Boston Puerto Rican Health Study

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.

Inclusion Criteria:

- self-identified Puerto Rican decent

- aged 45-75 at baseline

- able to answer questions in English or Spanish

- living in the Boston, MA metropolitan area

Exclusion Criteria:

- unable to answer questions due to serious health conditions

- plan to move away from the area within two years

- Mini Mental State Examination (MMSE) score