When 50-year-old Bronxite Juan Lina first agreed to participate in a health study of the Hispanic/Latino population of the United States four years ago, he didn't have health insurance and was relieved for the medical check-up that participation in the study provided. But now he's glad he decided to take part because of a greater purpose.

"This study will let people know what kind of diseases the Hispanic community suffers from, so they will be aware," he said in a recent phone interview. "A lot of people in the Hispanic community don't know anything about their health. They don't know how to take control."

The University Heights resident is one of more than 4,000 in the Bronx—among 16,415 people nationwide—participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a landmark decade-long study funded by the National Institutes of Health (NIH) to explore the health conditions and behaviors of the largest minority group in the United States. Beginning in 2008, four field centers in cities across the country (the Bronx, Chicago, Miami and San Diego) began knocking on doors in neighborhoods with a high Hispanic/Latino concentration according to census data. A team of about a dozen Einstein researchers and more than 30 staffers—representing the study's Bronx site—created a research clinic on Fordham Road to start interviewing and examining its participants.

Robert C. Kaplan, Ph.D.Faculty ProfileResearch Profile

After a first comprehensive examination years ago, Einstein researchers kept tabs on participants with annual phone calls, and through medical records if any were hospitalized. On October 1, 2014, Einstein's research team started a second round of in-person examinations, which they expect will take three years to complete.

"It's a major effort," said Dr. Carmen Isasi, associate professor of epidemiology & population health and of pediatrics, and co-investigator on the study. "Not only to do the exam, but to see what health events each participant has had since we saw them previously."

A Study Long Overdue

Roughly 1 in every 6 people in the United States is Hispanic/Latino. In the Bronx, the ratio is 1:2. Despite this, very little has been done to study the health of a demographic that is growing every day.

"Hispanics are one of the fastest growing U.S. populations and, proportionate to their numbers, they are probably the most understudied with regard to heart disease, diabetes or almost any area of public health," said Dr. Robert Kaplan, professor of epidemiology & population health and Einstein's principal investigator on the study.

Understanding Complexities Tied to Diversity

Though complete results are years away, initial findings published earlier this year show the Hispanic/Latino community has been misunderstood with generalizations.

"There's tremendous variation among the groups within this population, as well as a variation between younger and older generations, " said Dr. Kaplan, who also is the Dorothy and William Manealoff Foundation and Molly Rosen Chair in Social Medicine. "They suggest that most broad conclusions previously drawn about Hispanics are not so useful for understanding where particular needs may be."

Biological and behavioral findings ranged across subgroups, according to About Our Health: Results from the Hispanic Community Health Study/Study of Latinos (SOL), a book featuring the study's initial findings that was published by the National Alliance for Hispanic Health in early 2014. For example, the percentage of participants who reported having asthma ranged from 7.4 (Mexican) to 35.8 (Puerto Rican), while the percent of people eating five or more fruits/vegetables a day ranged from 19.2 (Puerto Rican) to 55.0 (Cuban). The book also includes findings about levels of recreational activity and pre-diabetes. And subsequent findings about smoking habits and anxiety/depression have been reported recently.

Location and Other Contributing Factors

"There is a lot of complexity to the population," noted Dr. Kaplan. "Even though the Bronx community has relatively good access to health insurance and medical care, there's evidence of a worse health status than other regions. We're studying social factors for why this may be, including the cost of living in New York City, challenges to finding healthy food or places to exercise and stress due to income or living conditions."

He added, "An important part of the study is to understand what the barriers are for living a healthy life. It's easy to speculate that people don't eat healthy foods because they aren't able to obtain them easily or because they are too expensive, but that may not be the case.

"Also, despite the fact that members of the Hispanic/Latino population tend to make up a large part of our nation's workforce, they often work in jobs that don't provide full health benefits and this can prevent them from seeking healthcare for themselves

Researchers are also looking at different cooking styles and recipes, which could ultimately provide information for physicians seeking to prescribe healthier diets that may be more appetizing to different communities, based on their heritage.

Other areas of research include looking at the health effects of various forms of stress, and the connection between habits and genetic risk for certain diseases. A related project initiated by Dr. Isasi examines how childhood factors affect the risk of chronic diseases. As part of this "SOL-Youth" project, to date, the Bronx site has also studied about 400 Hispanic child participants along with their parents.

Improving Health Literacy and Health Habits

"As part of participation in the study, our research team offers recommendations for getting better care around particular needs," said Dr. Isasi. "Many of the participants have access to primary care, but not specialty care. Access to specialty care to treat their diabetes or hypertension is limited, so we've tried to connect them to doctors at Montefiore," she said. Montefiore is Einstein's University Hospital and academic medical center.

"We've received considerable in-kind contributions from Montefiore," added Dr. Kaplan, "both in terms of voluntary involvement by Montefiore staff members and through payment for our participants' office visits in instances when we've discovered a health problem that requires evaluation by a specialist evaluation."

For Mr. Lina, the study has helped him eat healthier.

"I like it because it's given me a lot of information. I've tried to change the way I eat," he said, adding that he's more conscious that some of the foods he eats can result in high blood pressure, high cholesterol or even diabetes. "Sometimes we eat too much of the same food, and we eat too much sugar."

For more information on the HCHS/SOL initial findings, view About Our Health.