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.

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.

Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded (FACIT-Sp-Ex) Across English and Spanish-Speaking Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

The validity of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) has been examined in primarily non-Hispanics/Latinos with chronic illness. This study assessed the psychometric properties of the non-illness, expanded FACIT-Sp (FACIT-Sp-Ex) in 5,163 U.S. Hispanic/Latino adults. Measures were interviewer-administered in English or Spanish. Confirmatory factor analyses indicated four factors: Meaning, Peace, Faith, and Relational. The scale demonstrated measurement invariance across English and Spanish. Subscales displayed adequate internal and test-retest reliability. Scores were positively associated with Duke Religion Index (DUREL) subscales. When all subscales were entered in a single model, Meaning and Peace were inversely associated with depressive symptoms and positively associated with HRQOL. Faith was positively associated with depressive symptoms and inversely associated with HRQOL. Relational was not associated with any outcome. FACIT-Sp-Ex subscales were generally more strongly associated than DUREL subscales with well-being. The FACIT-Sp-Ex appears to be a valid measure of spiritual well-being in U.S. Hispanics/Latinos.

Spiritual well-being, religious activity, and the metabolic syndrome: results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

Sociocultural risk and protective factors for developing the metabolic syndrome (MetS), a risk factor for cardiovascular disease (CVD), have not been well studied in Hispanics/Latinos residing in the United States (U.S.). Religiosity and/or spirituality (R/S), important aspects of Hispanic/Latino culture, have been inversely associated with CVD and multiple CVD risk factors. Cross-sectional associations between dimensions of R/S and prevalent MetS, and its five individual components were examined using multiple logistic and linear regression, among 3278 U.S., middle-aged and older Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Dimensions of R/S were not associated with presence of the MetS. Certain dimensions of Spiritual Well-being (Meaning, Peace, Faith), and frequency of non-organizational religious activity were weakly but significantly associated with one or more MetS components including waist circumference, diastolic blood pressure, and systolic blood pressure. R/S variables were not associated with triglycerides, fasting glucose or HDL cholesterol levels. Prospective, longitudinal studies are needed to gain a deeper understanding of the nature of the relationship between R/S and health risk factors in U.S. Hispanics/Latinos.

Factor structure of the Perceived Stress Scale-10 (PSS) across English and Spanish language responders in the HCHS/SOL Sociocultural Ancillary Study.

Despite widespread use, psychometric investigation of the original English and translated Spanish versions of the 10-item Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983) has been limited among the U.S. Hispanic/Latino population. The present study examined the factor structure, factorial invariance, and reliability and validity of PSS scores from English and Spanish versions using data from 5,176 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. The total sample and language multigroup confirmatory factor analyses supported a bifactor model with all 10 PSS items loading on a general perceived stress factor, and the 4 reverse-worded items also loading on a reverse-worded factor. Internal consistency ranged from .68 to .78, and it was indicated that reliable variance exists beyond the general perceived stress factor. The model displayed configural, metric, scalar, and residual invariance across language groups. Convergent validity analyses indicated that both the general perceived stress factor and the reverse-worded factor were related to scores of depression, anxiety, and anger in the expected directions. The reverse-worded factor added to the validity of the PSS beyond the general perceived stress factor. The total computed score of the PSS can be recommended for use with Hispanics/Latinos in the United States that complete the measure in English or Spanish and the reverse-worded factor can enhance prediction. (PsycINFO Database Record

Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults.

PURPOSE: To examine the association of psychosocial stress with obesity, adiposity, and dietary intake in a diverse sample of Hispanic/Latino adults. METHODS: Participants were 5077 men and women, aged 18 to 74 years, from diverse Hispanic/Latino ethnic backgrounds. Linear regression models were used to assess the association of ongoing chronic stressors and recent perceived stress with measures of adiposity (waist circumference and percentage body fat) and dietary intake (total energy, saturated fat, alternative healthy eating index-2010). Multinomial logistic models were used to describe the odds of obesity or overweight relative to normal weight. RESULTS: Greater number of chronic stressors and greater perceived stress were associated with higher total energy intake. Greater recent perceived stress was associated with lower diet quality as indicated by alternative healthy eating index-2010 scores. Compared with no stressors, reporting three or more chronic stressors was associated with higher odds of being obese (odds ratio = 1.5, 95% confidence interval [CI] 1.01-2.1), greater waist circumference (ß = 3.3, 95% CI 1.0-5.5), and percentage body fat (ß = 1.5, 95% CI 0.4-2.6). CONCLUSIONS: The study found an association between stress and obesity and adiposity measures, suggesting that stress management techniques may be useful in obesity prevention and treatment programs that target Hispanic/Latino populations.

Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

OBJECTIVE: The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease, stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, and current smoking) in the multisite Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (2010-2011). METHODS: Participants were 5313 men and women 18 to 74 years old, representing diverse Hispanic/Latino ethnic backgrounds, who underwent a comprehensive baseline clinical examination and sociocultural examination with measures of stress. RESULTS: Chronic stress burden was related to a higher prevalence of coronary heart disease after adjusting for sociodemographic, behavioral, and biological risk factors (odds ratio [OR; 95% confidence interval], 1.22 [1.10-1.36]) and related to stroke prevalence in the model adjusted for demographic and behavioral factors (OR [95% confidence interval], 1.26 [1.03-1.55]). Chronic stress was also related to a higher prevalence of diabetes (OR = 1.20 [1.11-1.31]) and hypertension (OR = 1.10 [1.02-1.19]) in individuals free from CVD (n = 4926). Perceived stress (OR = 1.03 [1.01-1.05]) and traumatic stress (OR = 1.15 [1.05-1.26]) were associated with a higher prevalence of smoking. Participants who reported a greater number of lifetime traumatic events also unexpectedly showed a lower prevalence of diabetes (OR = 0.89 [0.83-0.97]) and hypertension (OR = 0.88 [0.82-0.93]). Effects were largely consistent across age and sex groups. CONCLUSIONS: The study underscores the advantages of examining multiple indicators of stress in relation to health because the direction and consistency of associations may vary across distinct stress conceptualizations. In addition, the study suggests that chronic stress is related to higher CVD risk and prevalence in Hispanics/Latinos, the largest US ethnic minority group.

Body mass index, sex, and cardiovascular disease risk factors among Hispanic/Latino adults: Hispanic community health study/study of Latinos.

BACKGROUND: All major Hispanic/Latino groups in the United States have a high prevalence of obesity, which is often severe. Little is known about cardiovascular disease (CVD) risk factors among those at very high levels of body mass index (BMI). METHODS AND RESULTS: Among US Hispanic men (N=6547) and women (N=9797), we described gradients across the range of BMI and age in CVD risk factors including hypertension, serum lipids, diabetes, and C-reactive protein. Sex differences in CVD risk factor prevalences were determined at each level of BMI, after adjustment for age and other demographic and socioeconomic variables. Among those with class II or III obesity (BMI ≥35 kg/m(2), 18% women and 12% men), prevalences of hypertension, diabetes, low high-density lipoprotein cholesterol level, and high C-reactive protein level approached or exceeded 40% during the fourth decade of life. While women had a higher prevalence of class III obesity (BMI ≥40 kg/m(2)) than did men (7% and 4%, respectively), within this highest BMI category there was a >50% greater relative prevalence of diabetes, hypertension, and hyperlipidemia in men versus women, while sex differences in prevalence of these CVD risk factors were ≈20% or less at other BMI levels. CONCLUSIONS: Elevated BMI is common in Hispanic/Latino adults and is associated with a considerable excess of CVD risk factors. At the highest BMI levels, CVD risk factors often emerge in the earliest decades of adulthood and they affect men more often than women.