The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: Challenges and opportunities

USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA.
BMC Public Health (Impact Factor: 2.26). 03/2010; 10(1):107. DOI: 10.1186/1471-2458-10-107
Source: PubMed


The Boston Puerto Rican Health Study is an ongoing longitudinal cohort study designed to examine the role of psychosocial stress on presence and development of allostatic load and health outcomes in Puerto Ricans, and potential modification by nutritional status, genetic variation, and social support.
Self-identified Puerto Ricans, aged 45-75 years and residing in the Boston, MA metro area, were recruited through door-to-door enumeration and community approaches. Participants completed a comprehensive set of questionnaires and tests. Blood, urine and salivary samples were extracted for biomarker and genetic analysis. Measurements are repeated at a two-year follow-up.
A total of 1500 eligible participants completed baseline measurements, with nearly 80% two-year follow-up retention. The majority of the cohort is female (70%), and many have less than 8th grade education (48%), and fall below the poverty level (59%). Baseline prevalence of health conditions is high for this age range: considerable physical (26%) and cognitive (7%) impairment, obesity (57%), type 2 diabetes (40%), hypertension (69%), arthritis (50%) and depressive symptomatology (60%).
The enrollment of minority groups presents unique challenges. This report highlights approaches to working with difficult to reach populations, and describes some of the health issues and needs of Puerto Rican older adults. These results may inform future studies and interventions aiming to improve the health of this and similar communities.

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Available from: Katherine L Tucker, Oct 02, 2015
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    • "Inclusion criteria/eligibility included selfidentified Puerto Rican ethnicity, aged 45–75 years, and being able to answer questions in English or Spanish. Individuals who were unable to answer questions due to serious health conditions or who had a low Mini Mental State Examination (MMSE) score (r10) were excluded (Tucker et al., 2010). Participants completed a comprehensive set of survey questionnaires and a neuropsychological test, via in person interviewing. "
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    ABSTRACT: Neighborhood context may influence health and health disparities. However, most studies have been constrained by cross-sectional designs that limit causal inference due to failing to establish temporal order of exposure and disease. We tested the impact of baseline neighborhood context (neighborhood socioeconomic status factor at the block-group level, and relative income of individuals compared to their neighbors) on allostatic load two years later. We leveraged data from the Boston Puerto Rican Health Study, a prospective cohort of aging Puerto Rican adults (aged 45-75 at baseline), with change in AL modeled between baseline and the 2nd wave of follow-up using two-level hierarchical linear regression models. Puerto Rican adults with higher income, relative to their neighbors, exhibited lower AL after two years, after adjusting for NSES, age, gender, individual-level SES, length of residence, and city. After additional control for baseline AL, this association was attenuated to marginal significance. We found no significant association of NSES with AL. Longitudinal designs are an important tool to understand how neighborhood contexts influence health and health disparities. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Health & Place 05/2015; 33. DOI:10.1016/j.healthplace.2015.02.001 · 2.81 Impact Factor
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    • "The Internal Review Boards of Tufts Medical Center and Northeastern University have approved the study's protocol. The original 1500 participants were recruited using door-to-door enumeration and community approaches within randomly selected census blocks that were located in census tracks with at least 25 Puerto Rican adults between the ages of 45 and 75 years (Tucker et al. 2010). Eligibility included living within the Boston metropolitan area, Spanish or English language proficiency, 45–75 years of age, and self-identification as of Puerto Rican descent. "
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    ABSTRACT: Taking medications are complex symbolic acts, infused with diverse meanings regarding body and identity. This article focuses on the meanings of medications for older Puerto Ricans living on the United States mainland, a population experiencing stark health disparities. We aim to gain an understanding of the way multiple cultural and personal meanings of medications are related to and integrated in identity, and to understand how they are situated within Puerto Rican culture, history and circumstance on the US mainland. Data is drawn from thirty qualitative interviews, transcribed and translated, with older Puerto Ricans living on mainland United States. Thematic Analysis indicated four prevalent themes: embodiment of medication use; medications redefining self through the fabric of daily life; healthcare experience defined through medication; and medicine dividing the island and the mainland. While identity is impacted by experience of chronic illness, the experience of medication prescription and consumption is further related to the construction of the sense of self in distinct ways. For these individuals, medication use captures the dilemma of immigration. While cultural belonging and well-being remains on the island of Puerto Rico, the mainland hosts both easier access to and excess reliance on medication. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
    Sociology of Health & Illness 02/2015; 37(6). DOI:10.1111/1467-9566.12240 · 1.88 Impact Factor
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    • "In the BPRHS, there were 1171 participants of Puerto Rican origin, aged 45e75 years, living in the Greater Boston, MA metropolitan area, after excluding those with missing data and implausible energy intake, defined as <2512 kJ (600 kcal) per day or >20093 kJ (4800 kcal) per day. Details for the study have been described previously [12]. Fasting blood were collected for biochemical and genetic analyses. "
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    ABSTRACT: Background and aims: Lipoprotein lipase (LPL) is a candidate gene for obesity based on its role in triglyceride hydrolysis and the partitioning of fatty acids towards storage or oxidation. Whether dietary fatty acids modify LPL associated obesity risk is unknown. Methods and results: We examined five single nucleotide polymorphisms (SNPs) (rs320, rs2083637, rs17411031, rs13702, rs2197089) for potential interaction with dietary fatty acids for obesity traits in 1171 participants (333 men and 838 women, aged 45-75 y) of the Boston Puerto Rican Health Study (BPRHS). In women, SNP rs320 interacted with dietary polyunsaturated fatty acids (PUFA) for body mass index (BMI) (P = 0.002) and waist circumference (WC) (P = 0.001) respectively. Higher intake of PUFA was associated with lower BMI and WC in homozygotes of the major allele (TT) (P = 0.01 and 0.005) but not in minor allele carriers (TG and GG). These interactions were replicated in an independent population, African American women of the Atherosclerosis Risk in Communities (ARIC) study (n = 1334). Conclusion: Dietary PUFA modulated the association of LPL rs320 with obesity traits in two independent populations. These interactions may be relevant to the dietary management of obesity, particularly in women.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 07/2014; 24(12). DOI:10.1016/j.numecd.2014.07.003 · 3.32 Impact Factor
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