NIH-funded project will follow 16,000 Hispanic/Latino participants in four cities

UM a site in landmark U.S. Hispanic health study

n a groundbreaking study that will make a significant contribution to the nation’s health, the University of Miami is one of four sites in the country that will conduct the largest long-term epidemiological study of health and disease in Hispanic populations living in the United States.

The federally funded, $61 million Hispanic Community Health Study, which began on September 30, will follow 16,000 participants of Hispanic/ Latino origin—4,000 at each of four sites—who will undergo a series of physical examinations and interviews to help identify the prevalence of and risk factors for a wide variety of diseases, disorders, and conditions.

Study participants will range from 18 to 74 years of age and will be tracked over time for occurrence of disease. The study also will determine the role of cultural adaptation and economic disparities in the prevalence and development of disease.

The Hispanic Community Health Study is broad-based, addressing a wide variety of conditions, including heart disease, stroke, asthma, chronic obstructive pulmonary disease, sleep disorders, dental disease, hearing impairment and tinnitus, diabetes, kidney and liver disease, and cognitive impairment.

The study will assess risk factors such as poor diet, physical inactivity, obesity, smoking, high blood pressure, and blood lipids, as well as acculturation, social and economic disparity, psychosocial factors, occupation, health care access, the environment, and medication and supplement use.

Because the risk of disease in a population can be influenced by different cultural and genetic factors, the study includes population groups from several geographic areas and countries of origin and with residence in the United States for varying lengths of time.

The six-and-a-half-year study, funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), will recruit persons who identify themselves as Hispanics or Latinos but will emphasize Mexican-Americans, Puerto Ricans, Cuban-Americans, and Central and South Americans.

In the study’s $10 million South Florida component, more than 50 percent of the participants will be Cuban-American, and over 20 percent will be South and Central American, according to UM professor of psychology Neil Schneiderman, principal investigator of the project’s Miami site.

The Miami component, which is being run out of the University’s new Clinical Research Building, is composed of investigators from the Miller School’s Departments of Medicine, Surgery, Pediatrics, Epidemiology and Public Health, Family Medicine, and Psychiatry and Behavioral Sciences.

The other three field study sites are in Bronx, New York (Albert Einstein College of Medicine of Yeshiva University); Chicago (Northwestern University); and San Diego (San Diego State University). The University of North Carolina, Chapel Hill, is the study’s data coordinating center.

The study, Schneiderman says, could help answer many important questions, such as why U.S. Hispanics are experiencing increased rates of obesity and diabetes yet fewer deaths from heart disease than non-Hispanics, and why Hispanics are reportedly living longer than other groups, despite having less access to health care and higher rates of poverty.

Several possible theories have been advanced to account for such inconsistencies, and some researchers believe it may actually be a combination of factors at work.

• One theory is the healthy-immigrant hypothesis. “Many of the Hispanics in the United States are immigrants,” Schneiderman says. “In general, healthier people tend to move, and the sick or weak tend to stay behind.”

• U.S. mortality rates may not reflect the true death rate for Hispanics. Some physicians might fail to note Hispanic status on death certificates, some researchers argue. “There’s also the issue of where people die,” Schneiderman says. “Some immigrants go back to their native countries to die, so their deaths are not part of the U.S. mortality rate.”

• Cultural factors, such as social networks and family support, may also play a part. “We don’t do much touching in our society; we don’t hug, we don’t spend a lot of time doing those kinds of things. But in the Hispanic community, that’s much more common,” Schneiderman explains.

“There’s also a lot of value in the Hispanic community on the family and on togetherness as opposed to individualism,” Schneiderman adds. “While individualism is good in terms of your early life, when people get older and they’re lonely, they tend to be isolated in non-Hispanic populations, whereas Hispanics have more of a family to fall back on.”

The Hispanic population is the largest minority population in the United States and is expected to triple by 2050. “As this population continues to increase—and to experience varying rates of disease—it is vitally important to understand the risk factors and health behaviors that contribute to these diseases,” says National Institutes of Health director Elias A. Zerhouni. “The knowledge gained from the Hispanic Community Health Study will benefit not only Hispanic populations but will also enhance understanding of health and disease in other ethnic groups.”