Minority Health and Health Disparities Laboratory
Division of Intramural Research
National Heart, Lung and Blood Institute

Scientific Summary

In addition to his role as Director of the National Institute on Minority Health and Health Disparities (NIMHD), Dr. Pérez-Stable conducts research from within his intramural lab at the National Heart, Lung, and Blood Institute (NHLBI). Dr. Pérez-Stable’s research focuses on health and health care disparities among racial and ethnic minority populations, with three main areas of lab research: (1) Tobacco use behavior and its relation to other substance use, unhealthy behaviors, migration-related social determinants, chronic stress, and mental health among Latinos of different national heritages; (2) Differential risk of lung cancer in racial and ethnic minority populations, as shown by metabolic biomarkers of nicotine and tobacco-specific carcinogens; and (3) Relationships of migration- and environment-related social determinants of health with chronic diseases, such as diabetes.

Unhealthy Behaviors, Mental Health Symptoms and Measures of Chronic Stress

Analyses published in the American Journal of Public Health in 2010 showed that African American individuals who engaged in unhealthy behaviors, such as smoking, binge drinking, insufficient physical activity, and self-reported poor diet, avoided episodes of depression when faced with increased chronic stress compared to white individuals. Newer analyses of the Health and Retirement Survey by Dr. Pérez-Stable and his team have shown that Latino older adults who engaged in unhealthy behaviors experienced significantly higher stress-induced depressive symptoms. These discordant observations have warranted further investigations to understand the biological mechanisms that link chronic stress, unhealthy behaviors, and depression.

1. Health and Retirement Study (HRS); Using longitudinal data from a survey of 6,479 participants during the 2006 and 2008 waves of HRS, assessments were made to investigate whether unhealthy behaviors moderated the relationship between chronic stress and being at-risk for depressive symptoms by race/ethnicity (Whites, African Americans, Latinos). Findings suggest that Latinos with greater chronic stress and unhealthy behaviors have significantly higher odds of future depressive symptoms.
2. National Health and Nutrition Examination Survey (NHANES); In cross-sectional surveys of the NHANES from 2005-2012 with 12,272 participants, analyses were conducted to estimate whether unhealthy behaviors modified relationships between allostatic load (as measured by 10 physiologic biomarkers indicating the burden of chronic stress) and depressive disorder (assessed by the Patient Health Questionnaire, PHQ-9) by race/ethnicity. Findings suggest that allostatic load was not associated with depressive disorder and did not differ with unhealthy behaviors in any racial/ethnic group.
3. Sacramento Area Latino Study on Aging (SALSA); The interaction of unhealthy behaviors with allostatic load, as a measure of chronic stress, in predicting significant depressive symptoms was evaluated by analyzing data of 1,789 SALSA study participants (almost entirely Mexican Americans) recruited in 1998-1999, re-examined in 2001-2002 and stratified by U.S. or non-U.S. birth. Results suggested that foreign born Latinos with greater allostatic load and unhealthy behaviors had increasingly higher odds of future depressive symptoms.
4. Hispanic Community Health Study/Study of Latinos (HCHS/SOL); The longitudinal associations between allostatic load, unhealthy behaviors, and depressive symptoms was examined using data from 11,187 Latino participants of HCHS/SOL study. Preliminary findings suggest that Puerto Ricans with greater allostatic load and unhealthy behaviors have significantly lower odds of future depressive symptoms.

Tobacco use behavior among Latinos of different national origins

Studies suggest that cigarette smoking among Latino adults is less prevalent than among White adults, but Latino youth are likelier to endorse ideas of smoking. Additional research suggests that cigarette smoking behavior among Latinos differs by gender¹, acculturation level², educational attainment¹, and the national heritage of one’s family and culture¹. Dr. Pérez-Stable and his team have investigated how these factors interact with each other and whether some of them might be used to focus on efforts of tobacco control and public health. Dr. Pérez-Stable’s lab has been pursuing these questions with a special emphasis on Latino adults by national heritage and Latino youth by gender using available public data sets.

National Health Interview Survey (NHIS); Data from 2009-2012 was used to investigate the relationship between acculturation level, educational attainment, and cigarette smoking by gender and national heritage among Latinos. Results showed that Mexican men with higher educational and acculturation levels had lower odds of smoking.

National Youth Tobacco Survey (NYTS); Within-gender racial/ethnic differences in smoking susceptibility over time and age among adolescent never smokers were examined for the period of 1999-2018. Smoking susceptibility among Latinos was found to be higher than that of whites.

Differential risk of lung cancer among racial and ethnic minorities

In collaboration with HCHS/SOL investigator Dr. Robert Kaplan, Dr. Pérez-Stable and his team submitted an ancillary study to HCHS/SOL to evaluate levels of the tobacco-specific biomarker NNAL [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol] in urine as well as other nicotine-use biomarkers, such as cotinine and trans-3’-hydroxycotinine, in serum of Latinos of different national heritage groups. The following are being examined:

1. Smoking behavior and exposure using urinary NNAL [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol] and serum cotinine among 1,250 smokers and 250 nonsmokers in the HCHS/SOL cohort.
2. Nicotine metabolism using the ratio of trans-3’-hydroxycotinine to cotinine among 1,250 HCHS/SOL smokers stratified by national heritage group and gender.
3. Self-reported secondhand smoke exposure and occupational exposure to combustion among 250 nonsmokers and 1,250 smokers in HCHS/SOL.
4. Non-daily smoking behavior, rates of nicotine metabolism, and the presence of specific loci on chromosomes 2 and 4 by genetic markers of ancestry among HCHS/SOL smokers.

Genome wide association data will be available and facilitate analyses of ancestry to evaluate possible associations of newly identified alleles on chromosomes 2 and 4 that were shown to be related to non-daily tobacco use behavior. This research will enhance our understanding of the different smoking behaviors among Latinos by ancestral race and the existing and growing patterns of light and non-daily smoking. The study will expand on previous research by the HCHS/SOL Smoking Genetics Working Group, which found associations between non-daily smoking and loci on chromosomes 2 and 4, by exploring tobacco use biomarkers and links to ancestral genetic markers.

Dr. Pérez-Stable’s team is also conducting an analysis of tobacco biomarker data from NHANES to compliment the HCHS/SOL project. Previous research has identified that the optimal level of tobacco biomarkers to distinguish smokers from nonsmokers differs by race/ethnicity, with Latinos having a dramatically lower optimal level compared to African Americans and whites. Since smoking prevalence among Latinos differs by national heritage, Dr. Pérez-Stable’s lab is expanding this work by assessing two biomarkers of tobacco use for optimal levels to distinguish smokers from nonsmokers by race/ethnicity as well as by national heritage among Latinos. Preliminary findings suggest that African Americans and Puerto Ricans have the highest optimal levels of NNAL, although overall, Latinos have the lowest.

References

1. Kaplan, R.C. et al., (2014). Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos. Am J Prev Med. 46(5):496-506.
2. Bethel, J.W. and Schenker, M.B., (2005). Acculturation and smoking patterns among Hispanics: a review. Am J Prev Med. 29(2):143-8.

Biography

Eliseo J. Pérez-Stable, M.D. is Director of the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH). He oversees the Institute's budget to advance the science of minority health and health disparities. Under this framework, the Institute (1) conducts and supports research programs to advance knowledge and understanding of mechanisms to improve minority health, (2) identifies and understands health disparities, and (3) develops effective interventions to reduce these disparities in community and clinical settings.

Dr. Pérez-Stable's research interests have centered on improving the health of racial/ethnic minorities and underserved populations, advancing patient-centered care, improving cross-cultural communication skills among health care professionals, and promoting diversity in the biomedical research workforce. Recognized as a leader in Latino health care and disparities research, Dr. Pérez-Stable has spent more than 30 years leading research on smoking cessation and tobacco control policy in Latino populations in the United States and Latin America.

Read his complete biography on his page.

Staff

Erik J. Rodriquez, PhD, Staff Scientist (erik.rodriquez@nih.gov)
Saida Coreas, BS, Postbaccalaureate Fellow (saida.coreas@nih.gov)
Ms. Sana Rahman, Special Volunteer (sana.rahman@nih.gov)