PURPOSE The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a multi-center, community based cohort study of Hispanic/Latino adults in the United States. A diverse participant sample is required that is both representative of the target population and likely to remain engaged throughout follow-up. The choice of sample design, its rationale, and benefits and challenges of design decisions are described in this paper. METHODS The study design calls for recruitment and follow-up of a cohort of 16,000 Hispanics/Latinos aged 18-74 years, with 62.5% (10,000) over 44 years of age and adequate subgroup sample sizes to support inference by Hispanic/Latino background. Participants are recruited in community areas surrounding four field centers in the Bronx, Chicago, Miami, and San Diego. A two-stage area probability sample of households is selected with stratification and over-sampling incorporated at each stage to provide a broadly diverse sample, offer efficiencies in field operations, and ensure that the target age distribution is obtained. CONCLUSIONS Embedding probability sampling within this traditional, multi-site cohort study design enables competing research objectives to be met. However, the use of probability sampling requires developing solutions to some unique challenges in both sample selection and recruitment, as described here.

OBJECTIVEWe examine differences in prevalence of diabetes and rates of awareness and control among adults from diverse Hispanic/Latino backgrounds in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).RESEARCH DESIGN AND METHODSThe HCHS/SOL, a prospective, multicenter, population-based study, enrolled from four U.S. metropolitan areas from 2008 to 2011 16,415 18–74-year-old people of Hispanic/Latino descent. Diabetes was defined by either fasting plasma glucose, impaired glucose tolerance 2 h after a glucose load, glycosylated hemoglobin (A1C), or documented use of hypoglycemic agents (scanned medications).RESULTSDiabetes prevalence varied from 10.2% in South Americans and 13.4% in Cubans to 17.7% in Central Americans, 18.0% in Dominicans and Puerto Ricans, and 18.3% in Mexicans (P < 0.0001). Prevalence related positively to age (P < 0.0001), BMI (P < 0.0001), and years living in the U.S. (P = 0.0010) but was negatively related to education (P = 0.0005) and household income (P = 0.0043). Rate of diabetes awareness was 58.7%, adequate glycemic control (A1C <7%, 53 mmol/mol) was 48.0%, and having health insurance among those with diabetes was 52.4%.CONCLUSIONSPresent findings indicate a high prevalence of diabetes but considerable diversity as a function of Hispanic background. The low rates of diabetes awareness, diabetes control, and health insurance in conjunction with the negative associations between diabetes prevalence and both household income and education among Hispanics/Latinos in the U.S. have important implications for public health policies.

Rationale: Hispanic/Latino populations have a high prevalence of cardiovascular risk factors and may be at risk for sleep-disordered breathing (SDB). An understanding of SDB among these populations is needed given evidence that SDB increases cardiovascular risk.Objectives: To quantify SDB prevalence in the U.S. Hispanic/Latino population and its association with symptoms, risk factors, diabetes, and hypertension; and to explore variation by sex and Hispanic/ Latino background.Methods: Cross-sectional analysis from the baseline examination of the Hispanic Community Health Study/Study of Latinos. Measurements and Main Results:The apnea-hypopnea index (AHI) was derived from standardized sleep tests; diabetes and hypertension were based on measurement and history. The sample of 14,440 individuals had an age-adjusted prevalence of minimal SDB (AHI > 5), moderate SDB (AHI > 15), and severe SDB (AHI > 30) of 25.8, 9.8, and 3.9%, respectively. Only 1.3% of participants reported a sleep apnea diagnosis. Moderate SDB was associated with being male (adjusted odds ratio, 2.7; 95% confidence interval, 2.3-3.1), obese (16.8; 11.6-24.4), and older. SDB was associated with an increased adjusted odds of impaired glucose tolerance (1.7; 1.3-2.1), diabetes (2.3; 1.8-2.9), and hypertension. The association with hypertension varied across background groups with the strongest associations among individuals of Puerto Rican and Central American background.Conclusions: SDB is prevalent in U.S. Latinos but rarely associated with a clinical diagnosis. Associations with diabetes and hypertension suggest a large burden of disease may be attributed to untreated SDB, supporting the development and evaluation of culturally relevant detection and treatment approaches. had full access to the study data and take responsibility for the integrity of the data and accuracy of analyses.Correspondence and requests for reprints should be addressed to Susan Redline, M.D., M. 11,12). Baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analyzed to estimate the prevalence of SDB and SDB symptoms, to describe associations with risk factors and diabetes and hypertension, and to explore variation in SDB by sex and Hispanic/Latino background. We hypothesized that SDB would be more prevalent in Hispanic/Latino groups with higher rates of obesity, and associated with an increased prevalence of hypertension and diabetes. Some of the results of these studies have been previously reported in the form of abstracts (13-15). MethodsThe online supplement provides detailed methods and additional results. SampleThe HCHS/SOL is a community-based cohort study of 16,415 self-identified Hispanic/Latino persons 18-74 years old recruited from randomly selected households in four U.S. field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). The multistage sampling design and cohort selection procedures have been described (16,17). Briefly, participants were recruited between 2008 and 2011 from defined geographic areas selecte...

Background Prior national surveys capture smoking behaviors of the aggregate US Hispanic/Latino population, possibly obscuring subgroup variation. Purpose To describe cigarette use among Hispanic/Latino adults across subgroups of age, sex, national background, socioeconomic status, birthplace and degree of acculturation to the dominant US culture. Methods Cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18 to 74 years old, recruited in Bronx NY, Chicago IL, Miami FL and San Diego CA during 2008–2011. Results Prevalence of current smoking was highest among Puerto Rican persons (men 35.0%, women 32.6%) and Cuban persons (men 31.3%, women 21.9%), with particularly high smoking intensity as measured by pack-years and cigarettes/day among Cubans. Dominican persons had the lowest smoking prevalence (men 11.0%, women 11.7%). Persons of other national backgrounds had smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low socioeconomic status were more likely to smoke, were less likely to have quit smoking, and less frequently used over-the-counter quit aids as compared to those with higher income and education. Smoking was more common among individuals who were US-born and who had higher level of acculturation to the dominant US culture, particularly among women. Conclusions Smoking behaviors vary widely across Hispanic/Latino groups in the US, with high prevalence of smoking among population subgroups with specific, readily-identifiable characteristics.

To identify risk factors for fractures in multi-ethnic women, we studied 159,579 women enrolled in the Women's Health Initiative. In general, risk factors for fractures were similar across ethnic groups. However, irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures. Introduction:Fracture rates tend to be lower in minority women, but consequences may be greater. In addition, the number of fractures is expected to increase in minority women because of current demographic trends. There are limited prospective data on risk factors for fractures in minority women. Materials and Methods:We studied 159,579 women 50-79 yr of age enrolled in the Women's Health Initiative. Information on risk factors was obtained by questionnaire or examination. Nonspine fractures that occurred after study entry were identified over an average follow-up of 8 ± 2.6 (SD) yr. Results: Annualized rates (%) of fracture in whites, blacks, Hispanics, Asians, and American Indians were 2.0, 0.9, 1.3, 1.2, and 2.0, respectively. Significant predictors [HR (95% CI)] of fractures by ethnic group were as follows: blacks: at least a high school education, 1.22 (1.0, 1.5); (+) fracture history, 1.7 (1.4, 2.2); and more than two falls, 1.7 (1.9, 2.0); Hispanics: height (>162 cm), 1.6 (1.1, 2.2); (+) fracture history, 1.9 (1.4, 2.5); more than two falls, 1.8 (1.4, 2.3); arthritis, 1.3 (1.1, 1.6); corticosteroid use, 3.9 (1.9, 8.0); and parental history of fracture, 1.3 (1.0, 1.6); Asians: age (per 5 yr), 1.2 (1.0, 1.3); (+) fracture history, 1.5 (1.1, 2.0); current hormone therapy (HT), 0.7 (0.5, 0.8); parity (at least five), 1.8 (1.1, 3.0); more than two falls, 1.4 (1.1, 1.9); American Indian: (+) fracture history, 2. 9 (1.5, 5.7); current HT, 0.5 (0.3, 0.9). Women with eight or more risk factors had more than a 2-fold higher rate of fracture compared with women with four or fewer risk factors. Two ethnicity × risk factor interactions were identified: age and fall history. Conclusions: Irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures.