sol data book: a report to the communities 

participants by preferred language use

At the examination visit, each participant was asked which language he or she preferred to use during the visit. 

Chart 10: Percent of Participants by Language Preference

participants by place of birth and time living in the 

united states

Participants reported their place of birth. They also reported the number of years they lived in the 50 States or District of 

Columbia. Responses were grouped into three categories: less than 10 years, 10 to 19 years, and 20 or more years.

Chart 11: Percent of Participants by Place of Birth

The majority, about 3 of every 4 

persons, requested the use of 

Spanish instead of English.

Approximately three–fourths of the 

participants were not born in the 50 

States or District of Columbia. 

In this chart, participants from 

Puerto Rico are reported among 

those born outside the 50 States or 

District of Columbia. 
48%

25%

27%

Less Than

10 Years

10–19 

Years

20+ 

Years

 section v: description of participants 19

Chart 12: Percent of Participants by Number of Years Living in the United States

Almost half of all participants lived 

at least 20 years in the 50 States or 

District of Columbia. One-fourth 

lived in the United States less than 10 

years and approximately one-fourth 

lived in the United States 10-19 years.

clockwise from top left: Dietary interview; Height measurement; Lung function test; Measurement of ankle 

blood pressure photo by larissa avilés-santa

photo by larissa avilés-santa
20 hchs/sol data book: a report to the communities 

VI. Disease Conditions

coronary heart disease and stroke

Coronary Heart Disease (CHD) is a broad term used to 

describe certain conditions that affect the heart. These 

conditions produce narrowed or blocked arteries that 

lead to a lack of blood flow to the heart muscle which can 

lead to damage to the heart. This is called a heart attack 

(Mayo Clinic, Heart disease). A stroke occurs when blood 

flow to a part of the brain is partially or totally blocked. 

This blockage of blood to the brain can lead to brain cell 

death, causing permanent damage (Pub Med Health, 

Stroke, 2012).

CHD and stroke can be prevented by maintaining 

a healthy lifestyle (Mayo Clinic, 5 medication–free 

strategies to help prevent heart disease). This includes:

• Not smoking 

• Exercising on a regular basis 

• Eating foods that are low in saturated fats, trans fats, 

and sodium; and including vegetables, fruits, whole 

grains, lean meats and low–fat dairy products

• Maintaining a healthy weight

• Getting regular health screenings that include 

checking blood pressure, cholesterol levels, and 

diabetes screening

Coronary heart disease was determined by a 

participant’s self–reported responses to questions about 

previous heart attacks, coronary bypass surgery, or other 

procedures used to clear blocked arteries. The charts 

show the percentage of participants with CHD.

above: This figure shows how the arteries become 

blocked and harm the heart and the brain.
0

2

4

6

8

10

12

14

16

Age 18-44 Age 45-64 Age 65–74

1.1 0.8

6.0

3.4

13.6

5.9

Men Women

0

1

2

3

4

5

6

7

Age 18-44 Age 45-64 Age 65–74

0.8 0.3

2.5

1.8

5.9

3.2

Men Women

0

1

2

3

4

5

6

Central American Cuban Dominican Mexican Puerto Rican South American

1.6

2.1

3.3

4.9

2.6

3.2

 section vi: disease conditions 21

Chart 13: Percent with Coronary Heart Disease by Age and Sex

Chart 14: Percent with Coronary Heart Disease by Background

Chart 15: Percent with Stroke by Age and Sex

More men than women reported 

having CHD. For all men and 

women, CHD increased with age. 

The highest percentage with CHD 

was in men aged 65–74 years.

The highest percentage of self–

reported CHD was for participants 

of Puerto Rican background. The 

lowest percentages were among 

those of Central American, Mexican, 

and South American backgrounds.

A higher percentage of men than 

women reported a history of stroke. 

For both groups, having a stroke 

history increased with age. The 

highest percentage of stroke was in 

men aged 65–74 years. 

Stroke was determined by a participant’s self–reported history of stroke.
0

1

2

3

4

5

Central American Cuban Dominican Mexican Puerto Rican South American

1.5

1.1

2.5 2.3

0.9

1.4

22 hchs/sol data book: a report to the communities 

pulmonary disease

Asthma and chronic obstructive pulmonary disease (COPD) 

are common lung diseases that cause shortness of breath, 

wheeze, cough, and phlegm. These symptoms occur due to 

the airways of the lung tightening. Sometimes the airway 

tightens enough to cause “attacks” of severe shortness 

of breath and wheeze that can require urgent care from a 

physician. Asthma usually occurs in children and young 

adults and is the leading cause of hospital visits in these 

groups. Many children grow out of asthma and asthma is 

often a reversible disease. COPD is like asthma but occurs 

in older adults, is not reversible, and is the third leading 

cause of death in the United States (Murphy et al., 2012). 

Both are treated most commonly with inhalers. Asthma was 

determined by a participant’s reported medical history of 

asthma.

Chart 16: Percent with Stroke by Background

A higher percentage of participants 

of Dominican and Puerto Rican 

backgrounds reported a history 

of stroke than those in the other 

groups. The lowest percentages were 

reported by participants of South 

American and Mexican backgrounds. 

top to bottom: Lung function test; Asthma inhaler
0

10

20

30

40

Age 18-44 Age 45-64 Age 65–74

15.5

17.2

12.1

20.0

11.0

20.9

Men Women

0

10

20

30

40

Central American Cuban Dominican Mexican Puerto Rican South American

11.6

7.4

16.0

35.8

9.3

21.2

 section vi: disease conditions 23

Chart 17: Percent with Asthma by Age and Sex

Chart 18: Percent with Asthma by Background

Asthma was equally common among 

men and women in the 18 to 44 age 

group. Above that age, it was more 

common in women.

Participants of Puerto Rican, Cuban, 

and Dominican backgrounds were 

two to five times more likely to 

report ever having asthma in their 

lives than were participants of 

Mexican background.

• If you have asthma, visit your health care provider on a regular basis, take prescribed medications, and avoid known 

asthma triggers (NHLBI, Take Action: Stop Asthma Today!, 2010).
0

5

10

15

20

Age 45-64 Ages 65–74

7.0

10.5

9.5

Men Women

12.6

0

5

10

15

20

Central American Cuban Dominican Mexican Puerto Rican South American

5.0

7.2

6.3

16.8

4.7

10.1

24 hchs/sol data book: a report to the communities 

Chart 19: Percent with COPD by Age and Sex

Chart 20: Percent with COPD by Background

COPD increased with age in men 

and women. Women had more self–

reported COPD than men. 

The percentage of participants 

who reported a history of COPD 

was highest among those of Puerto 

Rican background and lowest 

among those of Central American 

and South American backgrounds. 

Major risk factors for COPD include age, smoking (ever) and a prior history of asthma. Additional factors such as occupational 

exposures, environmental exposures, access to health care, and differences in diagnosis and reporting could help explain 

these results. Additional research using lung function (breathing test) measures will help understand these results.

• If you have COPD or think you may be at risk, you can take steps to make breathing easier and live a longer and 

more active life. Get a simple breathing test and talk with your doctor or health care provider about treatment 

options (NHLBI, Take the first step to breathing better).

Chronic obstructive pulmonary disease (COPD) was determined by a participant’s reported medical history. 
0

5

10

15

20

25

30

35

40

45

50

Age 18-44 Age 45-64 Age 65–74

37.7

32.4

28.7

24.2

20.8

16.5

Men Women

0

5

10

15

20

25

30

35

40

45

50

Central American Cuban Dominican Mexican Puerto Rican South American

35.4 33.7

20.7

29.8

22.9

28.3

 section vi: disease conditions 25

Chart 21: Percent with at Least One Unfilled Dental Cavity by Age and Sex

Chart 22: Percent with at Least One Unfilled Dental Cavity by Background

Younger participants had the 

most unfilled dental cavities. In 

all age groups, women had a lower 

percentage of untreated cavities 

than men.

The percent of participants with 

one or more unfilled cavities was 

highest in participants of Central 

American background and lowest 

in participants of Dominican 

background.

oral health

Participant’s teeth were examined to determine the 

presence of dental decay and number of missing teeth. 

Decay will weaken the tooth and, if not treated, will get 

worse and much of the tooth surface will be destroyed. 

The tooth can become very painful, fall out, or need to be 

pulled. If the tooth was treated by a dentist, it is called a 

filled tooth.

The low percent with unfilled cavities in the older group 

was often due to that group having more missing teeth that 

are no longer at risk for decay, but may cause problems in 

biting and chewing food.

photo by larissa avilés-santa

above: Oral health exam
0

10

20

30

40

50

60

70

80

90

Central American Cuban Dominican Mexican Puerto Rican South American

63.2

49.4

62.7 60.8

66.3 65.3

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

36.3

41.7

75.1

79.6 76.7 75.8

Men Women

26 hchs/sol data book: a report to the communities 

Chart 24: Percent with at Least One Missing Tooth by Background

There are differences in the percent 

having at least one missing tooth 

by background. Those reporting 

Mexican background had the lowest 

percent missing, about 50 percent. 

In the other groups, 60 to 66 percent 

have one or more missing teeth.

• A healthy mouth is important for general health and well–being. Having a healthy mouth makes it easier to eat well and 

enjoy food, speak clearly and smile.

• You can keep your mouth healthy by brushing and flossing, eating healthy foods, using fluoride toothpaste, and not 

smoking. Visiting a dentist for check–ups is also important, so any problems can be found and treated before they 

become serious.

Chart 23: Percent with at Least One Missing Tooth by Age and Sex

In the two oldest age groups, about 

three–fourths of participants are 

missing at least one tooth. 
0

10

20

30

40

50

60

70

Age 18-44 Age 45-64 Age 65–74

5.2 4.9

30.5

18.3

62.2

43.8

Men Women

0

5

10

15

20

25

Central American Cuban Dominican Mexican Puerto Rican South American

16.5

14.5

16.6

21.0

14.8

17.6

 section vi: disease conditions 27

Chart 25: Percent with Hearing Impairment by Age and Sex

Chart 26: Percent with Hearing Impairment by Background

The percentage of participants 

with hearing impairment increased 

with age. About one in every two 

participants aged 65–74 years had 

hearing problems. Men had more 

hearing impairment than women.

The percentage of participants 

with hearing impairment was 

highest among those of Puerto 

Rican background. The percentages 

among the other background groups 

were fairly similar. 

• Protecting ears from loud noises at work or at home can help to prevent hearing loss. 

• Hearing impairments may be helped by medical treatment, hearing aids, or learning techniques to improve the ability to hear 

what family and friends are saying. A person experiencing hearing problems should seek help from a doctor or audiologist.

hearing loss

Hearing impairment was determined by using a hearing 

test called audiometry to measure how well people can 

hear sounds. Hearing impairment is a common, but often 

unrecognized, problem, as people get older. Poorer hearing 

can contribute to social isolation and a feeling of being left 

out of conversations.

above: Hearing test
0

10

20

30

40

50

60

70

80

90

Age 18-44 Age 45-64 Age 65–74

9.2 6.8

40.3 41.6

72.4

77.4

Men Women

28 hchs/sol data book: a report to the communities 

VII. Risk Factors for 

Cardiovascular Disease

hypertension

Hypertension is another word for high blood pressure. When 

blood pressure is measured, two numbers are provided—the 

systolic pressure when the heart is pumping (top number), 

and the diastolic pressure when the heart is relaxed (bottom 

number). An example of a blood pressure reading is 120/72. 

If the top number is greater than 140 or the bottom number 

greater than 90, or if a person is taking medication for blood 

pressure, a person is described as having hypertension. 

Hypertension is harmful because it can lead to heart attacks 

and strokes (NHLBI, What is high blood pressure? 2012).

• Know your blood pressure numbers. Have your blood 

pressure checked at least once per year, or more often if 

you have hypertension.

• Eat a diet that includes fruits, vegetables, fat–free dairy 

products and is rich in whole grains, fish, poultry, beans, 

seeds, and nuts.

• Limit sodium, sweets, sugary beverages and red meats.

Chart 27: Percent with Hypertension by Background

The percentage of participants with 

hypertension increased with age. 

above: Blood pressure measurement
0

10

20

30

40

Central American Cuban Dominican Mexican Puerto Rican South American

26.1

21.7

31.8 31.5

20.3

32.2

 section vii: risk factors for cardiovascular disease 29

Chart 28: Percent with Hypertension by Background

The percentages of participants 

with a history of hypertension were 

lowest among those of Mexican 

and South American backgrounds 

and highest among those of Cuban, 

Dominican, and Puerto Rican 

backgrounds. 

cholesterol

Blood cholesterol level, presented in milligrams per 

decileter (mg/dL), is a measure of several kinds of fat 

carried in the blood. Although not all kinds of fat in the 

blood are harmful, the higher the total blood cholesterol 

number, the greater the risk of hardening of the arteries 

and of getting heart disease. Therefore, it is important to 

get blood tests for cholesterol from time to time. 

In the United States and most countries in the Americas, 

cholesterol levels are measured in the amount of 

cholesterol in the blood. Doctors and patients use 

guidelines when cholesterol is tested. A total cholesterol 

level less than 200 mg/dL is “desirable” because it means 

a lower risk for CHD. A total cholesterol level of 200 to 

239 mg/dL is ”borderline high.” A value of 240 mg/dL 

and above is “high blood cholesterol” because it doubles 

the risk of CHD compared to those whose cholesterol is 

“desirable” (NHLBI, At a Glance: What you need to know 

about high blood cholesterol, 2009).

photo by larissa avilés-santa

above: Blood draw for lab tests
0

10

20

30

40

50

60

70

Age 18-44 Age 45-64 Age 65–74

36.8

26.2

51.9

61.1

38.2

58.0

Men Women

0

10

20

30

40

50

60

Central American Cuban Dominican Mexican Puerto Rican South American

47.3

43.3

36.7 36.4

47.8 48.0

30 hchs/sol data book: a report to the communities 

Chart 29: Percent with Undesirable Cholesterol Levels by Age and Sex

This chart shows the percentages 

of participants with undesirable 

cholesterol levels that were equal 

to or greater than 200 mg/dl. The 

percentage of participants with 

undesirable cholesterol was lowest 

in the youngest group. More men 

and women aged 45–64 years had 

undesirable cholesterol levels than 

the men and women, respectively, in 

the other age groups. 

Chart 30: Percent with Undesirable Cholesterol Levels by Background

The percentages of participants 

with undesirable cholesterol 

levels were lowest among those 

of Dominican and Puerto Rican 

backgrounds.

• Know your cholesterol level and have it checked periodically by your health care provider.

• To maintain healthy levels of blood cholesterol, reduce saturated and trans fats in your diet, be physically active, and 

maintain a healthy weight.
 section vii: risk factors for cardiovascular disease 31

prediabetes and diabetes

Prediabetes and diabetes are serious illnesses that affect millions of persons in the United States. Diabetes was determined in 

participants by measuring the levels of blood glucose (sugar). This was measured both while fasting and after drinking a sugar 

drink. Hemoglobin A1c is another blood value that was measured. It shows a person’s average blood glucose level over a longer 

period of time. Participants could have normal, medium, or high values of blood glucose based on these tests. If a participant 

was normal on all three, they did not have prediabetes or diabetes. If they were at the medium levels, they had prediabetes. If 

they were high on one or more, they were considered to have diabetes.

left to right: Oral glucose tolerance test (diabetes test); Testing blood glucose level

photo by larissa avilés-santa
0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

33.0

23.7

46.9

44.7

40.7 42.4

Men Women

0

10

20

30

40

50

Central American Cuban Dominican Mexican Puerto Rican South American

36.1 37.7

32.1

34.4 36.3 37.0

32 hchs/sol data book: a report to the communities 

Chart 31: Percent with Prediabetes by Age and Sex

Prediabetes was lowest in the 

18–44 age group and highest in the 

45–64 age group. In the middle and 

oldest age groups, the percentages 

of participants with prediabetes 

were similar for men and women, 

respectively.

Chart 32: Percent with Prediabetes by Background

Approximately one in three 

participants had prediabetes in 

each background group. There was 

little difference in prediabetes by 

background.
0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

6.0 6.1

25.2 26.0

45.8 46.6

Men Women

0

5

10

15

20

25

Central American Cuban Dominican Mexican Puerto Rican South American

17.8

18.9 18.4 19.2

10.7

14.0

 section vii: risk factors for cardiovascular disease 33

Chart 33: Percent with Diabetes by Age and Sex

Almost one out of two participants 

in the oldest age group had diabetes 

and one in four in the middle age 

group had diabetes.

Chart 34: Percent with Diabetes by Background

The percentage of participants with 

diabetes was lowest in those of 

South American background.

Other results from this study showed that:

• A similar number of men and women had either diabetes or prediabetes in each age group.

• The number of participants with either prediabetes or diabetes increased as their weight increased. 

• Among participants aged 40 to 49 years, 6 in every 10 had either diabetes or prediabetes. 

• One out of three participants with diabetes was not aware of having the disease.
0

10

20

30

40

50

60

Age 18-44 Age 45-64 Age 65–74

36.5 38.0 37.0

48.7

34.1

47.3

Men Women

34 hchs/sol data book: a report to the communities 

obesity

Obesity is determined by measuring a person’s weight and 

height. Together these two make up a measure called the 

body mass index (BMI) that indicates whether a person 

is underweight (BMI less than 18.5), healthy weight (BMI 

between 18.5 and 24.9), overweight (BMI between 25 and 

29.9), or obese (BMI 30 or more). Several studies have 

shown that obesity increases the chance of chronic diseases 

such as diabetes and heart disease. 

Table 1: Ranges of BMI for Categories of Weight

Category of Weight BMI

Underweight less than 18.5

Healthy weight 

(normal weight)

18.5 – 24.9

Overweight 25 – 29.9

Obesity greater than or equal to 30

Calculate your own BMI at this website: 

http://nhlbisupport.com/bmi/bmicalc.htm

Chart 35: Percent with Obesity by Age and Sex

In men, the percentage of obesity 

was about the same for each age 

group. For women, the percentage 

of obesity was lowest in the 

youngest age group. 

above: Scale
0

10

20

30

40

Age 18-44 Age 45-64 Age 65–74

27.6

16.4

22.0

18.3

13.9

10.1

Men Women

0

10

20

30

40

50

60

Central American Cuban Dominican Mexican Puerto Rican South American

38.5 38.8 41.1

46.8

30.3

37.1

 section vii: risk factors for cardiovascular disease 35

smoking

Chart 37: Percent of Current Cigarette Smokers by Age and Sex

The percentage of current smokers 

was higher for men than women 

in all age groups. In men, the 

percentage of smokers declined 

with age.

Chart 36: Percent with Obesity by Background

Obesity was highly prevalent in all 

of the background groups. It was 

highest among those of Puerto 

Rican background.

• For a large number of HCHS/SOL participants, excess weight was a problem. Achieving and maintaining a healthy 

weight are important steps for preventing health problems.
0

10

20

30

40

Central American Cuban Dominican Mexican Puerto Rican South American

14.3

16.7

11.4

33.8

13.3

27.2

36 hchs/sol data book: a report to the communities 

Chart 38: Percent of Current Cigarette Smokers by Background

The highest percentage of 

participants reporting to be current 

smokers was among those of 

Puerto Rican background, followed 

by those of Cuban background. 

The lowest percentage of current 

smokers was in participants of 

Dominican background.

• Smoking can increase your risk for heart disease, stroke, cancer, and lung disease. If you smoke, quitting will benefit 

many aspects of your overall health. 
0

5

10

15

20

25

30

35

40

45

Central American Cuban Dominican Mexican Puerto Rican South American

24.9

22.3

27.4

38.0

24.2

27.9

0

5

10

15

20

25

30

35

40

45

Age 18-44 Age 45-64 Age 65–74

18.9

29.0

23.7

39.3

22.9

34.3

Men Women

 section vii: risk factors for cardiovascular disease 37

Chart 40: Percent with High Levels of Depressive Symptoms by Background

The highest percentage of 

participants reporting high 

depressive symptoms was among 

those of Puerto Rican background 

and lowest was among those of 

Mexican background.

• Depression can be successfully treated with therapy or medications. If depressive symptoms continue and a person 

cannot seem to “shake it off,” the person should see a professional and seek help for depression.

symptoms of depression

Participants answered questions that describe some feelings or actions that accompany depression. People who are 

depressed have symptoms of sadness, lack of energy, feelings of loneliness, problems with sleep, and other emotional 

and physical feelings. 

The medical condition of depression needs to be diagnosed by a mental health professional, but questionnaires can 

measure whether people have a high level of depressive symptoms or high risk of depression. Persons with high 

depressive symptoms may be at a greater risk of heart disease and stroke.

Chart 39: Percent with High Levels of Depressive Symptoms by Age and Sex

More women than men in all age 

groups reported high depressive 

symptoms: about one in three of 

women reported high depressive 

symptoms. About one in five men 

reported high depressive symptoms. 

The highest percentage of high 

depressive symptoms was reported 

in women aged 45–64 years and the 

lowest was reported in men aged 

18–44 years. 
0

5

10

15

20

25

30

35

40

Central American Cuban Dominican Mexican Puerto Rican South American

14.7 15.6 15.5 16.8

14.3 14.4

0

5

10

15

20

25

30

35

40

Age 18-44 Age 45-64 Age 65–74

14.7 16.2 14.7

16.4

13.4

15.0

Men Women

38 hchs/sol data book: a report to the communities 

anxiety symptoms

Being anxious at times of stress is very common. In 

HCHS/SOL, participants stated how they generally felt 

in response to statements such as: “I feel nervous and 

restless.” They could answer that they feel that way almost 

never, sometimes, often or almost always. Their responses 

to 10 such statements were added and a person could 

have a total score ranging from 10 (not at all anxious) to 

40 (very highly anxious). The median anxiety score is the 

score where half the participants are higher and half are 

lower, in other words, the half–way point.

Chart 42: Median Anxiety Score by Background

There was very little difference in 

anxiety by background.

• Being anxious at times of stress is very common, but some people feel anxious most of the time even when there is 

no explanation for it. Anxiety is a risk factor for heart disease and may be accompanied by depression. Persons who 

are anxious or depressed should seek help from a mental health professional.

Chart 41: Median Anxiety Score by Age and Sex

Women were slightly more anxious 

than men, but there was very little 

difference by age.
0

5

10

15

Central American Cuban Dominican Mexican Puerto Rican South American

9.3

10.1 10.2

11.1

8.1

12.6

0

5

10

15

20

25

30

35

Age 18-44 Age 45-64 Age 65–74

7.4

1.8

22.0

10.2

29.5

21.1

Men Women

 section vii: risk factors for cardiovascular disease 39

sleep problems

Sleep apnea is a disorder defined by an increased number 

of breathing pauses during sleep, usually associated with 

symptoms of loud snoring, snorting and gasping for air, or 

“stop breathing.” This often results in lower oxygen levels 

in the blood and increased stress on the heart. 

Sleep apnea was diagnosed after an overnight sleep study 

was performed. The sleep study reports the number of 

times per hour of sleep someone has breathing pauses. 

In this report, participants with 15 or more pauses were 

considered to have sleep apnea. The photo shows the sleep 

monitor worn in HCHS/SOL, which recorded breathing, 

snoring, oxygen levels, and head position.

above: In HCHS/SOL, participants wore a sleep 

monitor for a night in their home. The monitor 

measured airflow and oxygen levels during sleep, 

allowing sleep apnea to be detected.

Chart 44: Percent with Sleep Apnea by Background

The highest percentage of 

participants reporting sleep 

apnea was among those of Cuban 

background and the lowest was 

among those of South American 

background.

Chart 43: Percent with Sleep Apnea by Age and Sex

The percentage of participants with 

sleep apnea increased with age and 

was higher in men than in women at 

all ages.

photo by larissa avilés-santa
0

10

20

30

40

50

Central American Cuban Dominican Mexican Puerto Rican South American

18.7

32.6

6.9

12.6

35.5

7.0

19.2

32.6

7.7

20.6

31.8

4.2

20.9

34.0

9.9

21.9

34.6

5.7

Sleepiness Snoring Stop Breathing

0

10

20

30

40

50

Central American Cuban Dominican Mexican Puerto Rican South American

19.0

37.2

8.4

16.5

43.8

11.0

18.4

37.3

7.6

18.4

42.4

6.4

24.1

35.2

10.4

22.0

43.1

4.1

Sleepiness Snoring Stop Breathing

40 hchs/sol data book: a report to the communities 

There are other sleep problems that may be signs of sleep apnea. These are sleepiness, loud snoring, and stopped breathing. 

These charts show the frequency of symptoms of sleep problems among participants. 

Chart 45: Percent of Women with Sleep Problems by Background

Chart 46: Percent of Men with Sleep Problems by Background

Although the percentages of sleep 

problems varied by background 

somewhat, approximately one in 

three women reported symptoms 

of snoring and one in five women 

reported daytime sleepiness. 

Reports of snoring were more 

frequent in men compared 

to women. In men, a higher 

percentage of participants who 

stopped breathing during sleep 

were among those of Cuban and 

Puerto Rican backgrounds and 

lowest among those of South 

American background. 

• Sleep apnea is very common, but is usually not diagnosed or treated. Sleep apnea can increase risk for hypertension (high 

blood pressure) and diabetes. Sleep apnea can be treated. All persons, men and women, young and old who have loud 

snoring, stop breathing during sleep have un–refreshing sleep or have daytime sleepiness should discuss this with their 

doctor, who can determine whether further testing or treatment is indicated. Ways to improve sleep include maintaining a 

healthy weight and sleeping at least 7 hours nightly (NHLBI, At a Glance: Healthy Sleep, 2009).
0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

42.6

33.1

18.5

5.8

15.9

30.2

27.1 26.8

7.2

14.9

34.1

43.8

0 Risk Factors 1 Risk Factors 2 Risk Factors 3+ Risk Factors

0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

28.7

34.7

24.6

12.0 11.9

28.9 30.6

27.7

6.7

19.4

29.7

44.2

0 Risk Factors 1 Risk Factors 2 Risk Factors 3+ Risk Factors

 section vii: risk factors for cardiovascular disease 41

multiple risk factors for cardiovascular disease 

High blood pressure, high cholesterol level, obesity, diabetes, and cigarette smoking are major risk factors for heart disease and 

strokes. The more risk factors someone has, the higher their risk of heart disease and stroke. The charts that follow describe 

the percent of HCHS/SOL participants who have 0, 1, 2, and 3 or more of these risk factors. A health goal is for participants at 

all ages to have as few risk factors as possible (Daviglus et al., 2013).

Chart 47: Percent of Women with Multiple Risk Factors by Age

Chart 48: Percent of Men with Multiple Risk Factors by Age

In women, about 43 percent of those 

aged 18–44 years had no risk factors, 

but only about 7 percent of those 

aged 65–74 years had no risk factors. 

Similarly in men, younger age groups 

had fewer risk factors than older 

age groups. In the oldest age group, 

about 44 percent had three or more 

unfavorable risk factors. 

• Prevent heart disease by not smoking, having a healthy lifestyle, eating a balanced diet, and maintaining routine physical 

activity. These daily lifestyle habits work together to prevent the development of diabetes, weight gain, high blood 

pressure, and high cholesterol levels.

• If you already have one or more risk factors, two are better than three, one is better than two, and zero is best of all. 
0

10

20

30

40

50

60

Age 18-44 Age 45-64 Age 65–74

45.0

33.6

54.3

41.9

56.6

42.1

Men Women

42 hchs/sol data book: a report to the communities 

VIII. Lifestyle

diet

Dietary information was obtained by asking participants 

what they ate on the previous day. A dietary pattern was 

determined by gathering dietary information at their 

initial examination and a month or two later by telephone. 

Dietary data are tabulated into groups of higher and 

lower amounts of intake. For fruits and vegetables, the 

group is for those eating 5 or more fruits and vegetables 

per day. Sodium is presented for those consuming less 

than 2,300 mg of sodium per day. Fats are presented for 

those consuming less than 10 percent of calories from 

fat. These groupings are commonly used in presenting 

consumption of fruits and vegetables, sodium and fat.

Chart 49: Percent Eating 5 or More Fruits and Vegetables by Age and Sex

A healthy diet should include plenty 

of fruits and vegetables. More men 

consumed at least 5 fruits and 

vegetables (without fried potatoes) 

per day than women. This percentage 

improved in older ages. 
0

10

20

30

40

50

60

Central American Cuban Dominican Mexican Puerto Rican South American

43.9

47.4

38.9

19.2

49.4

55.0

0

10

20

30

40

50

Central American Cuban Dominican Mexican Puerto Rican South American

18.2

20.5

33.2

21.7

13.3

4.8

0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

3.6

23.4

7.0

35.4

10.6

44.2

Men Women

 section viii: lifestyle 43

Chart 50: Percent Eating 5 or More Fruits and Vegetables by Background

Chart 52: Percent Consuming Less Than 2,300 mg Sodium by Background

While almost half of all 

participants from Cuban and 

South American backgrounds 

reported eating at least 5 fruits and 

vegetables per day, only one out of 

five Puerto Ricans met this target.

A higher percentage of Dominican 

followed by Puerto Rican, Mexican, 

and Central American backgrounds 

reported consuming less than 

2,300 mg of sodium per day. 

Chart 51: Percent Consuming Less Than 2,300 mg Sodium by Age and Sex

The percentage of participants 

consuming less than 2,300 mg of 

sodium per day increased with age. 

Across age groups, women consumed 

less sodium than men. 
0

10

20

30

40

50

60

70

80

Central American Cuban Dominican Mexican Puerto Rican South American

61.2

48.5

67.8

39.3

61.5

47.7

0

10

20

30

40

50

60

70

80

Age 18-44 Age 45-64 Age 65–74

46.2 46.2

54.5 54.8 54.9 54.8

Men Women

44 hchs/sol data book: a report to the communities 

Chart 54: Percent Consuming Less Than 10% Calories from Saturated Fat by Background

Nearly two out of three participants 

of Dominican, South American and 

Central American backgrounds 

reported meeting intake of less 

than 10 percent of calories from 

saturated fat; one out of two 

participants of Mexican and Cuban 

backgrounds met this intake.

A healthy diet includes:

• Eating enough fruits and vegetables

• Being aware of sodium intake (check food labels and select foods with lower sodium values)

• Reducing calories from saturated fats

Chart 53: Percent Consuming Less Than 10% Calories from Saturated Fat by Age and Sex

About half of all participants 

reported consuming less than 10 

percent of calories from saturated 

fat. Men and women had equal 

percentages. 
0

10

20

30

40

50

Age 18-44 Age 45-64 Age 65–74

43.1

19.9

15.8

9.9

12.7

10.2

Men Women

 section viii: lifestyle 45

physical activity

The number of minutes a day in physical activity was 

determined from self–report of various levels of activity 

performed by the participants. Recreational physical 

activities may include walking, riding a bike, swimming, 

jogging, dancing, gardening, and other types of leisure 

activities.

Moderate intensity activity raises your heart rate to a point 

where you sweat and feel you're working, yet you are able 

to carry on a conversation during the activity. Examples of 

moderate level activities include gardening, walking to the 

store, and shopping for groceries. 

During vigorous activity, breathing and heart rate are fast. 

Examples of vigorous activity include very hard physical 

labor like home construction, walking while carrying heavy 

loads, riding a bike, swimming, and running.

Chart 55: Average Minutes per Day of Recreational Physical Activity by Age and Sex

Men aged 18–44 years reported more 

recreational physical activity than 

older men and women of all ages. 

top to bottom: Group physical activity; Carpenter
0

10

20

30

40

50

Central American Cuban Dominican Mexican Puerto Rican South American

19.8

23.3

18.0

28.3

22.0

17.7

0

20

40

60

80

100

120

140

Central American Cuban Dominican Mexican Puerto Rican South American

91.7 88.0

66.3 63.5 68.1

59.4

0

20

40

60

80

100

120

140

Age 18-44 Age 45-64 Age 65–74

126.8

51.3

89.8

51.3

19.2 21.8

Men Women

46 hchs/sol data book: a report to the communities 

Chart 56: Average Minutes per Day of Recreational Physical Activity by Background

Chart 58: Average Minutes per Day of Work–Related Physical Activity by Background

Participants of Cuban background 

reported less recreational physical 

activity than the other background 

groups.

Participants of Cuban background 

reported fewer minutes per day of 

work–related physical activity than 

other background groups.

Work–related physical activity includes physical activities performed during the work day for at least 10 minutes at a time. 

Chart 57: Average Minutes per Day of Work–Related Physical Activity by Age and Sex

Men aged 18–44 years reported more 

minutes per day of work–related 

physical activity than older men and 

women of all ages. Men and women 

aged 65–74 years engaged in fewer 

minutes of work–related physical 

activity than younger participants.
 section viii: lifestyle 47

Physical activity plays an important role in controlling weight. You gain weight when the calories you burn during physical 

activity are less than the calories you eat or drink. Regular physical activity helps strengthen bones; improves mental health; 

improves ability to perform daily activities and prevent falls. Also, it helps to lower risk for heart disease, stroke, type 2 

diabetes, and other health problems. In general, individuals who engage in regular physical activity may live longer. 

• Moderate–intensity activity, like brisk walking, is generally safe for most people. Everyone can gain the health benefits 

of physical activity—age, ethnicity, shape or size do not matter. A healthy lifestyle that involves physical activity can 

help prevent many health problems.

• Aim for at least 150 minutes of physical activity per week (or 30 minutes per day, 5 or more days per week).

For more information: http://health.gov/paguidelines/guidelines/summary.aspx
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

59.8

66.3 70.5 73.4

63.5

74.9

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

57.7

72.6 69.9

78.5 78.3 78.5

Men Women

48 hchs/sol data book: a report to the communities 

IX. Awareness, Treatment, 

and Control

awareness, treatment, and control of hypertension

In this study, participants were asked if their doctor or a medical provider had told them that they had high blood pressure 

or hypertension. If they reported yes, then they were considered to be aware of their hypertension.

Chart 60: Percent Aware of Hypertension by Background

Hypertensive men of Central 

American background were less 

aware and participants of Cuban 

background were more aware of 

their hypertension.

• Assessment of blood pressure though routine medical practice or community screenings can increase awareness of 

hypertension so that treatment can be obtained.

Chart 59: Percent Aware of Hypertension by Age and Sex

For hypertensive men, awareness of 

their hypertension increased with 

age. Hypertensive women generally 

were more aware of hypertension 

than men.
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

43.0

50.3

54.6

59.4

50.8

60.6

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

37.7

54.3 55.9

68.8 72.4 71.4

Men Women

above: Blood pressure monitor

 section ix: awareness, treatment and control 49

Chart 62: Percent Under Hypertension Treatment by Background

A higher percentage of 

participants of Cuban and Puerto 

Rican backgrounds were under 

hypertension treatment than the 

other background groups. The 

lowest percentage of participants 

under treatment was among those of 

Central American background.

• There are many kinds of medications that can lower 

blood pressure to healthier levels. A person who 

has hypertension should be under medical care of 

someone who can recommend the best treatment.

The goal is for all persons with high blood pressure to be under treatment for hypertension.

Chart 61: Percent Under Hypertension Treatment by Age and Sex

In the 18-44 age group, about half 

of the women and about a third 

of the men were under treatment 

for hypertension. In the 65–74 age 

group, participants under treatment 

increased to almost three–fourths 

under treatment. 
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

19.5

32.8 33.8

38.9

31.3

41.9

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

23.3

41.8

34.1

45.7

39.7

34.2

Men Women

50 hchs/sol data book: a report to the communities 

Chart 64: Percent with Hypertension Under Control by Background

Hypertensive participants of Cuban 

and Puerto Rican backgrounds 

had the highest percentages of 

participants with hypertension 

under control. Only about 20 percent 

of hypertensive participants of 

Central American background had 

their condition under control.

• If you have hypertension, follow the advice of a health professional to keep your blood pressure under control.

Chart 63: Percent with Hypertension Under Control by Age and Sex

The poorest control was seen in the 

hypertensive group of men aged 

18–44 years, with only one–fourth 

of them under control.
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

61.6 60.8

70.2 72.1

56.4 58.4

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

61.6

56.4

64.4 66.8

77.4

69.3

Men Women

 section ix: awareness, treatment and control 51

Chart 66: Percent Aware of Diabetes by Background

More than 70 percent of participants 

of Puerto Rican and Dominican 

backgrounds were aware that they 

had diabetes, whereas fewer from 

Central American, Mexican, Cuban, 

and South American backgrounds 

were aware.

• Medicines, diet and exercise can all help lower sugar in the blood and prevent diabetes complications.

awareness, treatment, and control of diabetes

Participants were asked whether they were aware they had diabetes.

Chart 65: Percent Aware of Diabetes by Age and Sex

About two-thirds of participants 

who had diabetes were aware of it. 

Older participants were more likely 

than younger participants to be 

aware of their diabetes. In the oldest 

age group, more men than women 

were aware of having diabetes. 
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

49.3 46.5 48.8 53.0

41.8 40.0

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

40.5 40.5

48.4

56.1

73.2

59.3

Men Women

52 hchs/sol data book: a report to the communities 

Chart 68: Percent Under Diabetes Treatment by Background

More diabetic participants of Puerto 

Rican background reported being 

treated for diabetes than those of 

Central American and Dominican 

backgrounds who, in turn, were 

more likely to be treated than 

those of Mexican, Cuban, or South 

American backgrounds.

Chart 67: Percent Under Diabetes Treatment by Age and Sex

The percentage of participants 

under treatment for diabetes 

increased with age. It was higher 

in women than in men aged 45–64 

years, but was higher in men than 

women aged 65–74 years.
0

10

20

30

40

50

60

70

80

90

100

Central American Cuban Dominican Mexican Puerto Rican South American

43.9

49.6 47.7

54.7

47.1

57.4

0

10

20

30

40

50

60

70

80

90

100

Age 18-44 Age 45-64 Age 65–74

41.2

52.9 54.3 54.3 54.0

61.5

Men Women

 section ix: awareness, treatment and control 53

Chart 70: Percent with Diabetes Under Control by Background

More diabetic participants 

of Cuban and Puerto Rican 

backgrounds had control over their 

diabetes than those of Mexican, 

Dominican, South American, and 

Central American backgrounds.

Chart 69: Percent with Diabetes Under Control by Age and Sex

Only about half of all participants 

with diabetes had their condition 

under control. Control over diabetes 

increased slightly with age. 

• Taking medications prescribed by the doctor can help lower blood sugar to an acceptable level and prevent 

diabetes complications.
0

10

20

30

40

50

60

Bronx Chicago Miami San Diego

20.5

14.9

50.3

17.8

27.0

3.8

49.2

16.9

Age 18–64 Age 65–74

0

10

20

30

40

50

60

70

80

Bronx Chicago Miami San Diego

27.7

4.1

56.8

16.9

70.7

19.2

54.1

26.1

Age 18–64 Age 65–74

54 hchs/sol data book: a report to the communities 

X. Health Insurance

health insurance coverage

Having health insurance is an indicator of access to medical care in the United States. It increases the chance of having 

access to recommended preventive tests and services, and getting specialized medical care. 

types of health insurance

Chart 72: Percent with Employer Health Insurance by Age and Field Center

Approximately half of the 

participants in the Chicago and 

San Diego Field Centers 18–64 age 

group had insurance through their 

employers.

Chart 71: Percent Without Health Insurance By Age and Field Center

Among the four field centers, the 

highest percentage of participants 

without health insurance was in the 

Miami Field Center 18–64 age group 

and the lowest percentage without 

health insurance was in the Bronx 

Field Center 65–74 age group. The 

younger age group was more likely 

to be without health insurance than 

the older age group.
0

10

20

30

40

50

60

70

80

Bronx Chicago Miami San Diego

65.1

52.4

22.4 22.8

42.8

69.4

11.3

35.4

Age 18–64 Age 65–74

0

10

20

30

40

50

60

70

80

90

Bronx Chicago Miami San Diego

8.8 11.0

5.0

9.8

69.2

75.4 75.2

71.1

Age 18–64 Age 65–74

 section x: health insurance 55

Chart 73: Percent with Medicaid Health Insurance by Age and Field Center

Chart 74: Percent with Medicare Health Insurance by Age and Field Center

Most participants from the Bronx 

and Miami had insurance through 

Medicaid.

The majority of participants in 

the 65–74 age group were insured 

through Medicare. 
56 hchs/sol data book: a report to the communities 

XI. Summary

This Data Book provides a glimpse into the potential 

value of the Hispanic Community Health Study/Study 

of Latinos. It describes the health status of a sample 

of persons of diverse backgrounds and locations and 

identifies risk factors for cardiovascular diseases in 

this population. The study can serve as the foundation 

for future research into possible causes of and ways to 

prevent the important health problems shown in these 

pages. The goal is to improve the health of everyone by 

identifying the best ways to prevent health problems and 

applying the best treatments for diseases. 

As shown in this Data Book, prediabetes, diabetes, and 

obesity continue to be very common in Hispanic /Latino 

populations. Prediabetes if not appropriately managed, 

can progress to diabetes. Additionally, obesity, which 

is very prevalent in this study population, can lead to 

diabetes and high blood pressure. 

A new finding from this study showed that a substantial 

number of persons reported having sleep disturbances. 

Other studies have shown the harmful consequences of 

sleep disturbances to cardiovascular health. 

Cardiovascular disease is caused by a combination of risk 

factors and the Data Book reports the percent of participants 

with up to three or more of harmful factors. In the oldest 

age group, about three–fourths have two or more of these 

harmful factors. 

Some of the unhealthy behaviors, such as cigarette smoking, 

are at low levels in some of the background groups, but 

much too high in others. On the other hand, a substantial 

number of persons ate high numbers of servings of fruits 

and vegetables. Younger men, both in work and recreation, 

were the most physically active. Although the percentage 

of patients with hypertension (high blood pressure) was 

not excessive, it is of significant concern because many 

participants were either not being treated or did not have 

their condition under control. Similarly, for diabetes, about 

two–thirds were aware of their diabetes, but less than half 

had it under control.

For some of these diseases and conditions with known 

prevention and treatment, the health message is clear:

• For prevention, follow recommendations to increase 

physical activity, and improve diet, and follow the 

advice of a doctor or health provider.

• For treatment, first know your blood pressure, 

cholesterol, and blood glucose numbers to have 

greater self–awareness of your health status.

• Seek advice from a medical provider on the best way 

to be treated for these conditions.

• Finally, follow all advice given. 

In closing, an appreciation goes to all who have made this 

study possible. First, thanks go to the participants who 

devoted their time, energies, and dedication. Second, a 

vast number of physicians, nurses, technical personnel, 

administrators, computer experts, and statisticians have 

made this beginning possible. Finally, appreciation is given 

to all of the new staff, trainees and other individuals who 

developed an appreciation of the complexity and value of 

research that can improve the health of all Americans.
 section xii: references 57

XII. References

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world. Huffington Post. http://www.huffingtonpost.com/2012/06/22/california–border–crossing_n_1619067.html [Accessed 

5–5–2013]

Daviglus ML, Talavera GA, Avilés–Santa ML, Allison M, Cai J, Criqui MH, Gellman M, Giachello AL, Gouskova N, Kaplan RC, 

LaVange L, Penedo F, Perreira K, Pirzada A, Schneiderman N, Wassertheil–Smoller S, Sorlie PD, Stamler J. (2012). Prevalence 

of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds 

in the United States. JAMA. 308(17):1775–84. 

Kucher, K. (2010, September 16). In Depth: Mexico’s bicentennial and San Diego. U~T San Diego. http://www.utsandiego.com/

news/2010/sep/16/mexicos–impact–region/?page=2#article

Lavange LM, Kalsbeek WD, Sorlie PD, Avilés–Santa LM, Kaplan RC, Barnhart J, Liu K, Giachello A, Lee DJ, Ryan J, Criqui 

MH, Elder JP. (2010). Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos. Ann 

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prevention/WO00041 [Accessed 5–6–2013]

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Murphy, SL, Xu,J, & Kochanek, KD. Preliminary Data for 2010. (2012). National Center for Health Statistics. National Vital 

Statistics Reports. 60(4). (http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf) [Accessed 5–6–2013]

National Heart, Lung, and Blood Institute. (2009, August). At–a–glance: Healthy Sleep. NIH Publication No. 09–7426. http://

www.nhlbi.nih.gov/health/public/sleep/healthy_sleep_atglance.pdf

National Heart, Lung, and Blood Institute. National Institutes of Health. (2009, August). At a glance: What you need to know 

about high blood cholesterol. NIH Publication No.09–7424. http://www.nhlbi.nih.gov/health/public/heart/chol/cholesterol_

atglance.pdf [Accessed 5–6–2013]

National Heart, Lung, and Blood Institute. National Heart, Lung, and Blood Institute. Take Action: Stop Asthma Today! (2010, 

September). NIH Publication No. 10–7542. http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci–action–guide.pdf

National Heart, Lung and Blood Institute. Take the first step to breathing better. Learn more about COPD. http://www.nhlbi.nih.

gov/health/public/lung/copd/index.htm [Accessed 5–6–2013]
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National Heart, Lung, and Blood Institute. (2012, August). What is high blood pressure? http://www.nhlbi.nih.gov/health/

health–topics/topics/hbp/ [Accessed 5–6–2013]

New York City Department of City Planning. (2011, March). NYC 2010: Results from the 2010 census. Population growth and 

race/Hispanic composition. http://www.nyc.gov/html/dcp/pdf/census/census2010/pgrhc.pdf [Accessed 5–6–2013]

Pub Med Health: Stroke. (last reviewed 2012, May). A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/

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Ready T & Brown–Gort A. (2005). The State Of Latino Chicago: This Is Home Now. Institute of Latino Studies. University of 

Notre Dame. http://www.csu.edu/CERC/documents/StateofLatinoChicago.pdf [Accessed 2–7–2012]

Sorlie PD, Aviles–Santa LM, Wassertheil–Smoller S, Kaplan RC, Daviglus ML, Giachello AL, Schneiderman N, Raij L, Talavera 

G, Allison M, Lavange L, Chambless LE, Heiss G. (2010). Design and implementation of the Hispanic Community Health 

Study/Study of Latinos. Annals of Epidemiology, 20(8):629–641. 

U.S. Census Bureau. 2010 Census/American Fact Finder. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml 

[Accessed 5–6–2013]

Wikipedia, Miami: http://en.wikipedia.org/wiki/Miami [Accessed 2/15/2013] 
The NHLBI Health Information Center is a service of the National Heart, Lung and Blood Institute (NHLBI) of the National 

Institutes of Health. The NHLBI Health Information Center provides information to health professionals, patients, and the 

public about the treatment, diagnosis and prevention of heart, lung, and blood diseases and sleep disorders.

for more information

NHLBI Health Information Center

P.O. Box 3015

Bethesda, MD 20824–0101

Phone: 301–592–8573 (or dial 7–1–1 for access to free Telecommunications Relay Services, TRS)

Fax: 301–592–8563

Email: NHLBIinfo@nhlbi.nih.gov

Websites:

NHLBI: www.nhlbi.nih.gov

HCHS/SOL: www.saludsol.net

NHLBI Health Topics Index

Health Topics includes articles on sleep disorders, tests, and procedures, along with videos and Spanish-language articles.

Website: www.nhlbi.nih.gov/health/health-topics/by-alpha/

DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person 

in the United States shall, on the grounds of race, color, national origin, handicap or age, be excluded from participation 

in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with 

respect to any education program or activity) receiving Federal financial assistance. In addition, Executive Order 11141 

prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and 

Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for 

employment because of race, color, religion, sex or national origin. Therefore, the National Heart, Lung, and Blood Institute 

must be operated in compliance with these laws and Executive Orders.

Suggestion Citation: Hispanic Community Health Study/Study of Latinos Data Book: A Report to the Communities (NIH 

Publication No. 13-7951). Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 

National Heart, Lung, and Blood Institute. September 2013.