Diabetes Incidence Among Hispanic/Latino Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: To examine diabetes incidence in a diverse cohort of U.S. Hispanic/Latinos. RESEARCH DESIGN AND METHODS: The Hispanic Community Health Study/Study of Latinos is a prospective cohort study with participants aged 18-74 years from four U.S. metropolitan areas. Participants were assessed for diabetes at the baseline examination (2008-2011), annually via telephone interview, and at a second examination (2014-2017). RESULTS: A total of 11,619 participants returned for the second examination. The overall age-adjusted diabetes incidence rate was 22.1 cases/1,000 person-years. The incidence was high among those with Puerto Rican and Mexican backgrounds as well as those aged ≥45 years and with a BMI ≥30 kg/m2. Significant differences in diabetes awareness, treatment, and health insurance coverage, but not glycemic control, were observed across Hispanic/Latino background groups, age groups, and BMI categories. CONCLUSIONS: Differences in diabetes incidence by Hispanic/Latino background, age, and BMI suggest the susceptibility of these factors.

Corrigendum to "Risk Factor Control Across the Spectrum of Cardiovascular Risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)" [American Journal of Preventive Cardiology, Volume 5, March 2021, 100147].

[This corrects the article DOI: 10.1016/j.ajpc.2021.100147.].

Risk factor control across the spectrum of cardiovascular risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: Presence of cardiovascular disease (CVD) risk factors (RFs) should prompt patients and their providers to work aggressively towards controlling those that are modifiable. The extent to which a greater CVD RF burden is related to CVD RF control in a contemporary and diverse Hispanic/Latino population is not well-understood. METHODS: Using multicenter community-based data from the Hispanic Community Health Study/Study of Latinos, we assessed the self-reported prevalence of hypertension, hypercholesterolemia, diabetes, and prevalent CVD (ischemic heart disease or stroke). We used contemporaneous guidelines to define RF control. Multivariable logistic regression for complex survey sampling was used to examine whether having more CVD RFs was associated with CVD RF control (adjusting for age, sex, Hispanic background group, education, and health insurance). RESULTS: Our sample included 8521 participants with at least one CVD RF or prevalent CVD. The mean age in HCHS/SOL target population was 49 (SE 0.3) years and 56% were women. Frequency of one, two, or three self-reported CVD RFs was 57%, 26%, 8%, respectively, and overall 9% of participants had prevalent CVD. After adjusting for sociodemographic factors, compared to those reporting one CVD RF, individuals with three CVD RFs were the least likely to have blood pressure, cholesterol, and glucose optimally controlled (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.40-0.80). However, those with prevalent CVD were more likely to have all three risk factors controlled, (OR: 1.43; 95% CI: 1.01-2.01). CONCLUSION: Hispanic/Latino adults with three major CVD RFs represent a group with poor overall CVD RF control. Secondary CVD prevention fares better. The potential contributors to inadequate CVD RF control in this highly vulnerable group warrants further investigation.

Prioritizing Competencies for "Research" Promotores and Community Health Workers.

Background. The community health worker (CHW) model is utilized globally to promote health and reduce health disparities in hard-to-reach and underserved communities. The model is deemed successful due to involvement of these natural helpers who are familiar with the local customs, language, and traditions. "Research" CHWs (also known as promotores) serve as cultural mediators between their community and academic researchers and are increasingly involved in the design and implementation of research; yet few of these individuals have received formal training in research methods or ethics. This study identified requisite skills and knowledge needed by research CHWs. Method. Investigators who utilized the CHW/promotor model were recruited to complete a survey and participate in one of four focus group sessions. Participants identified (1) research roles, (2) training received, (3) research competencies, (4) training barriers and facilitators, and (5) assessment preferences. Results. Participants (n = 20) completed a survey with 19 also participating in a focus group session. All participants involved CHWs in research implementation, with nearly half involving CHWs in the study design and/or dissemination of findings phases. Critical thinking skills and application of ethical principles (e.g., demonstrating respect) were prioritized over knowledge of research infrastructure (e.g., institutional review board/ethics review process). Research ethics training designed for academic researchers was deemed inappropriate because sophisticated terminology and web-based delivery were perceived as an access barrier. Self-assessment and contextualized scenarios were recommended to assess critical thinking. Conclusions. Researchers using the CHW model should provide relevant and accessible research competency training.

Wildfire Smoke Exposure: Awareness and Safety Responses in the Agricultural Workplace.

Objective: The study examines how wildfire smoke exposure may impact health and safety in the agricultural workplace. Methods: Semi-structured interviews were conducted with agricultural employers and focus group discussions were held with farmworkers in three regions of California. Results: Agricultural employers had varying knowledge about and experience responding to poor air quality due to wildfire smoke. Respirators or masks were not mentioned as a potential protective measure when describing their safety practices. Farmworkers reported experiencing poor air quality due to wildfire smoke, although knowledge of safety precautions varied. Farmworkers reported employer and supervisors' attitudes toward safety as having the greatest impact on the implementation of workplace safety measures. Conclusion: Adapting health promotion and workplace safety strategies to meet the multiple vulnerabilities and diverse needs of farmworkers is critical to successful implementation of workplace protection and safety measures. Given limited familiarity with the topic, wildfire smoke exposure resources are needed to assist employers and supervisors in their compliance with a new wildfire smoke safety regulation in California. To the best of our knowledge, this is the first study to explore agricultural employer and farmworker perceptions of the health and safety impacts of wildfire smoke and workplace exposure.

Loneliness, Cardiovascular Disease, and Diabetes Prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

The relationship between loneliness and both cardiovascular disease (CVD) and diabetes mellitus (DM) has been understudied in U.S. Hispanics, a group at high risk for DM. We examined whether loneliness was associated with CVD and DM, and whether age, sex, marital status, and years in U.S moderated these associations. Participants were 5,313 adults (M (SD) age = 42.39 (15.01)) enrolled in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Loneliness was assessed via the 3-item Revised UCLA Loneliness Scale. Level of reported loneliness was low. Loneliness was significantly associated with CVD: OR 1.10 (CI 1.01-1.20) and DM: OR 1.08 (CI 1.00-1.16) after adjusting for depression, demographics, body mass index, and smoking status. Age, sex, marital status, and years in U.S. did not moderate associations. Given that increased loneliness is associated with higher cardiometabolic disease prevalence beyond depressive symptoms, regardless of age, sex, marital status, or years in the U.S., Hispanic adults experiencing high levels of loneliness may be a subgroup at particularly elevated risk for CVD and DM.

Associations of Lipid Levels and Cognition: Findings from the Hispanic Community Health Study/Study of Latinos.

OBJECTIVE: Hispanics/Latinos in the United States are less aware of their cholesterol levels and have a higher burden of associated adverse cardiovascular and cerebrovascular outcomes than non-Latino whites. Investigations of the associations between cholesterol levels and cognition in this population have often occurred within the context of metabolic syndrome and are limited to select lipids despite the fact that triglycerides (TGs) may be more relevant to the health of Hispanics/Latinos. METHODS: Baseline data from the Hispanic Community Health Study/Study of Latinos, collected from 2008 to 2011, was used to investigate the associations of lipid levels (i.e., TG, total cholesterol, TC; low-density and high-density lipoprotein cholesterol, LDL-C and HDL-C) with cognition (i.e., learning, memory, verbal fluency, and digit symbol substitution, DSS), adjusting for relevant confounders. RESULTS: In 7413 participants ages 45 to 74 years from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds, separate, fully adjusted linear regression models revealed that TG levels were inversely associated with DSS performance; however, this relationship was no longer significant once additional cardiovascular disease risk factors were added to the model (p = .06). TC and LDL-C levels (separately) were positively associated with learning and verbal fluency regardless of adjustments (p-values < .05). Separate analyses investigating the effect modification by background and sex revealed a particularly robust association between TC levels and DSS performance for Puerto Ricans and Central Americans (albeit in opposite directions) and an inverse relationship between TG levels and DSS performance for women (p-values < .02). CONCLUSIONS: It is important to consider individual lipid levels and demographic characteristics when investigating associations between cholesterol levels and cognition in Hispanics/Latinos.

Body Mass of U.S. Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): How Do Diet Quality and Sedentary Time Relate?

Little evidence exists on diet quality- and sedentary time-related differences in body mass index (BMI) among immigrant and nonimmigrant Hispanics/Latinos with different lengths of U.S. residence. A total of 13,962 (80.2% foreign-born) Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants aged 18 to 60 from four U.S. cities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) underwent standardized interviews and fasting blood tests. Diet quality was total Alternative Healthy Eating Index score. Sedentary time was number of <100 counts/minute over 3 to 6 days. BMI was examined using regression models adjusted for age, income, Hispanic/Latino background, HCHS/SOL site, and tobacco use. Two three-way interactions (diet or sedentary time length of residence sex) were tested to examine health behavior-related differences in BMI among immigrant and nonimmigrant males and females. The diet length of residence sex interaction was significant (b = .005, 95% confidence interval [-.003, .008]). For a 10-unit Alternative Healthy Eating Index difference, the BMI difference was greater among immigrant females in the United States longer (0 years = .84 kg/m2; 10 years = 1.64 kg/m2). Diet-related obesity prevention efforts may start soon after migration, particularly for immigrant women.

Building a comprehensive mentoring academy for schools of health.

Formal mentoring programs are increasingly recognized as critical for faculty career development. We describe a mentoring academy (MA) developed for faculty across tracks (i.e., researchers, clinicians, educators) within a "school of health" encompassing schools of medicine and nursing. The program is anchored dually in a clinical and translational science center and a school of health. The structure includes the involvement of departmental and center mentoring directors to achieve widespread uptake and oversight. A fundamental resource provided by the MA includes providing workshops to enhance mentoring skills. Initiatives for junior faculty emphasize establishing and maintaining strong mentoring relationships and implementing individual development plans (IDPs) for career planning. We present self-report data on competency improvement from mentor workshops and data on resources and barriers identified by junior faculty (n = 222) in their IDPs. Mentors reported statistically significantly improved mentoring competency after workshop participation. Junior faculty most frequently identified mentors (61%) and collaborators (23%) as resources for goal attainment. Top barriers included insufficient time and time-management issues (57%), funding limitations (18%), work-life balance issues (18%), including inadequate time for self-care and career development activities. Our MA can serve as a model and roadmap for providing resources to faculty across traditional tracks within medical schools.

Associations of insulin resistance with cognition in individuals without diagnosed diabetes: Results from the Hispanic Community Health Study/Study of Latinos.

AIMS: Insulin resistance (IR) adversely impacts memory and executive functioning in non-Hispanic whites without diabetes. Less is known in Hispanics/Latinos, despite the fact that Hispanics/Latinos have higher rates of insulin resistance than non-Hispanic whites. We investigated the association between IR and cognition and its variation by age. METHODS: Data from 5987 participants 45-74 years old without diabetes from the Hispanic Community Health Study/Study of Latinos. IR was considered continuously using homeostasis model assessment for insulin resistance (HOMA-IR) and also dichotomized based on clinically relevant thresholds for hyperinsulinemia (fasting insulin > 84.73 pmol/L or HOMA-IR > 2.6) and sample-based norms (75th percentile of fasting insulin or HOMA-IR). Cognitive testing included the Brief Spanish English Verbal Learning Test (B-SEVLT), Verbal Fluency, and Digit Symbol Substitution. RESULTS: There was 90% overlap in participant categorization comparing clinically relevant and sample-based thresholds. In separate fully-adjusted linear regression models, age modified the association between HOMA-IR and Digit Symbol Substitution (p = 0.02); advancing age combined with higher HOMA-IR levels resulted in higher scores. Age also modified the association between clinically relevant hyperinsulinemia and B-SEVLT recall (p = 0.03); with increasing age came worse performance for individuals with hyperinsulinemia. CONCLUSION: The relationship of IR with cognition in Hispanics/Latinos without diabetes may reflect an age- and test-dependent state.

Variations of dietary intake by glycemic status and Hispanic/Latino heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: A healthy diet is important for diabetes prevention and control; however, few studies have assessed dietary intake among US Hispanics/Latinos, a diverse population with a significant burden of diabetes. To address this gap in the literature, we determined intake of energy, macro/micronutrients, and vitamin supplements among Hispanics/Latinos by glycemic status and heritage. RESEARCH DESIGN AND METHODS: Cross-sectional study of adults aged 18-74 years from the Hispanic Community Health Study/Study of Latinos (2008-2011) with complete baseline data on glycemic status and two 24-hour dietary recalls (n=13 089). Age-adjusted and sex-adjusted and multivariable-adjusted measures of intake were determined by glycemic status and heritage. RESULTS: Mean age-adjusted and sex-adjusted energy intake was significantly lower among Hispanics/Latinos with diagnosed diabetes compared with those with normal glycemic status (1665 vs 1873 kcal, P<0.001). Fiber intake was higher among those with diagnosed diabetes versus normal glycemic status (P<0.01). Among those with diagnosed diabetes, energy intake was highest among those with Cuban heritage compared with most other heritage groups (P<0.01 for all, except Mexicans), but there was no difference after additional adjustment. Fiber intake was significantly lower for those of Cuban heritage (vs Dominican, Central American, and Mexican), and sodium intake was significantly higher (vs all other heritage groups) (P<0.01 for all); findings were null after additional adjustment. There was no difference in supplemental intake of vitamin D, calcium, magnesium, or potassium by glycemic status. CONCLUSIONS: As part of the care of Hispanics/Latinos with diabetes, attention should be made to fiber and sodium consumption.

Commuting and Sleep: Results From the Hispanic Community Health Study/Study of Latinos Sueño Ancillary Study.

INTRODUCTION: Commute time is associated with reduced sleep time, but previous studies have relied on self-reported sleep assessment. The present study investigated the relationships between commute time for employment and objective sleep patterns among non-shift working U.S. Hispanic/Latino adults. METHODS: From 2010 to 2013, Hispanic/Latino employed, non-shift-working adults (n=760, aged 18-64 years) from the Sueño study, ancillary to the Hispanic Community Health Study/Study of Latinos, reported their total daily commute time to and from work, completed questionnaires on sleep and other health behaviors, and wore wrist actigraphs to record sleep duration, continuity, and variability for 1 week. Survey linear regression models of the actigraphic and self-reported sleep measures regressed on categorized commute time (short: 1-44 minutes; moderate: 45-89 minutes; long: ≥90 minutes) were built adjusting for relevant covariates. For associations that suggested a linear relationship, continuous commute time was modeled as the exposure. Moderation effects by age, sex, income, and depressive symptoms also were explored. RESULTS: Commute time was linearly related to sleep duration on work days such that each additional hour of commute time conferred 15 minutes of sleep loss (p=0.01). Compared with short commutes, individuals with moderate commutes had greater sleep duration variability (p=0.04) and lower interdaily stability (p=0.046, a measure of sleep/wake schedule regularity). No significant associations were detected for self-reported sleep measures. CONCLUSIONS: Commute time is significantly associated with actigraphy-measured sleep duration and regularity among Hispanic/Latino adults. Interventions to shorten commute times should be evaluated to help improve sleep habits in this minority population.

Structural social support and cardiovascular disease risk factors in Hispanic/Latino adults with diabetes: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE(S): Cross-sectional and longitudinal studies have yielded inconsistent findings on the associations of social support networks with cardiovascular health in Hispanic/Latino adults with diabetes. We examined the cross-sectional associations of structural social support and traditional cardiovascular disease (CVD) risk factors in a diverse sample of Hispanic/Latino adults with diabetes. RESEARCH DESIGN AND METHODS: This analysis included 2994 adult participants ages 18-74 with diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL - 2008-2011). Select items from the Social Network Inventory (SNI) were used to assess indices of structural social support, i.e. network size (number of children, parents, and in-laws) and frequency of familial contact. Standardized methods were used to measure abdominal obesity, BMI, hypertension, hypercholesterolemia, and smoking status. Multivariate regression was used to examine associations of structural support with individual CVD risk factors with demographics, acculturation, physical health, and psychological ill-being (depressive symptoms and anxiety) included as covariates. RESULTS: There were no significant cross-sectional associations of structural support indices with abdominal obesity, hypertension, hypercholesterolemia, or smoking status. There was a marginally significant (OR: 1.05; 95%CI 0.99-1.11) trend toward higher odds of obesity in participants reporting a larger family unit (including children, parents, and in-laws) and those with closer ties with extended family relatives (OR: 1.04; 95%CI 0.99-1.09). CONCLUSIONS: Structural social support was marginally associated with higher odds of obesity in Hispanic/Latino adults with diabetes. Alternate forms of social support (e.g. healthcare professionals, friends, peers) should be further explored as potential markers of cardiac risk in Hispanics/Latinos with diabetes.

Evaluating Two Evidence-Based Intervention Strategies to Promote CRC Screening Among Latino Adults in a Primary Care Setting.

Regular use of colorectal cancer screening can reduce incidence and mortality, but participation rates remain low among low-income, Spanish-speaking Latino adults. We conducted two distinct pilot studies testing the implementation of evidence-based interventions to promote fecal immunochemical test (FIT) screening among Latinos aged 50-75 years who were not up-to-date with CRC screening (n = 200) at a large Federally Qualified Health Center (FQHC) in San Diego, CA. One pilot focused on an opportunistic clinic visit "in-reach" intervention including a 30-min session with a patient navigator, review of an educational "flip-chart," and a take-home FIT kit with instructions. The second pilot was a system-level "outreach" intervention consisting of mailed materials (i.e., FIT kit, culturally and linguistically tailored instructions, and a pre-paid return envelope). Both received follow-up calls to promote screening completion and referrals for additional screening and treatment if needed. The primary outcome was FIT kit completion and return within 3 months assessed through electronic medical records. The in-reach pilot consisted of mostly insured (85%), women (82%), and Spanish-speaking (88%) patients. The outreach pilot consisted of mostly of Spanish-speaking (73%) women (64%), half of which were insured (50%). At a 3-month follow-up, screening completion was 76% for in-reach and 19% for outreach. These data demonstrate that evidence-based strategies to promote CRC screening can be implemented successfully within FQHCs, but implementation (particularly of mailed outreach) may require setting and population-specific optimization. Patient, provider, and healthcare system related implementation approaches and lessons learned from this study may be implemented in other primary care settings.

Ethical and regulatory challenges of research using pervasive sensing and other emerging technologies: IRB perspectives.

Vast quantities of personal health information and private identifiable information are being created through mobile apps, wearable sensors, and social networks. While new strategies and tools for obtaining health data have expanded researchers' abilities to design and test personalized and adaptive health interventions, the deployment of pervasive sensing and computational techniques to gather research data is raising ethical challenges for Institutional Review Boards (IRBs) charged with protecting research participants. To explore experiences with, and perceptions about, technology-enabled research, and identify solutions for promoting responsible conduct of this research we conducted focus groups with human research protection program and IRB affiliates. Our findings outline the need for increased collaboration across stakeholders in terms of: (1) shared and dynamic resources that improve awareness of technologies and decrease potential threats to participant privacy and data confidentiality, and (2) development of appropriate and dynamic standards through collaboration with stakeholders in the research ethics community.

HEMOGLOBIN A1C, BLOOD PRESSURE, AND LDL-CHOLESTEROL CONTROL AMONG HISPANIC/LATINO ADULTS WITH DIABETES: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL).

OBJECTIVE: To determine the prevalence of Hispanic/Latino adults with diabetes who meet target hemoglobin A1c, blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) recommendations, and angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blocker (ARB) and statin medication use by heritage and sociodemographic and diabetes-related characteristics. METHODS: Data were cross-sectional, collected between 2008 and 2011, and included adults age 18 to 74 years who reported a physician diagnosis of diabetes in the Hispanic Community Health Study/Study of Latinos (N = 2,148). Chi-square tests compared the prevalence of hemoglobin A1c, BP, and LDL-C targets and ACE/ARB and statin use across participant characteristics. Predictive margins regression was used to determine the prevalence adjusted for sociodemographic characteristics. RESULTS: The overall prevalence of A1c <7.0% (53 mmol/mol), BP <130/80 mm Hg, and LDL-C <100 mg/dL was 43.0, 48.7, and 36.6%, respectively, with 8.4% meeting all three targets. Younger adults aged 18 to 39 years with diabetes were less likely to have A1c <7.0% (53 mmol/mol) or LDL-C <100 mg/dL compared to those aged 65 to 74 years; younger adults were more likely to have BP <130/80 mm Hg (P<.05 for all). Individuals of Mexican heritage were significantly less likely to have A1c <7.0% (53 mmol/mol) compared to those with Cuban heritage, but they were more likely to have BP <130/80 mm Hg compared to those with Dominican, Cuban, or Puerto Rican heritage (P<.05 for all); there was no difference in LDL-C by heritage. Overall, 38.2% of adults with diabetes were taking a statin, and 50.5% were taking ACE/ARB medications. CONCLUSION: Hemoglobin A1c, BP, and LDL-C control are suboptimal among Hispanic/Latinos with diabetes living in the U.S. With 8.4% meeting all three recommendations, substantial opportunity exists to improve diabetes control in this population. ABBREVIATIONS: A1c = hemoglobin A1c; ABC = hemoglobin A1c, blood pressure, low-density-lipoprotein cholesterol; ACE = angiotensin-converting enzyme; ADA = American Diabetes Association; ARB = angiotensin receptor blocker; BMI = body mass index; BP = blood pressure; CHD = coronary heart disease; CVD = cardiovascular disease; HCHS/SOL = Hispanic Community Health Study/Study of Latinos; LDL-C = low-density-lipoprotein cholesterol; NHANES = National Health and Nutrition Examination Survey; PAD = peripheral artery disease.

Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013.

OBJECTIVE: To assess prostate cancer (PC) mortality in Mexico from 1980 to 2013, according to the state marginalization level. MATERIALS AND METHODS: Using age-adjusted rates in men ≥ 40 years old, we estimated trends and age-cohort-period effects of PC mortality from 1980-2013 according to state marginalization status by using a joinpoint regression model and a Poisson regression model proposed by Holford. RESULTS: The PC mortality risk has increased nationwide at a constant rate (2% annually) during the past 13 years. The highest annual increase was observed among states with very high (4.4%) and high (7.7%) marginalization rates. In contrast, states with very low levels of marginalization showed a significant reduction of 1.5% per year. The main changes were observed in the 1945-1950 birth year cohorts. CONCLUSIONS: Differences in PC mortality across regions of Mexico may reflect differences in the timing of the diagnosis and treatment of PC.

Levels of Participants Satisfaction with Initial Contact and Examination Visit: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: This study examined perceived satisfaction among Hispanic/Latino individuals who participated in a baseline examination for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large cohort study of 16,415 adults living in four selected communities. METHOD: An estimated 22% (n= 3,584) of participants completed a questionnaire regarding satisfaction with staff attention, the overall experience during the study examination, and the influence of the informed consent digital video disc (DVD). RESULTS: The majority of participants who completed the questionnaire expressed overall satisfaction with the study. Most participants reported that staff were friendly, courteous and respectful and study test procedures were clearly explained. Participants who preferred to complete the interview in Spanish felt that the informed consent DVD positively influenced their ability to make an informed decision to enroll in the study. Participants who preferred to complete the interview in English tended to report that the baseline examination was longer than expected compared with participants who completed the interview in Spanish. CONCLUSION: Results demonstrate that culturally and linguistically trained staff and the use of the study's informed consent DVD were effective in explaining study procedures and positively influenced decisions to participate in the HCHS/SOL study. These results can inform recruitment and enrollment strategies for future participation of minority groups into longitudinal cohort studies.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

Relationships of nativity and length of residence in the U.S. with favorable cardiovascular health among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Individuals with favorable levels of all readily measured major CVD risk factors (low CV risk) during middle age incur lower cardiovascular morbidity and mortality, lower all-cause mortality, and lower Medicare costs at older ages compared to adults with one or more unfavorable CVD risk factors. Studies on predictors of low CV risk in Hispanics/Latinos have focused solely on Mexican-Americans. The objective of this study was to use data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; enrolled 2008 to 2011) to assess relationships of nativity and length of residence in the US, a commonly used proxy for acculturation, with low CV risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure<120/<80; body mass index <25kg/m(2); and no major ECG abnormalities) in 15,047 Central American, South American, Cuban, Dominican, Mexican, Puerto Rican men and women, and Hispanic/Latino men and women identifying as other or >1 heritage. We also tested whether associations varied by Hispanic/Latino background. Women living in the US<10years were 1.96 (95% confidence interval: 1.37, 2.80) times more likely to be low CV risk than US-born women after adjusting for sociodemographic characteristics, diet, physical activity, and self-reported experiences of ethnic discrimination. Findings varied in men by Hispanic/Latino background, but length of residence was largely unrelated to low CV risk. These findings highlight the role acculturative processes play in shaping cardiovascular health in Hispanics/Latinos.