UM targets health disparities among U.S. Hispanics

El Centro is backed by a $7 million grant from the National Center for Minority Health Disparities

Spending countless hours in laboratories and conducting groundbreaking clinical trials, medical researchers over the years have developed powerful new classes of drugs that are helping people with HIV/AIDS and other serious health problems live longer and more productive lives.
But while such research, which is aimed at attacking the biomedical aspects of disease, is plentiful, few scientific studies have created culturally tailored interventions to help prevent certain diseases before they affect specific groups of people.
Now a new federally funded center at the University of Miami’s School of Nursing and Health Studies promises to be one of the few of its kind to take this approach.

The new University of Miami Center of Excellence for Hispanic Health Disparities Research, or El Centro, will develop behavioral interventions customized specifically for Hispanics and examine the cultural and ethnic factors that place this group at a higher risk for HIV/AIDS and other sexually transmitted diseases, substance abuse, family and intimate partner violence, and co-occurring mental conditions.

Funded by a $7 million, five-year grant from the National Center for Minority Health Disparities, it is one of only 16 such centers nationwide and the only one based at a school of nursing.

School of Nursing and Health Studies Dean Nilda Peragallo, principal investigator of El Centro and an internationally recognized expert on health disparities, says the center “will improve the health and lifespan of all U.S. Hispanics, especially as their numbers continue to increase.”

With more than 40 million people of Hispanic origin now living in the United States, the group represents the largest and fastest growing minority segment in the country. Sadly, a disproportionate number of U.S. Hispanics are at risk for developing serious health conditions that may be exacerbated, in part, by cultural factors such as barriers to health care due to language or economic circumstances and stress related to adapting to a foreign culture.

In addition, “many recent immigrants give up strong social and family networks when they leave their home country to come to the U.S.,” says Victoria Mitrani, professor of nursing and health studies and coprincipal investigator of El Centro. “This disruption can leave people feeling alienated, disconnected, stressed, and bereft of emotional and instrumental support, putting them at risk for poor health.”

El Centro has embarked on a series of multiyear clinical trials and pilot studies.
Associate Professor Elias Vasquez, for example, is the lead investigator of a one-year El Centro study that will develop an intervention program for Hispanic heterosexual, gay, and bisexual men who are disproportionately affected by substance abuse, HIV/AIDS, and intimate partner violence. Vasquez says the intervention protocol he and his team of investigators develop will be similar to the one Peragallo created for an HIV risk-reduction investigation of Latina women in Chicago.

Other El Centro studies: With the HIV/AIDS rate among Hispanic women four times higher than that of non-Hispanic white females, Dean Peragallo will lead a three-year investigation aimed at increasing HIV risk-reduction behaviors among Hispanic women in the inner city.
The study, already under way, is similar in many respects to Peragallo’s Chicago study but is much larger in scope, recruiting up to 450 Hispanic women from community health sites in Miami-Dade and Broward Counties and including subjects of diverse Hispanic and Latin American origins. The Chicago study examined only Mexican and Puerto Rican females.

Using a new family therapy model, one study is attempting to lessen symptoms of attention deficit disorder, conduct disorder, and/or depression in a group of 11- to 14-year-old Hispanic adolescents before they fall victim to future problems such as substance abuse and unsafe sexual practices. “The goal is to treat symptoms early and not wait until more serious problems become entrenched,” says Daniel Santisteban, a research professor in the School of Nursing and Health Studies and principal investigator of the study. “We want to intervene and replace a trajectory of serious psychiatric and behavioral problems with a trajectory of healthy development.”

Mitrani is leading an 18-month study that will attempt to improve the health of pregnant females who are already HIV-positive by getting them to adhere to their prescribed drug regimen. Despite new antiretroviral drugs that are effective in controlling HIV, many people afflicted with the virus continue to die sooner from complications of the disease because they fail to take their medications in the prescribed manner, frustrating physicians and health care workers who treat such patients.

“A pregnant woman will be more likely to take her medication to prevent passing on the HIV virus to her unborn child than she would be to take it for her own benefit,” says Mitrani, who has more than 12 years of research experience working with HIV-positive minority women. “If we can get women to get into the habit of better medication adherence during pregnancy, then maybe they can continue after their baby is born.” Her prenatal study will be conducted in cooperation with the Miller School of Medicine’s Department of Obstetrics and Gynecology.

While research will be its primary mission, El Centro will also maintain an administrative core, which will oversee day-to-day operations of the center. A research education and training division will educate and mentor young scientists involved in health disparities research.

El Centro is the second major UM study addressing Hispanic health issues. Last year, the University became one of four sites in the country to take part in the largest long-term epidemiological study of health and disease in Hispanic populations living in the United States. The ongoing, federally funded Hispanic Community Health Study is following some 16,000 participants of Hispanic/Latino origin to help identify the prevalence of and risk factors for a wide variety of diseases and conditions, ranging from heart disease, stroke, and asthma to diabetes, and kidney and liver disease.

Says Mitrani, “The fact that we have two major initiatives for Hispanic health at UM is a great opportunity for synergy and a sign that UM will become even more of a hub for Hispanic health research.”