Boston Puerto Rican Health Study
Condition: Cardiovascular Risk Factor
Study type: Observational

Summary: 
      The investigators 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.
    

Detailed description: 
      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 for 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 1500 Puerto Rican adults, aged 45-75
      years at baseline, and completed two-year follow-up interviews on more than 1250
      participants. 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; 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 partners, 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 may be
      implemented. To date, we have completed approximately 840 5-year follow-up interviews.
    

Intervention name(s): The Heart Healthy Initiative for Hispanic Adults (HIP)
Intervention type(s): Behavioral
Intervention description(s): This randomized controlled pilot intervention study will include 150 Hispanic adults (45-75y) in the Greater Boston area. Participants will be randomized to either the intervention or control group after completing their baseline interview. The intervention group will receive 6 months of weekly group educational sessions, Zumba fitness classes and interactions with an embodied computer agent (ECA). The fitness classes and interactions with the ECA will continue for the second 6 months of the 1 year intervention. Intervention activities will occur at community centers in the greater Boston area. Control participants will receive standard of care for the first 6 months and will be offered the full intervention (weekly group educational sessions, Zumba fitness classes and interactions with the ECA) for the second 6 months of the study. Participants will complete an interview and blood draw at baseline, 6 months, and 12 months.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Puerto Ricans older adults, aged 45-75 years, living in the Boston area.
      
Biospecimen description: 
      blood, urine, saliva
    
Keywords: Puerto Rican; CVD; Hispanic; health disparities; allostatic load; diet