Current Centers for Population Health and Health Disparities
Boston Puerto Rican Health Study
316 Robinson Hall, Northeastern University
Boston, MA 02115
Katherine Tucker, PhD Contact Principal Investigator
Abstract: Puerto Rican adults living on the United States mainland 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, 200308) 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 paradoxlower 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 1,450 Puerto Rican adults, aged 4575 years at baseline, and have completed to date more than 900 2-year followup interviews; we are continuing, with the expectation of completing at least 1,150. 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 future. Our overall aim for this renewal is, therefore, to extend followup 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; this will allow us to better understand the dynamics of these disparities. Our model follows the transdisciplinary "cells to society" concept developed jointly with our CPHHD partners 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 environmental (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 and also fully considers the social and physical environment to ensure success. With the 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 that contribute to CVD risk so that effective interventions maybe implemented.
- Understand the complex interactions of diet and other behavioral and environmental factors, genetics, and psychosocial stress on the high and increasing prevalence of CVD risk factors in Puerto Rican adults;
- Extend followup to the initial funding period for the BPR-CPHHD,
- Measure and analyze relevant characteristics and CVD risk factors;
- Add additional contextual and outcome measures for CVD risk in this established cohort of Puerto Rican adults to better understand the dynamics of the health disparities in this population.
Project 1 will examine, and ultimately better understand, the complex interactions between the social, cultural, environmental, biological, behavioral, physiological, and genetic factors that affect CVD in this group of high-risk Puerto Rican adults.
- Measure associations between nutritional variables and CVD risk measures and indicators;
- Measure associations between allostatic load and FRS with ABI and IMT at 5 years and assess the relationship between measures of allostatic load, and the Framingham Risk Score (FRS) across three time points, with CVD indicators (ABI and IMT) at the 5-year time point;
- Assess associations between indicators of neighborhood food availability and walkability and CVD risk measures, ABI and IMT, at 5 years.
Project 2 will examine in the study population how stressors, personal resources, social networks, and perceptions and characteristics of the local environment relate to cardiovascular risk indicators over time.
- Assess associations between depressive symptomatology, psychosocial stress, and CVD risk;
- Assess the characteristics of social networks and their effects on cardiovascular risk;
- Assess characteristics of the local environment and its impact on heart health and cardiovascular risk.
Project 3 will extend the Center's work in an ongoing cohort of Puerto Rican adults, aged 4575 years at baseline, using genome wide association (GWA) genotyping to examine cardiovascular health, diabetes, hypertension, and genetics to develop predictive tools to assess disease risk in this understudied population.
- Genotype 1,350 Puerto Rican adults participating in the BPR-CPHHD Study, using the Affymetrix Genome-Wide Human SNP (single nucleotide polymorphism) Array 6.0 s;
- Utilize the genome-wide data generated by Aim 1 to target genetic regions for further analysis relating to prevalence of markers of vascular health, with an emphasis on hypertension and type 2 diabetes;
- Replicate findings observed in this population for cardiovascular health and diabetes in various studies in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) and Nutrition, Aging, and Memory in Elders (NAME);
- Complete detailed statistical analyses of specified genes with markers of cardiovascular health, hypertension, and type 2 diabetes, in interaction with environmental variables, including dietary intake, body weight, physical activity, acculturation, and psychosocial stress; and to examine the effect of genotype on 2-year progression of measures of cardiovascular health, hypertension, and diabetes.
Project 4 addresses the public health impact of traffic-related air pollutionparticularly ultrafine particle (UFP) exposureon the development of cardiovascular disease in older Puerto Rican adults.
- Add to evidence for the causal pathway between UFP exposure and development of CVD;
- Explore the role that traffic-related pollutants, UFP specifically, might play in CVD disparities in the Puerto Rican population.
Project 5 will create an effective and sustainable multilevel heart healthy action program for Puerto Rican adults to reduce the risk of and the complication from CVD.
- Develop and implement a multilevel heart healthy action program (HAP) for Puerto Ricans aged 4560 years living in the metro-Boston area;
- Evaluate the efficacy of HAP over a 2-year period;
- Establish a computer-participant working alliance that uses health behavior automated dialogues via an embodied conversational agent (ECA) to promote and re-enforce positive heart healthy behaviors among participants over a 1-year period.