Puerto Rican Adults Research Articles

APOE4 allele-specific associations between diet, multimodal biomarkers, and cognition among Puerto Rican adults in Massachusetts.

Apolipoprotein E (APOE) is the strongest genetic risk factor for sporadic Alzheimer's Disease (AD), and the ε4 allele (APOE4) may interact with lifestyle factors that relate to brain structural changes, underlying the increased risk of AD. However, the exact role of APOE4 in mediating interactions between the peripheral circulatory system and the central nervous system, and how it may link to brain and cognitive aging requires further elucidation. In this analysis, we investigated the association between APOE4 carrier status and multimodal biomarkers (diet, blood markers, clinical diagnosis, brain structure, and cognition) in the context of gene-environment interactions. Participants were older adults from a longitudinal observational study, the Boston Puerto Rican Health Study (BPRHS), who self-identified as of Puerto Rican descent. Demographics, APOE genotype, diet, blood, and clinical data were collected at baseline and at approximately 12th year, with the addition of multimodal brain magnetic resonance imaging (MRI) (T1-weighted and diffusion) and cognitive testing acquired at 12-year. Measures were compared between APOE4 carriers and non-carriers, and associations between multimodal variables were examined using correlation and multivariate network analyses within each group. A total of 156 BPRHS participants (mean age at imaging = 68 years, 77% female, mean follow-up 12.7 years) with complete multimodal data were included in the current analysis. APOE4 carriers (n = 43) showed reduced medial temporal lobe (MTL) white matter (WM) microstructural integrity and lower mini-mental state examination (MMSE) score than non-carriers (n = 113). This pattern was consistent with an independent sample from the Alzheimer's Disease Neuroimaging Initiative (ADNI) of n = 283 non-Hispanic White adults without dementia (mean age = 75, 40% female). Within BPRHS, carriers showed distinct connectivity patterns between multimodal biomarkers, characterized by stronger direct network connections between baseline diet/blood markers with 12-year blood/clinical measures, and between blood markers (especially lipids and cytokines) and WM. Cardiovascular burden (i.e., hypertension and diabetes status) was associated with WM integrity for both carriers and non-carriers. APOE4 carrier status affects interactions between dietary factors, multimodal blood biomarkers, and MTL WM integrity across ~12 years of follow-up, which may reflect increased peripheral-central systems crosstalk following blood-brain barrier breakdown in carriers.

Abstract 13302: Associations of Allostatic Load With Brain Macro-Morphology, Subclinical Cerebrovascular Disease, and Microstructural Integrity of White Matter Pathways: The Boston Puerto Rican Health Study

Introduction: Allostatic load (AL), a measure of overall body wear and tear, has been associated with structural and functional alterations of the brain, but the evidence remains scarce. We aimed to evaluate the prospective associations of AL with brain MRI measures in the Boston Puerto Rican Health Study (BPRHS). Research Questions: Whether AL is associated with 1) brain macro-morphology: brain age and volumes, 2) subclinical cerebrovascular disease: white matter hyperintensity (WMH) and brain infarcts, and 3) microstructural integrity of white matter (WM) pathways in Puerto Rican adults. Methods: Adults from the BPRHS cohort who provided blood and urine samples at baseline, 2-y, and 6-y visits and underwent MRI scans at 13-y visit were included in analyses (n=226). AL was evaluated as a composite score (0-11) of 11 physiological parameters in five body systems. An overall AL score was calculated by averaging the scores of the baseline, 2-y, and 6-y visits, with higher scores indicating greater dysregulation. We evaluated brain age and volumes using T1-weighted MRI, WMH and brain infarcts using T2-weighted MRI, and microstructural integrity of WM pathways using diffusion tensor imaging. Multivariable logistic regression models were used to examine the associations between AL and brain infarcts, and linear regression models were used for other MRI outcomes. Results: Mean age at baseline was 54.6 ± 6.6 y, with 79.2% female. Higher AL was associated with higher brain age z scores (β = 0.129, P = 0.031) and lower volumes of total WM, cerebral WM (especially parietal and temporal lobes), cerebellum, and brain stem. Higher AL was also associated with higher grades of WMH (β = 0.207, P = 0.024) and higher odds of small vessel infarcts [OR (95% CI) = 3.50 (1.56-7.87), P = 0.002], but not large vessel infarcts [OR (95% CI) = 1.33 (0.73-2.40), P = 0.348]. Diffusion tensor imaging parameters showed that participants with higher AL had more microstructural deterioration patterns in major WM pathways. Conclusions: Higher AL score was associated with brain macro- and microstructural disruptions and a higher risk of subclinical cerebrovascular disease, suggesting that AL may be a potential indicator of the need for early intervention in preventing neuronal damage in older adults.

29 Human Immunodeficiency Virus (HIV) Status, Injection Drug Use, and Cognitive Effects in a Spanish-Speaking Population

Objective:Injection drug use is a significant public health crisis with adverse health outcomes, including increased risk of human immunodeficiency virus (HIV) infection. Comorbidity of HIV and injection drug use is highly prevalent in the United States and disproportionately elevated in surrounding territories such as Puerto Rico. While both HIV status and injection drug use are independently known to be associated with cognitive deficits, the interaction of these effects remains largely unknown. The aim of this study was to determine how HIV status and injection drug use are related to cognitive functioning in a group of Puerto Rican participants. Additionally, we investigated the degree to which type and frequency of substance use predict cognitive abilities.Participants and Methods:96 Puerto Rican adults completed the Neuropsi Attention and Memory-3rd Edition battery for Spanish-speaking participants. Injection substance use over the previous 12 months was also obtained via clinical interview. Participants were categorized into four groups based on HIV status and injection substance use in the last 30 days (HIV+/injector, HIV+/non-injector, HIV/injector, HIV-/non-injector). One-way analysis of variance (ANOVA) was conducted to determine differences between groups on each index of the Neuropsi battery (Attention and Executive Function; Memory; Attention and Memory). Multiple linear regression was used to determine whether type and frequency of substance use predicted performance on these indices while considering HIV status.Results:The one-way ANOVAs revealed significant differences (p’s < 0.01) between the healthy control group and all other groups across all indices. No significant differences were observed between the other groups. Injection drug use, regardless of the substance, was associated with lower combined attention and memory performance compared to those who inject less than monthly (Monthly: p = 0.04; 2-3x daily: p < 0.01; 4-7x daily: p = 0.02; 8+ times daily: p < 0.01). Both minimal and heavy daily use predicted poorer memory performance (p = 0.02 and p = 0.01, respectively). Heavy heroin use predicted poorer attention and executive functioning (p = 0.04). Heroin use also predicted lower performance on tests of memory when used monthly (p = 0.049), and daily or almost daily (2-6x weekly: p = 0.04; 4-7x daily: p = 0.04). Finally, moderate injection of heroin predicted lower scores on attention and memory (Weekly: p = 0.04; 2-6x weekly: p = 0.048). Heavy combined heroin and cocaine use predicted worse memory performance (p = 0.03) and combined attention and memory (p = 0.046). HIV status was not a moderating factor in any circumstance.Conclusions:As predicted, residents of Puerto Rico who do not inject substances and are HIVnegative performed better in domains of memory, attention, and executive function than those living with HIV and/or inject substances. There was no significant difference among the affected groups in cognitive ability. As expected, daily injection of substances predicted worse performance on tasks of memory. Heavy heroin use predicted worse performance on executive function and memory tasks, while heroin-only and combined heroin and cocaine use predicted worse memory performance. Overall, the type and frequency of substance is more predictive of cognitive functioning than HIV status.

H - 48 Preliminary Normative Data for a Letter Fluency (PAN) Test Via Teleneuropsychology for Puerto Rican Adults.

Explore internal consistency, concurrent validity, and impact of demographic factors to provide preliminary normative data for a teleneuropsychological (TeleNP) and culturally-sensitive letter fluency (PAN) test based on Benton and Hamsher's (1976) approach (two easy and one difficult letter) for Spanish-speaking Puerto Ricans. 102 cognitively healthy Puerto Ricans (Female: 69%; Age: M = 63.2, SD = 6.1; Education: M = 16.2, SD = 3.6) residing on the island were administered the letters PAN and a category (Animal) fluency task via Zoom, as part of a larger neuropsychological battery. Cronbach's alpha was applied to explore PAN's internal consistency. Concurrent validity was examined through Pearson correlation between PAN and Animal fluency. Analyses of variance were used to explore the effect of age, education, and sex. Descriptive statistics were conducted to develop normative data stratified by statistically significant demographics. Cronbach's alpha for PAN was α= 0.833. Each letter had a positive and significant correlation with Animal fluency (0.477, 0.471, 0.471; p < 0.001). Only age and education significantly impacted performance on all letters. M and SD raw scores among the sample were P (M = 14.0; SD = 4.5), A (M = 11.8; SD = 4.1), N (M = 8.8; SD = 3.5). Data suggest good internal reliability and moderate concurrent validity. Results supports that each consecutive letter is more difficult. This study provides preliminary normative data for cognitively healthy Puerto Rican adults, which can improve diagnostic accuracy while providing clinicians with a TeleNP and culturally-appropriate testing tool. Future research with PAN should include clinical samples.

H - 45 Preliminary Teleneuropsychological Normative Data for the Mini Mental State Examination for Puerto Rican Adults.

Established guidelines for teleneuropsychology (TeleNP) indicate that normative studies are warranted for future regular use of TeleNP practice (Bilder et al., 2020). Consequently, this study aims to explore the impact of demographic factors to provide preliminary normative data for the Mini Mental State Exam (MMSE) via TeleNP for Spanish-speaking Puerto Ricans. A TeleNP version of the MMSE was administered as part of a larger neuropsychological battery to 102 cognitively healthy Puerto Ricans (69% female) between 55-78years old, 4-23years of education (Age: M = 63.2, SD = 6.1; Education: M = 16.3, SD = 3.5) and residing on the island. A thorough neurological/psychiatric history and the CERAD Wordlist were used to exclude (< 2 SD; 1 removed case) any dementia-suspicious case. Multiple regression analysis was used to clarify if age, education, or sex significantly predicted MMSE total score. Normative data was generated and stratified by statistically significant demographics. Frequency of the most missed item was reviewed. Age and education explained 26% of the variance of the MMSE score (p < 0.001). The total sample had an average raw score of M = 29.08 (SD = 1.16). Normative scores are presented according to age and education level. Most frequently missed item was delayed recall (35%; ≤2/3). This study provides preliminary normative data for cognitively healthy and community-dwelling Puerto Rican adults, which can improve diagnostic accuracy and reduce rates of false negatives while providing clinicians a TeleNP-appropriate screening tool. Future research with the MMSE via TeleNP should include a larger sample, including a clinical population.

Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts.

Increasing numbers of opioid-overdose deaths have been witnessed among Hispanics and other underserved populations in Massachusetts. Puerto Rican adults (PRs) have a disproportionately higher prevalence of chronic diseases than non-Hispanic White adults-conditions linked to increased prescription opioid use and misuse. Stress indicators, including low acculturation, low social support, and perceived discrimination, have been recognized as correlates of chronic diseases. However, little research has been undertaken on how these socio-cultural factors relate to persistent prescription opioid use among PRs. This study evaluated the prevalence of prescription opioid use and socio-cultural factors associated with persistent prescription opioid use among PRs. Data from the prospective population-based Boston Puerto Rican Health Study, at baseline, ~2-year, and ~ 6-year follow-up, were used to estimate prescription opioid use prevalence and its associations with acculturation, social support, and perceived discrimination. Analyses were conducted using multivariable binary logistic regression modeling. The study sample was comprised of 798 PRs (age 56.5 ± 7.5y) with data at all three-time points. A high prevalence of prescription opioid use was observed and was associated with lower household income. PRs with experiences of perceived discrimination had higher odds of persistent prescription opioid use (y/n; OR = 2.85, 95% CI: 1.46-5.58). No significant associations were found between acculturation, social support, and persistent prescription opioid use. Our study reported a high prevalence of prescription opioid use in PRs, with persistent prescription opioid use significantly associated with perceived discrimination. Future programs to limit discrimination practices may reduce persistent prescription opioid use and opioid-related complications among PRs.

P23-058-23 Ultra-Processed Food Intake and Osteoporosis Among Puerto Rican Adults

P23-058-23 Ultra-Processed Food Intake and Osteoporosis Among Puerto Rican Adults

P14-020-23 Association Between Food Insecurity, Dietary Quality, and Metabolic Syndrome Among Puerto Rican Adults

P14-020-23 Association Between Food Insecurity, Dietary Quality, and Metabolic Syndrome Among Puerto Rican Adults

Longitudinal Associations Between Sleep and Cognitive Function in a Cohort of Older Puerto Rican Adults: Sex and Age Interactions.

Evidence on sleep duration or quality and cognitive function in diverse older adults is limited. We examined prospective associations between subjective sleep measures and cognitive function, with modifying effects of sex and age (<65 vs ≥65 years). Data are from the longitudinal Boston Puerto Rican Health Study, Waves 2 (n = 943) and 4 (n = 444), with mean follow-up of 10.5 years (range 7.2-12.8). Subjective measures of sleep duration (short <7, ref. 7, or long ≥8 hours) and insomnia symptoms (sum of difficulty falling asleep, waking up at night, and early morning awakening), were assessed at Wave 2. Linear regression models were used to assess changes in global cognition, executive function, memory, and Mini-Mental State Examination, and tested for modifying roles of sex and age. Significant 3-way interaction (sex × age × cognition) in fully adjusted models showed greater decline in global cognitive function in older men with short (β [95% confidence interval]: -0.67 [-1.24, -0.10]) or long sleep duration (-0.92 [-1.55, -0.30]), compared to women, younger men, and older men with 7 hours of sleep. Insomnia symptoms were associated with a greater decline in memory (-0.54, [-0.85, -0.22]) among older men, compared to women and younger men. Sleep duration showed a U-shaped association with cognitive decline, and insomnia symptoms were associated with memory decline in fully adjusted models. Older men, versus women and younger men, were at relatively greater risk for cognitive decline associated with sleep factors. These findings are important for personalizing sleep interventions to support cognitive health.

Association between Acid-Lowering Agents, Metformin, and Vitamin B12 among Boston-Area Puerto Ricans

BackgroundVitamin B12 involves several physiological functions, and malabsorption is reported with medication use. ObjectivesStudies have reported an inverse association between the use of metformin or acid-lowering agents (ALAs), such as proton pump inhibitors, histamine 2 receptor antagonists, and blood vitamin B12 concentration, because of malabsorption. The concomitant use of these medications is underreported. We sought to examine these associations in a cohort of Boston-area Puerto Rican adults. MethodsThis analysis was conducted within the Boston Puerto Rican Health Study (BPRHS), an ongoing longitudinal cohort that enrolled 1499 Puerto Rican adults aged 45–75 y at baseline. Our study comprised 1428, 1155, and 782 participants at baseline, wave2 (2.2 y from baseline), and wave3 (6.2 y from baseline), respectively. Covariate-adjusted linear and logistic regression was used to examine the association between baseline medication use and vitamin B12 concentration or deficiency (vitamin B12 <148 pmol/L or methylmalonic acid >271 nmol/L), and long-term medication use (continuous use for ∼6.2 y) and wave3 vitamin B12 concentration and deficiency. Sensitivity analyses were done to examine these associations in vitamin B12 supplement users. ResultsAt baseline, we observed an association between metformin use (β = –0.069; P = 0.03) and concomitant ALA and metformin use (β = –0.112; P = 0.02) and vitamin B12 concentration, but not a deficiency. We did not observe associations between ALA, proton pump inhibitors, or histamine 2 receptor antagonists, individually, with vitamin B12 concentration or deficiency. ConclusionsThese results suggest an inverse relationship between metformin, concomitant ALA, metformin use, and serum vitamin B12 concentration.

Association between a Calcium-to-Magnesium Ratio and Osteoporosis among Puerto Rican Adults

BackgroundThe ratio of calcium-to-magnesium intake (Ca:Mg) may be important for bone due to their competitive absorption. The Ca:Mg ratio has been related to health outcomes, but few studies have related it to bone. ObjectivesThe purpose of this analysis was to examine associations between the Ca:Mg intake with bone mineral density (BMD) and osteoporosis among Puerto Rican adults. MethodsAdults, aged 47–79 y, from the Boston Puerto Rican Osteoporosis Study, with complete BMD and dietary data (n = 955) were included. BMD was assessed with dual-energy X-ray absorptiometry and diet by a food frequency questionnaire. Calcium and magnesium intakes from food were energy adjusted, and the Ca:Mg was calculated. Adjusted linear and logistic regression models were utilized for testing associations between Ca:Mg and bone outcomes. ResultsCalcium intake was greater in the highest compared with lowest tertile, whereas magnesium intake was similar across tertiles. Mean BMD at hip sites was higher in the middle, compared with the lowest, tertile. Higher odds of osteoporosis were observed for the highest and lowest tertiles, compared with the middle tertile, after adjustment (T3 compared with T2 OR: 2.79; 95% CI: 1.47, 5.3; T1 compared with T2 OR: 2.01; 95% CI: 1.03, 3.92). Repeated analyses without supplement users (n = 432) led to stronger differences and ORs, but lost significance for some comparisons. ConclusionsDietary calcium and magnesium are important for bone, perhaps not independently. The Ca:Mg intake ratio appeared most protective within a range of 2.2–3.2, suggesting that a balance of these nutrients may be considered in recommendations for osteoporosis..

The neighborhood context and all-cause mortality among older adults in Puerto Rico.

Recent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality. We linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution. A five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates. Considering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

Abstract P211: Associations of the Mediterranean and MIND Diets With Brain Volume in the Boston Puerto Rican Health Study

Objectives: Although few studies are available, some evidence suggests that greater adherence to the MeD (Mediterranean Diet) and MIND (Mediterranean-Dietary Approaches to Reduce Hypertension Intervention for Neurocognitive Delay) dietary patterns may benefit cognitive function among Hispanic/Latino adults. Greater regional and total brain volumetric measures are associated with an increased risk of dementia, but whether the MeD and MIND dietary patterns relate to brain volume among Hispanic/Latino adults remains unclear. The objective of the current study was to quantify the associations of these dietary patterns with brain volume among Hispanic/Latino adults. Methods: Data are from the Boston Puerto Rican Health Study, which recruited 1500 older Puerto Rican adults residing in the Boston Metro Area. Approximately 13 years from baseline, a subsample of participants (n=240) were invited to a follow-up visit where brain scans were conducted using a 3T MRI scanner. Diet was estimated using the mean intake from a validated food frequency questionnaire administered at baseline, ~2, and ~6 years. The MeD score has 6 adequacy and 3 moderation components, whereas MIND has 10 and 5 components, respectively. Component scores were summed to get a total dietary score, where a higher value indicates greater adherence to the pattern. Total scores range from 0-9 for MeD and 0-15 for MIND. Outcomes included hippocampal, amygdalar, and total gray matter volumes. The residual method was used to adjust brain volumes for differences in intracranial volume and values were z score transformed prior to analyses. Multiple linear regression models were adjusted for age, sex, total energy, the time between the baseline and 13-year visits, education, physical activity, BMI, and smoking status. After exclusions for missing data, the sample size was n=225. Results: The mean age of the participants was 55±7 years and was primarily female [79%, (178 of 225)]. On average, the time between the baseline and MRI visits was 12.8±1.1 years. Higher MeD score was significantly associated with greater hippocampal [β (95% CI), 0.19 (0.053, 0.32), amygdalar [0.16 (0.03, 0.29)], and total grey matter volumes [0.14 (0.01, 0.26)] ( P &lt;0.05 for all). Similarly, positive associations were observed between the MIND score and hippocampal [0.18 (0.05, 0.31), amygdalar [0.14 (0.01, 0.27)], and total grey matter volumes [0.14 (0.01, 0.27)] ( P &lt;0.05 for all). Conclusion: Our findings suggest that the observed beneficial associations of the MeD and MIND dietary patterns with cognitive function among Hispanic/Latino adults, may in part be through impacts on regional and total brain volume. These results provide evidence that can inform tailored dietary recommendations and interventions targeting brain health among older Puerto Rican adults. Funding Sources: This study was supported by NIH grants R01AG055948, P50 HL105185, and P01 AG023394.

Healthcare utilization among pre-frail and frail Puerto Ricans.

Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

Prevalence and Correlates of HIV-Associated Health Behaviors in a Population-Based Sample of Puerto Rican Adults, 2019

IntroductionHigh incidence and prevalence of HIV persist in Puerto Rico. To inform HIV prevention efforts, this study examines factors linked to HIV-associated behaviors in the territory.MethodsUsing data from the 2019 Behavioral Risk Factor Surveillance System, multivariable logistic regression models were constructed to explore factors related to HIV-associated behaviors.ResultsAmong Puerto Rican residents (n=4446), 5.6% reported engaging in ≥1 HIV-associated behavior (past 12 months), and 39.2% had never been tested for HIV. Reporting HIV-associated behaviors was associated with male sex (adjusted odds ratio [aOR], 1.74; 95% confidence interval [CI], 1.30-2.33), higher household income (aOR, 1.71; 95% CI, 1.14-2.58), heavy alcohol use (aOR, 2.67; 95% CI, 1.68-4.25), and ever receiving an HIV test (aOR, 2.00; 95% CI, 1.40-2.86) in a multivariable model. Conversely, being married (aOR, 0.51; 95% CI, 0.35-0.72), having a recent routine checkup (aOR, 0.48; 95% CI, 0.32-0.72), and reporting 0 days of poor mental health (aOR, 0.61; 95% CI, 0.45-0.81) were associated with decreased odds of engaging in HIV-associated behaviors.ConclusionsFuture surveys should incorporate measures of social and structural determinants that would provide greater context for understanding behavioral factors associated with HIV vulnerability as well as for developing appropriate HIV interventions in Puerto Rico.

Proton Pump Inhibitor Use and Cognitive Function in the Boston Puerto Rican Health Study.

There is a lack of consensus among studies on the association between proton pump inhibitor (PPI) use and cognitive impairment. This association is not well studied among minority populations, including among Puerto Ricans. Therefore, we sought to examine this association among Boston-area Puerto Ricans. The Boston Puerto Rican Health Study is an ongoing longitudinal cohort that enrolled 1499 Boston-area Puerto Rican adults, aged 45-75 years at baseline. Complete outcome and exposure data was available for 1290 baseline participants. Covariate-adjusted linear regression and linear mixed effects models were used to examine the association between PPI use, and global cognition, executive function, and memory cross-sectionally and longitudinally over ~12.7 years of follow-up. Furthermore, we examined the cross-sectional association between long-term PPI use (continuous use of ~6.2 years) and global cognition, executive function, and memory. Among 1 290 participants at baseline, 313 (24.3%) self-reported PPI use. Baseline PPI use was not associated with baseline global cognition, executive function, or memory. Baseline PPI use also did not alter the trajectory of global cognition, executive function, or memory over ~12.7 years of follow-up. Long-term PPI use was not associated with global cognition, executive function, or memory over ~12.7 years of follow-up. In this study of Boston-area Puerto Ricans, we did not observe an association between PPI use and global cognition, executive function, or memory either cross-sectionally or over 12.7 years of follow-up.

Spanish Translation, Validation, and Factor Structure of the Religious/Spiritual Struggles Scale With Puerto Rican Adults

Religious/spiritual struggles (RSS) have been reported as a risk factor for mental health. Therefore, it is justified to explore how this construct may manifest among religious/spiritual people from diverse origins. The aims of this study were to: (1) translate and adapt the RSS Scale from English to Spanish; (2) examine its internal consistency (using α and ω coefficients); (3) explore its concurrent, convergent, and discriminant validity; and (4) examine its factor structure via confirmatory factor analysis (CFA) in a sample of 225 Puerto Rican adults. The Spanish RSS Scale showed excellent psychometric properties. In CFA with robust maximum likelihood estimation, a 25-item Spanish version of the instrument replicated the six-factor structure of the original 26-item English version and showed excellent reliability. The 25-item RSS scale also presented adequate concurrent, convergent, and discriminant validity. This work advances the development of measures of religious and spiritual aspects in Puerto Ricans.

Abstract 14801: Protective Associations of Dairy Foods and Cardiometabolic Markers Differ by Food Type and Fat Content: The Boston Puerto Rican Health Study

Introduction: The relation of dairy intake with cardiometabolic (CM) markers remains unclear due to a complex nutrient profile across dairy types. This study aimed to evaluate associations between dairy intake and CM markers among Puerto Rican adults with excessive CM burden. Methods: Baseline and 2-y follow-up data on diet and CM markers were available for 1110 participants aged 46-78y. Diet was assessed with a validated food frequency questionnaire. Dairy groups (total, milk, yogurt, cheese, cream, total with any fat, total without fat) were created from disaggregated foods and presented as servings/d/2000 kcal (s/d). Mean dietary intakes across two visits were used. CM biomarkers were assessed from fasted blood at 2-y and included waist circumference (WC), HDL and LDL cholesterol, TG, insulin, HbA1c, HOMA-IR, homocysteine (Hcy), C-reactive protein (CRP), blood pressure (BP) and Framingham risk score (FRS). Generalized linear and logistic regression were used to determine associations between dairy variables and each CM marker, adjusted for age, sex, BMI, kcal, alcohol and fruit /vegetable intakes, CVD/diabetes medications, language acculturation score, smoking, perceived stress, and physical activity. Multiple comparisons were adjusted by FDR correction. Results: Mean age was 59.3±7.7y, 70% female, 80% with metabolic syndrome. Total dairy intake was 2.3±1.1 s/d; 2.1±1.0 from dairy with fat and 0.2±0.5 without fat. Total dairy, dairy with fat, and milk intakes were associated with lower Hcy (β -0.37, SE 0.12, P =0.0012; β -0.39, SE 0.13, P =0.003; β -0.42, SE 0.13, P =0.002; respectively); non-fat dairy with lower WC (β -1.41, SE 0.44, P =0.001); milk with lower odds of high BP (OR 0.84, P =0.04); cheese with lower TG (β -18.5, SE 9.2, P= 0.04); yogurt with lower HbA1c (β -0.46, SE 0.17, P =0.008); cream with lower HbA1c (β -0.20, SE 0.10, P =0.04) and HOMA-IR (β -1.33, SE 0.56, P =0.02). No associations were seen with cholesterol, CRP, insulin, or TG. After FDR correction, findings remained significant for total dairy, dairy with fat, and milk with Hcy. Conclusions: Protective associations of dairy with specific CM markers vary by type of dairy and fat content. Associations were independent of overall dietary pattern and other risk factors for CM disease.

Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance-Heterosexual Cycle (NHBS-HET) 2016: National Cross-sectional Survey.

According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually. This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection. A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05. Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior. This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

Plasma metabolites associated with cognitive function across race/ethnicities affirming the importance of healthy nutrition.

We studied the replication and generalization of previously identified metabolites potentially associated with global cognitive function in multiple race/ethnicities and assessed the contribution of diet to these associations. We tested metabolite-cognitive function associations in U.S.A. Hispanic/Latino adults (n=2222) from the Community Health Study/ Study of Latinos (HCHS/SOL) and in European (n=1365) and African (n=478) Americans from the Atherosclerosis Risk In Communities (ARIC) Study. We applied Mendelian Randomization (MR) analyses to assess causal associations between the metabolites and cognitive function and between Mediterranean diet and cognitive function. Six metabolites were consistently associated with lower global cognitive function across all studies. Of these, four were sugar-related (e.g., ribitol). MR analyses provided weak evidence for a potential causal effect of ribitol on cognitive function and bi-directional effects of cognitive performance on diet. Several diet-related metabolites were associated with global cognitive function across studies with different race/ethnicities. Metabolites associated with cognitive function in Puerto Rican adults were recently identified. We demonstrate the generalizability of these associations across diverse race/ethnicities. Most identified metabolites are related to sugars. Mendelian Randomization (MR) provides weak evidence for a causal effect of ribitol on cognitive function. Beta-cryptoxanthin and other metabolites highlight the importance of a healthy diet.