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ObjectiveHispanics/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.MethodsBaseline 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.ResultsIn 7413 participants ages 45 to 74years 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).ConclusionsIt is important to consider individual lipid levels and demographic characteristics when investigating associations between cholesterol levels and cognition in Hispanics/Latinos.

Supplemental Material, Electronic_Supplementary_Material for 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? by Marisa J. Perera, Diana A. Chirinos, Carrie E. Brintz, Neil Schneiderman, Martha Daviglus, Gregory A. Talavera, Krista M. Perreira, Rebeca A. Espinoza Giacinto, Qibin Qi and Maria M. Llabre in Hispanic Health Care International

Supplemental material, HPP913548_suppl_mat for Prioritizing Competencies for “Research” Promotores and Community Health Workers by Camille Nebeker, Rebeca Espinoza Giacinto, Blanca Azucena Pacheco, Araceli López-Arenas and Michael Kalichman in Health Promotion Practice

AimsInsulin 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.MethodsData 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.ResultsThere 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.ConclusionThe relationship of IR with cognition in Hispanics/Latinos without diabetes may reflect an age- and test-dependent state.

CONTEXT: Diet modification is a mainstay of diabetes management. US Hispanics/Latinos are disproportionately affected by diabetes, but few studies have examined dietary intake among US Hispanics/Latinos with diabetes, and little is known regarding the influence of diabetes awareness on dietary intake. OBJECTIVE: We evaluated macronutrient intake and its associations with diabetes awareness and glycemic control among US Hispanics/Latinos with diabetes. PARTICIPANTS: This analysis included 3310 diabetic adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011). MAIN OUTCOME MEASURES: Diabetes was defined as diagnosed (based on medical history or antihyperglycemic medication use) or undiagnosed diabetes (based on fasting glucose ≥ 126 mg/dL, glycated hemoglobin [HbA1c] ≥ 6.5%, or 2 h glucose ≥ 200 mg/dL in the absence of a physician diagnosis). Dietary intake was assessed using two 24-hour recalls. RESULTS: Among Hispanic/Latino adults with diabetes, 21.2%, 55.7%, and 71.2% met the American Diabetes Association recommendations for fiber (≥14 g per 1000 kcal), saturated fat (

OF THE DISSERTATIONPsychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)byRebeca Espinoza Giacinto Doctor of Philosophy in Public Health (Global Health)University of California, San Diego, 2016San Diego State University, 2016Professor Gregory A. Talavera, ChairBackground: Individuals with uncontrolled diabetes are at higher risk for developing cardiovascular disease, dyslipidemia, hypertension and retinopathy. While there is evidence for poor diabetes management among high risk populations, such as Hispanic/Latinos, specific self-care and lifestyle practices that influence glycemic regulation remain poorly understood.Aims: This dissertation will examine psychosocial, sociocultural, and biobehavioral correlates of glycemic control among diverse Hispanic/Latinos with diabetes in the US through the following aims: (1) to examine psychosocial and sociocultural correlates of glycemic status; (2) to examine the role of sleep duration and glycemic status; and (3) to examine the reported use of conventional and complimentary medicine and types of care accessed and its related influence on glycemic regulation status.Methods: Chapters 2-4 employ data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data were collected as part of the HCHS/SOL study which included 16,415 self-identified Hispanic/Latinos ages 18-75 recruited between March 2008 and June 2011. Analyses for the current study involved a subset of individuals with diabetes. Results: As presented in Chapter 2, older age, shorter duration of US residence, annual doctor visits, and better dietary quality were independently associated with improved glycemic control. No other variables, including those for psychosocial and sociocultural factors, were significantly associated with glycemic control. As presented in Chapter 3, individuals with long sleep duration (>9 hrs.) had suboptimal glycemic control status, compared to those who reported average sleep duration (6< 9hrs.). As described in Chapter 4, individuals with poor glycemic status were more likely to report being prescribed diabetes medication as well as reporting concomitant use of diabetes medication and botanical/herbal use compared to those who reported use of neither prescribed diabetes medications or supplement use.Conclusion: Addressing social and structural barriers such as routine care, particularly among younger Hispanic/Latinos and those with longer residence in the US may aid in improving glycemic control status and preventing complications related to suboptimal diabetes management. Further research is needed to examine acculturative processes and glycemic control which may offer greater insights into specific correlates of diabetes management among ethnically diverse Hispanic/Latinos in the US.

Inadequate sleep quantity and quality are associated with a higher risk of type 2 diabetes. This relationship is not well-examined in U.S. Hispanics/Latinos, and prior analyses may be confounded by sleep apnea. This cross-sectional study examined joint associations of sleep duration and insomnia with diabetes among diverse U.S. Hispanic/Latinos.Baseline data on sleep quantity and quality were obtained from 15,227 participants (mean age 41; range 18-74 years) from the Hispanic Community Health Study/Study of Latinos. Complex survey multinomial logistic regression was used to examine associations between prevalent diabetes and six phenotypes defined by cross-classifying sleep duration (short ≤6 h, average6-9 h, long9 h) and insomnia, adjusting for sex, age, site and Hispanic/Latino background interaction, education, physical activity, diet quality, and sleep apnea.In the weighted population, 14% had diabetes, 28% had insomnia, 9% were short sleepers, and 19% were long sleepers. Compared with those with average sleep and no insomnia, those with short sleep and insomnia were more likely to have diabetes (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.02, 2.11). Average sleepers with insomnia (1.28; 95% CI 1.02, 1.61) and long sleepers without insomnia (1.33; 95% CI 1.07, 1.65) also had elevated odds of diabetes. Further adjustment for body mass index attenuated associations, except with long sleep without insomnia.Both decreased quantity and quality of sleep are associated with diabetes in Hispanic/Latinos, with the greatest odds among those with short sleep duration and insomnia. The association is largely explained by obesity.

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. Ethn Dis. 2016;26(3):435-442; doi:10.18865/ed.26.3.435