Appendix 1c Sorlie et al Design and Implementation SOL

Design and Implementation of the Hispanic Community Health
Study/Study of Latinos
PAUL D. SORLIE, PHD, LARISSA M. AVILE´S-SANTA, MD, MPH,
SYLVIA WASSERTHEIL-SMOLLER, PHD, ROBERT C. KAPLAN, PHD,
MARTHA L. DAVIGLUS, MD, PHD, AIDA L. GIACHELLO, PHD, NEIL SCHNEIDERMAN, PHD,
LEOPOLDO RAIJ, MD, GREGORY TALAVERA, MD, MPH, MATTHEW ALLISON, MD, MPH,
LISA LAVANGE, PHD, LLOYD E. CHAMBLESS, PHD, AND GERARDO HEISS, MD, PHD

PURPOSE: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive
multicenter community based cohort study of Hispanics/Latinos in the United States.
METHODS: The Study rationale, objectives, design, and implementation are described in this report.
RESULTS: The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino,
18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago,
Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000
persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban,
and Central and South American. The study includes research in the prevalence of and risk factors for
heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders.
CONCLUSIONS: The HCHS/SOL will (1) characterize the health status and disease burden in the
largest minority population in the United States; (2) describe the positive and negative consequences of
immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population
with diverse environmental exposures, genetic backgrounds, and early life experiences.
Ann Epidemiol 2010;20:629–641. Published by Elsevier Inc.
KEY WORDS:

Epidemiologic Methods, Cardiovascular Disease, Risk Factors, Hispanics, Acculturation.

INTRODUCTION
The rapid growth of the Hispanic/Latino population in
the United States has underscored the need for a thorough
evaluation of the health risks and disease burden in
Hispanics, the impact of immigration and acculturation on
health, and the causes of disease, including genetic and

From the Division of Cardiovascular Sciences, National Heart, Lung and
Blood Institute, National Institutes of Health, Bethesda, MD (P.D.S., L.M.
A.-S.); the Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY (S.W.-S., R.C.K.); the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL (M.L.D.); the Midwest Latino Health Research,
Training and Policy Center, University of Illinois-Chicago, Chicago, IL
(A.L.G.); the Department of Psychology (N.S.) and Miller School of Medicine, (L.R.) University of Miami, Miami, FL; the Graduate School of Public
Health, San Diego State University, San Diego, CA (G.T.); the Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA (M.A.); and the Collaborative Studies Coordinating
Center, Department of Biostatistics, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC (L.L.V., L.E.C.,
G.H.).
Address correspondence to: Paul D. Sorlie, PhD, National Heart, Lung,
and Blood Institute, Epidemiology Branch, 6701 Rockledge Drive, Room
10210, MSC 7936, Bethesda, MD 20892. Tel.: þ1-301-435-0456; Fax:
þ1-301-480-1455. E-mail: [email protected].
Received January 5, 2010; accepted March 3, 2010.
Published by Elsevier Inc.
360 Park Avenue South, New York, NY 10010

environmental, in a population with diverse life styles,
behaviors, exposures, ethnicity and places of origin. The
terms Hispanic or Latino are used interchangeably in this
study to refer to populations who self-identify in this manner.
The Hispanic/Latino population grew from 22.4 to 35.3
million persons from 1990 to 2000, became the largest
minority in the United States in 2003, and is expected to
triple by 2050 (1, 2). Despite increasing obesity and diabetes,
and a generally lower socioeconomic status, cardiovascular
mortality is often observed to be lower in Hispanics/Latinos,
a pattern often referred to as the Hispanic Paradox (3–6).
Data show that the longer Hispanic/Latino immigrants
live in the United States, the worse some cardiovascular
risk factors become (7). The diversity by country of origin
may influence disease risk by varying degrees, as suggested
by the differing levels of some risk factors and some morbidities observed in Hispanics/Latinos of different countries of
origin (8–10).
In response to a working group in 2003 titled ‘‘Epidemiologic Research in Hispanic Populations; Opportunities,
Barriers and Solutions’’ (11), the National Heart, Lung
and Blood Institute (NHLBI) initiated in 2006 the Hispanic
Community Health Study/Study of Latinos (HCHS/SOL).
To maximize productivity and scientific opportunities that
1047-2797/$ - see front matter
doi:10.1016/j.annepidem.2010.03.015

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Selected Abbreviations and Acronyms
ALT Z alanine transaminase
AHA/ACC Z American Heart Association/American College
of Cardiology
AHI Z apnea-hypopnea index
AST Z aspartate aminotransferase
ARES Z apnea risk evaluation system
CBC Z complete blood count
CRP Z c-reactive protein
DNA Z deoxyribonucleic acid
ECG Z electrocardiogram
ED Z emergency department
FEV1 Z forced expiratory volume in one second
FPQ Z food propensity questionnaire
FVC Z forced vital capacity
HCHS/SOL Z Hispanic Community Health Study/Study of Latinos
HCV Z hepatitis C virus
HDL Z high density lipoprotein
HEE Z hearing examination (questionnaire)
HX Z history
NHANES Z National Health and Nutrition Examination Survey
NHLBI Z National Heart, Lung, and Blood Institute
NINDS Z National Institute of Neurological Diseases and Stroke
OGTT Z oral glucose tolerance test
RNA Z ribonucleic acid
SBP Z systolic blood pressure
SF-12 Z standard form 12 items
TOAST Z trial of ORG10172 in acute stroke treatment
UIBC Z unsaturated iron binding capacity
WAIS-R Z Wechsler Adult intelligence Scale-Revised

could be realized within the HCHS/SOL, scientific direction and financial resources were also obtained from six
other Institutes or Centers within the National Institutes
of Health (National Center on Minority Health and Health
Disparities, the National Institute of Deafness and Other
Communications Disorders, the National Institute of
Dental and Craniofacial Research, the National Institute
of Diabetes and Digestive and Kidney Diseases, the National
Institute of Neurological Disorders and Stroke, and the
Office of Dietary Supplements). This study describes the
objectives, design, content, and implementation of this
landmark study that addresses cardiovascular disease, stroke,
asthma, chronic obstructive lung disease, sleep disorders,
dental caries and periodontal disease, hearing impairment
and tinnitus, diabetes, kidney and liver disease, and cognitive impairment. The protocol and manuals of operation
are found in the study web site (12).

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of up to 16,000 persons) with participants from each of the
following origins: Mexican, Cuban, Puerto Rican and
Dominican, and Central and South American;
2. To conduct a detailed and standard characterization of
these study participants including questionnaires and procedures to characterize chronic conditions and their putative
antecedent factors;
3. To conduct an annual follow-up telephone contact of
study participants;
4. To identify new coronary heart disease, stroke, heart
failure, and chronic obstructive lung disease events that
require hospitalization after the initial examination; to identify acute exacerbations of asthma or chronic obstructive
pulmonary disease requiring emergency department care
or hospitalization; to identify deaths; to review and adjudicate medical information from hospital, physician, and
other records;
5. To develop innovative hypotheses, carry out data analysis, and disseminate findings through publications from
this study;
6. To provide community education and feedback based on
the study findings that will improve the health of the
communities;
7. To provide opportunities for collaboration with the wider
community of scientists and publicize the potential for such
opportunities; and
8. To provide opportunities for career development and
research experience for minority investigators.

MATERIALS AND METHODS

The HCHS/SOL is a prospective, population-based,
cohort study consisting of a baseline examination lasting
approximately 7 hours, a follow-up telephone call within 6
weeks with a second 24-hour dietary recall, and annual
follow-up telephone calls to ascertain any hospitalizations
and other significant clinical events and to update participants’ contact information. The first annual call also
includes a food propensity interview to assess dietary
patterns. Health events that occur during the follow-up
are identified, relevant medical records obtained, and clinical events reviewed and evaluated according to predefined
criteria. Recruitment and examination of study participants
will last approximately three years, and follow-up and identification of clinical events will continue for an average of 3
years in this contract period. Institutional review board
approval has been obtained institutions at each field center
and the coordinating center.

The HCHS/SOL has the following specific operational
objectives:

Community Description and Involvement

1. To identify, sample and recruit up to 4000 persons who
self identify as Hispanics or Latinos, 18 to 74 years of age,
from each of four communities in the United States with
a stable population and strong community structure (a total

The four communities included in the HCHS/SOL are
located in the Bronx, NY; Chicago, IL; Miami, FL; and
San Diego, CA. These field centers were selected based on
the peer review of study proposals and with consideration

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of geographical balance and place of origin. A more detailed
description of the sites and maps of their location can be
found in the manual of operations (12). The population
numbers presented below are estimates based on the
2005–2007 American Community Survey (13).
The Bronx is home to about 700,000 Hispanic/Latino
individuals, representing 51% of the approximately 1.4
million Bronx residents (13). Puerto Ricans are the most
represented Hispanic/Latino subgroup in the Bronx constituting 46% of Hispanic/Latinos, followed by Dominicans
at 31%, Mexicans at 9%, and the remaining groups
combined at 14%. Recruitment is conducted throughout
the Bronx in census tracts that were selected based on the
goal of socioeconomic diversity and accessibility to the
HCHS/SOL clinical center.
The city of Chicago has over 700,000 individuals of
Hispanic/Latino origin, representing nearly 30% of the estimated 2.7 million residents (13). Persons of Mexican origin
constitute the majority of Hispanics/Latinos (73%), followed by Puerto Ricans (14%), and the remaining groups
combined at 13%. The targeted area for recruitment in Chicago is composed of ethnically diverse neighborhoods
including several that have been majority Hispanic/Latino
for decades and others with more recent Hispanic/Latino
in-migration.
Miami-Dade County, Florida has about 2.4 million residents of which 1.5 million are of Hispanic/Latino origin
(13). Persons of Cuban origin represent 52% of Hispanics,
followed by South American (16%), Central American
(14%), and the remaining groups combined at 18%.
Recruitment is being conducted in the southwest section
of Miami-Dade County and in Hialeah.
San Diego County has a population of about 3 million
with 30% of Hispanic/Latino origin (13). The vast majority
(88%) are of Mexican origin with 12% in the remaining
groups combined. The combined region of South Suburban
(54% Hispanic/Latino) and South Central (38% Hispanic/
Latino) San Diego County, commonly referred to as the
‘‘South Bay’’ is the target community.
The HCHS/SOL was developed recognizing the importance of community participatory research requiring
community involvement throughout the study (14). Each
field center has a community advisory board that meets on
a regular basis to provide advice on a wide range of community issues related to the study. Community members have
provided input and advice on the informed consent, questionnaire development, Spanish translation, and issues
related to community sensitivities and values.
Participant Sampling and Recruitment
The sampling design was established to support two analytical objectives: first to estimate the prevalence, mean values
and distribution of risk factors, with sufficient sample size to

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stratify by place of origin and other relevant demographic
characteristics; and second to evaluate relationships among
baseline risk factors, and relationships of baseline risk factors
with disease outcomes. Representative samples of participants are drawn from census tracts in these defined communities and are recruited from households using strategies that
maximize participation rates, minimize nonresponse, and
minimize attrition during follow-up. The study was conceptualized with recognition that community involvement was
essential for its success, thus a community-defined sample
was needed rather than a sample drawn from very wide
geographical areas. Recruitment involves intensive community publicity and direct contract from recruiters. A bilingual study web site is available for the public and
participants (www.saludsol.net) individualized to each field
center. The detailed sampling design and recruitment strategies are described by LaVange et al. (15).
Examination Overview
Each field center has a specialized examination site accessible to the sampled community. All sites are convenient
to public transportation and provide a van service or taxi
service to assist participant attendance. Participants are
reimbursed for expenses involved in attending the examination. Persons are excluded from the study if they have plans
to move from the region within 6 months, are unable to
travel to the field center, or are unable to complete the study
questionnaires in English or Spanish. Women who are pregnant are rescheduled for a visit approximately 3 months
postpartum. All staff are bilingual allowing the use of
Spanish or English at the preference of the participant.
All forms and questionnaires are in both languages.
The baseline examination averages 7 hours in length,
with variation associated with the age and health condition
of the participant. Because a fasting blood draw is required,
examinations begin in the morning. At the reception,
participants are welcomed, and informed consent is
obtained. Participants are asked to bring medications to
the study center where these are recorded.
Table 1 details the standardized examination content
and its typical flow and duration, although the sequence
may vary by field center. The examination includes a series
of fixed and flexible components that are organized to
accommodate first the collection of informed consent before
any data collection, followed by the collection of measurements that must be obtained in the fasting state, followed
by a glucose screening test to determine eligibility for
a glucose load. The fast is broken by a snack at the
appropriate time in the examination. Participant safety is
paramount and some procedures are not carried out if contraindicated (e.g., glucose tolerance test, albuterol challenge
during pulmonary testing, and a periodontal examination).
Neurocognitive testing and the ankle-brachial blood

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TABLE 1. Example of HCHS/SOL baseline interview and
procedure blocks
Content
Fasting block
Reception, informed consent, change clothes, urine
collection
Anthropometry
Phlebotomy, glucose load
2-Hour glucose load, snack
Procedures, flexible sequence
ECG
Ankle brachial SBP (persons 45–74 years of age)
Seated blood pressure
Audiometry þ HEE questionnaire
Lung function
Oral examination þ verification of screening status
Change clothes
Blocks of interviews, flexible sequence: A
24-Hour dietary recall, supplements
Blocks of interviews, flexible sequence: B
Alcohol
Dietary behavior
Economic background
Health care use
Hearing Hx
Medical Hx
Medication and supplement use
Blocks of interviews, flexible sequence: C
Neurocognitive (persons 45–74 years of age)
Occupation
Oral health
Personal identifiers
Personal information
Blocks of interviews, flexible sequence: D
Physical activity
Respiratory Hx
SF-12 health status
Sleep Hx
Sociocultural
Tobacco use
Well being
Visit exit
Exit interview
Sleep and activity monitoring instructions and
tracking
Total clinic attendance time

Estimated time
(minutes)
66
30
08
16
12
107
15
17
11
22
15
20
07
45
45
28
02
03
02
04
04
07
06
44
16
07
05
07
09
43
05
09
05
02
07
02
04
20
10
10
353

ECG Z electrocardiogram; SBP Z systolic blood pressure; HEE Z hearing examination; Hx Z history; SF Z standard form.

pressure measures are not carried out in those less than 45
years of age. Complete documentation of the examination
content, questionnaires, forms, and a manual of procedures
are available at the study web site (16).

Questionnaire Content
The questionnaires and a brief description of their content
can be found in Table 2. Questionnaires are interviewer-

administered and collect participant identification, location
and contact information; health and medical history
including cardiovascular and pulmonary diseases, sleep
habits and disorders, hearing loss or tinnitus, use of hearing
aids, noise exposure, and oral/dental health; social and
behavioral factors and support including family structure
and community involvement, association with religious
and other social organizations, education, and traditional
and/or Hispanic/Latino values; occupational history
including occupational risk factors potentially related to
cardiovascular and lung diseases, cancer, and hearing loss;
disability; access to health care and use of health care facilities; smoking history and passive smoke exposure; alcohol
consumption, and current physical activity. Dietary intake
is ascertained using a 24-hour dietary recall at the initial
examination and again 6 weeks later. A food propensity
questionnaire developed to include Hispanic/Latino foods
is administered during the first year annual follow-up call.
If not previously translated through a well-described and
standard process, questionnaires were newly translated
into Spanish, certified by an independent translator, and
tested by focus groups at each field center to identify relevant differences in word usage by nationality or region of
origin.
Examination Procedures
The baseline examinations are outlined in Table 2. Weight,
height, and abdominal and hip girth are measured with
participants wearing light clothing, as is an efficient measure
of bio-impedance to estimate body fat composition. Standard resting brachial blood pressure is measured three times
in the seated position with a tested, automated sphygmomanometer (Omron model HEM-907 XL [Omron Healthcare
Inc, Bannockburn, IL]). To obtain the ankle and brachial
blood pressure index, blood pressure is assessed bilaterally
in the brachial, dorsalis pedis, and posterior tibial arteries
with a Doppler probe. Digitized records of a standard digital
12-lead ECG and a 2-minute rhythm strip are obtained and
results processed at a central electrocardiogram (ECG)
reading center. Standard digitized spirometric measurements of timed pulmonary function (forced vital capacity
or FVC, the forced expiration volume in 1 second or
FEV1, and the ratio between these two values, FEV1/
FVC) are obtained using the SensorMedics model 1022
(SensorMedics/Viasys, Yorba Linda, CA) dry-rolling seal
volume spirometer. Participants whose first spirometric
test indicates impaired lung function undergo repeated
spirometry testing after inhaling a bronchodilator to determine if the airway obstruction is reversible. An oral examination is conducted to measure periodontal disease and
other dental conditions. The hearing examination includes
otoscopy and assessment of hearing loss using measures of

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633

TABLE 2. Components of the examination
Description
Initial procedures
Personal information
Contact information
Informed consent
Medical release form
Questionnaire
Health and medical history
Family history
Acculturation
Social and behavioral

Occupational
Health care
24-Hour dietary recall

Smoking
Alcohol consumption
Physical activity
Disability
Weight loss/gain
Sleep
Medication
Oral/dental health
Hearing
Exam procedures
Blood pressure
Pulmonary function
Sleep assessment
ECG
Anthropometry
Physical activity
Dental
Audiometry
Cognitive function

List all household members, age, origin, years in US, social security number for mortality follow-up, household location
for geocoding.
Collect names, addresses, and telephone numbers of two other persons who would know participant’s location.
Obtain signed informed consent that complies with all required standards.
Allows the study to obtain access to participant’s medical records.
General health status, cardiovascular and lung illnesses, asthma, diabetes and kidney diseases, cancer, sleep disorders, and
hearing loss or tinnitus.
All conditions under the study such as cardiovascular disease, diabetes, hearing loss, kidney disease, and cancer.
Assessment of residence history, country of origin, ancestry, and degree of adaptation to new physical, cultural, social, and
economic environment.
Family structure, community engagement, affiliation and association with other social structures such as church and
social organizations, formal education and training, traditional and/or Hispanic/Latino values and behaviors, and risk
factor behaviors.
Specific occupation(s) and aspects of occupation potentially related to lung and cardiovascular diseases, cancer, and
hearing loss.
Health insurance, use of health care facilities, barriers to health care and utilization access.
Questions on dietary habits over past 24 hours, plus a food propensity questionnaire (FPQ) developed to include
Hispanic/Latino foods. The 24-hour recall is obtained during initial examination and again within 6 weeks of
examination. Includes information on dietary supplements and botanicals, both standard and alternative. The FPQ is
administered in the 1-year follow-up telephone call.
Past and current cigarette use, ever use of cigars and pipes, cessation attempts including use of medications to assist
without quitting, and use of modified harm-reduction tobacco products, exposure to second hand smoke.
Usual intake and drinking patterns.
Current physical activity including work, household, leisure, and sport-related activity.
SF-12 instrument.
History of weight gain or loss.
Sleep disordered breathing, apnea, restless leg syndrome, number of hours slept, sleeping during the day.
Prescription and nonprescription use, vitamin/dietary supplements and alternative medications taken in past month.
Participants are instructed to bring all these medications to the examination site for direct recording.
Access and barriers to care, oral cancer, oral health-related quality of life.
Hearing ability, hearing aid use, tinnitus, noise exposure, hearing protector use, pressure equalization tube use, recent
cold/sinus/earache, recent loud noise/music exposure and self-assessment of hearing symmetry.
Standard epidemiology procedures (5 minute rest, 3 measures), and using an automated blood pressure device. Separately,
measure ankle and arm blood pressure using standardized Doppler procedures.
Obtain digitized spirometric measurements of timed pulmonary function (FVC, FEV1). After first spirometric test,
participants with impaired function will inhale a bronchodilator followed by a second spirometry test.
Overnight sleep disordered breathing, particularly to assess sleep interruption due to sleep apnea.
Standard digital 12-lead ECG and 2-minute rhythm strip.
Weight, standing height, abdominal, and bioelectrical impedence.
Measure activity using activity monitors worn by participants.
Medical exclusion, tooth count, functional occlusion/occlusion pairs, coronal caries, restorative materials, root caries,
periodontal disease, and recommendations for dental health care.
Otoscopy, acoustic immittance, and pure tone audiometry.
Six-item screener, the Spanish English Verbal Learning Test, the Word Fluency Test of the Multilingual Aphasia
Examination, and the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised (WAIS-R).
These measures tap five cognitive domains: global mental status, verbal learning and memory, word fluency, and
psychomotor speed, respectively.

FPQ Z food propensity questionnaire; SF-12 Z standard form 12 items; FVC Z forced vital capacity; FEV1 Z forced expiratory volume in one second; ECG Z electrocardiogram; WAIS-R Z wechsler adult intelligence scale-revised.

acoustic immittance and pure tone audiometry. Testing is
conducted in a sound-treated booth using earphones
(TDH-50 Telephonics Corporation, Framingdale, NY)
and a clinical audiometer in a manner consistent with the
guidelines of the American Speech-Language-Hearing

Association. Testing protocols for the dental and hearing
components are comparable to those used in the National
Health and Nutrition Examination Survey (NHANES).
Cognitive performance measures include a six-item
screener, the Spanish English Verbal Learning Test, the

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Word Fluency Test of the Multilingual Aphasia Examination, and the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). These
measures tap five cognitive domains: global mental status,
verbal learning and memory, word fluency, and psychomotor speed, respectively.
After the visit to the study examination center, participants are requested to wear a portable motion sensor
(Actical accelerometer, model 198-0200-03; Minimiter
Respironics, Bend, OR) to measure actual physical activity
for a period of 7 days. The Actical device measures the
occurrence and intensity of motion in all directions and
sums and stores the signals as ‘‘activity counts.’’ To assess
any sleep disturbances participants wear an Apnea Risk
Evaluation System (ARES [Advanced Brain Imaging, Carlsbad, CA]) Unicorder for 1 night. This device uses a novel
pulse oximeter measuring oxygen saturation and heart
rate, and sensors that measure airflow, snoring sounds (by
microphone), and head movement and body position
(by accelerometry) and enables computation of the apnea
hypopnea index (AHI).
Blood and urine specimens are collected at each site according to the standardized protocol. Daily fresh and frozen
specimens are shipped to the central laboratory for measurements outlined in Table 3. A urine sample is collected from
participants preferably at the beginning of the exam for
measurement of albumin and creatinine. Fasting blood is
collected soon after arrival, and a second collection is
done after a 2 hour glucose tolerance test. After the postload venipuncture, participants are provided with a snack.

TABLE 3. Components of the blood, urine, and laboratory
measurements
Measure
Venipuncture

Glucose tolerance
Spot urine
Additional blood
Lab Measurements
from blood

Lab measurements
from urine

Description
Obtain fasting blood samples for laboratory analytes
above. Whole blood, serum, plasma, and
leukocytes, DNA, and paxgene tubes are stored for
future analyses.
2-Hour oral glucose tolerance test.
Collect early on arrival at examination site.
Collect additional tubes of blood to use for 5% blind
replicate samples.
Total cholesterol, HDL cholesterol, triglycerides,
glucose (pre- and post-OGTT), insulin,
glycosylated hemoglobin, iron, creatinine, ALT,
AST, UIBC, CBC with differential, platelets,
serology for Hepatitis A, B, and C, and HCV RNA
(on the subset hepatitis C positive), CRP.
Albumin, creatinine

DNA Z deoxyribonucleic acid; HDL Z high density lipoprotein; OGTT Z oral
glucose tolerance test; ALT Z alanine transaminase; AST Z aspartate aminotransferase; UIBC Z unsaturated iron binding capacity; CBC Z complete blood count;
HCV Z hepatitis C virus; RNA Z ribonucleic acid; CRP Z C-reactive protein.

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Approximately 80 mL of blood are collected. A repository
of plasma, serum, genomic DNA, RNA, and urine is established at the central laboratory for future analysis. Details on
the laboratory collection, processing and analysis can be
found in the laboratory manual (17).
Data Collection, Management, and Quality Assurance
All data are collected using a direct computer-based data
entry system developed and programmed by the Coordinating Center. Intermediate paper forms are not used with
the exception of field center routing and scheduling forms,
neurocognitive tests that are not designed for computer
based administration, and back-up forms to allow for
computer or internet malfunctions. Online editing takes
place at the time of data entry so that queries can be made
of participants and errors corrected immediately.
Quality assurance includes central training of all staff;
standardized certification of the staff inclusive of recruiters;
direct observational monitoring of the recruitment, examination procedures, administration of the interview, and
equipment calibration schedules; within visit repeat
measurements of both laboratory and procedures to determine measurement variability; and analysis of all collected
data to identify errors in measurement or questionnaire
administration.
Central Laboratory and Reading Centers
To standardize the examination and measurement process
across study sites, a central laboratory and central reading
centers serve as foci for protocol development, training
and certification of staff, centralized measurements or readings, and quality assessment and control. The Central Laboratory established the uniform blood processing and
shipping procedures, conducts all laboratory assays, implements blind replicate measurements for a 5% sample,
conducts measurements of blinded samples from standardized samples, provides technical support to the field centers
and transfers the study results to the coordinating center.
Equivalent training, standardization, reading, and quality
control functions are also conducted by the Pulmonary
Function Testing Reading Center, the Central Electrocardiogram Reading Center, the Sleep Reading Center (for
the overnight sleep monitors), the Audiometry Reading
Center, the Nutrition Reading Center (for the 24-hour
dietary recall and food propensity questionnaires), and
a Neurocognitive Center (for the neurocognitive performance tests).
Participant Follow-Up
After the examination and completion of laboratory tests,
participants are provided with a summary of their study
results of established medical value. Interpretation of the

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results per current guidelines and pertinent recommendations are provided. Working with its community advisory
committee the study assists participants who do not have
a health care provider in obtaining a medical referral.
Each field center has a network of free or sliding fee scale
providers to assist those without medical insurance.
Participants are contacted by telephone approximately 6
weeks after the baseline visit to obtain a second 24-hour dietary recall. One year after the baseline visit, participants are
again contacted by telephone to obtain information on any
change in personal contact information, as well as doctor
visits, emergency care, or hospitalization since baseline.
After the NHANES procedures, a food propensity questionnaire is also administered (similar to a food frequency questionnaire, but without information on the portion size
consumed) to elicit information on consumption of certain
foods during the previous year (18).
Endpoint Ascertainment and Classification
During the annual follow-up phone call, deaths, hospitalizations, and emergency department visits of participants that
occur from the baseline examination through the end of the
follow-up period are identified. Information relevant to
the classification of study outcomes are abstracted from
the medical records by trained personnel. Events are classified according to study protocol (19) as a combination of
computer-based algorithms and an overview of the medical
records by a panel of clinical specialists trained in the
HCHS/SOL classification criteria. The HCHS/SOL event
classification criteria were selected for comparability to

635

those of other pertinent epidemiologic studies. The cardiovascular endpoints include myocardial infarction, fatal
coronary heart disease, heart failure, and stroke. Additionally, the study will ascertain exacerbations of asthma that
result in an emergency department or hospital visit, and
hospitalizations and emergency department visits for
chronic obstructive pulmonary disease. Deaths are identified
from reports by next-of-kin, obituary searches, and matches
to the National Death Index. A summary of the criteria for
these endpoints are shown in Table 4.
Study Governance and Oversight
A Steering Committee (consisting of the principal investigators of each field center, the principal investigator of the
coordinating center, and the project officer of the NHLBI)
provides the scientific and procedural direction for the
HCHS/SOL. Reporting to the Steering Committee are the
following committees: Ancillary Studies, Publications,
Community Relations, Endpoints, Operation/Examination,
Retention/Follow-up, Sampling/Recruitment, Translation/
Validation, Quality Control, Questionnaires, and Career
Development.
The HCHS/SOL is conducted under the oversight of
each institutional review board at the field centers and coordinating center institutions. The study has an Observational
Studies Monitoring Board that serves as advisory to the
NHLBI and provides oversight on participant burden,
safety, study progress and reviews all ancillary studies. As
a study funded by Federal contracts the data collection forms
received clearance from the Office of Management and

TABLE 4. Endpoint events and criteria
Endpoint

Information source

Criteria summary*

Acute myocardial infarction
Heart failure

Hospital, ED
Hospital, ED, self-report

Atrial fibrillation
Peripheral arterial disease

Hospital, ED, self-report
Hospital, ED, self-report

Resuscitated cardiac arrest
Angina pectoris

Hospital, ED
Hospital, ED

Cardiac revascularization
Venous thromboemobolism

Hospital, ED
Hospital, ED, self-report

Stroke
Transient ischemic attack
Chronic obstructive
Asthma

Hospital, ED
Hospital, ED
Hospital, ED, self-report
Hospital, ED, self-report

AHA/ACC criteria
Physician diagnosis, patient receiving treatment for heart failure, pulmonary edema
by x-ray, poor left ventricular function
Evidence of physician diagnosis, review of ECG findings
Evidence of symptomatic disease with a diagnostic procedure or therapeutic
intervention
Evidence from review of medical records
Evidence of physician diagnosis, revascularization procedure, findings from ECG
and angiography
Review of medical records
Physician review of positive duplex ultrasound or venogram, Doppler ultrasound or
impedance plethysmography, and results of ventilation/perfusion scans or
angiography
Modified TOAST criteria
NINDS criteria
Modification from other studies; see Pulmonary Disease Manual of Operations*
Modification from other studies, see Manual of Operations*

ED Z emergency department; AHA/ACC Z American Heart Association/American College of Cardiology; ECG Z electrocardiogram; TOAST Z Trial of ORG10172 in
Acute Stroke Treatment; NINDS Z National Institute of Neurological Diseases and Stroke.
*Specific references and details of criteria for event definitions can be found in the manual of operations (19).

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Budget. The table in the appendix describes each institution
and staff involved in the HCHS.
DISCUSSION
Although the HCHS/SOL is the most comprehensive study
of Hispanics/Latinos in the United States to date, limitations exist. First, whereas the community-based sampling
design will permit inferences to the larger population from
which it is drawn, inferences cannot be made regarding
prevalence of risk factors or disease to the larger Hispanic
Community across the United States. Because many of
the procedures have also been conducted by the NHANES
and other studies, the HCHS/SOL will conduct analysis to
compare to these other studies. Second, although the study
aims to investigate the ‘‘Hispanic Paradox,’’ this requires
comparison to non-Hispanic populations. However,
a non-Hispanic cohort was not included in this study.
Consequently, comparisons to non-Hispanic populations
will be based on the use of common protocols with other
studies, principally the Multi-Ethnic Study of Atherosclerosis and other NHLBI epidemiology cohorts. For research
components missing from the core study, there is an ancillary study process to encourage additional grant support.
Ancillary study procedures and policies can be found on
the HCHS web site (20).
The HCHS/SOL is designed to inform health care
providers, the public health community, and the Hispanic/
Latino population on the frequency of impaired health in
Hispanics/Latinos, the likely causes associated with these
conditions and the measures needed to promote the health
of the Hispanic/Latino population in the United States.
Although not a national sample, it will provide comprehensive information on risk factors and burden of disease
outcomes of significant breadth. Knowledge from this study
will also provide understanding of the consequences of
major changes in life-style and health care due to immigration. The resulting information will not only improve the
health of Hispanics or Latinos, but can lead to measures
resulting in improved health for the United States population at large.
The Hispanic Community Health Study/Study of Latinos was supported by
contracts from the National Heart, Lung, and Blood Institute (NHLBI) to
the University of North Carolina (N01-HC65233), University of Miami
(N01-HC65234), Albert Einstein College of Medicine (N01-HC65235),
Northwestern University (N01-HC65236), and San Diego State University
(N01-HC65237). The following Institutes/Centers/Offices contribute to
the HCHS/SOL through a transfer of funds to the NHLBI: National Center
on Minority Health and Health Disparities, the National Institute of Deafness and Other Communications Disorders, the National Institute of Dental
and Craniofacial Research, the National Institute of Diabetes and Digestive
and Kidney Diseases, the National Institute of Neurological Disorders and
Stroke, and the Office of Dietary Supplements.

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REFERENCES
1. U.S. Census Bureau. The Hispanic Population Census. 2000 Brief. Available at: http://www.census.gov/prod/2001pubs/c2kbr01-3.pdf. Accessed
December 5, 2008.
2. U.S. Census Bureau. Hispanic Population of the United States: 1970–
2050. Available at: http://www.census.gov/population/www/socdemo/
hispanic/hispanic_pop_presentation.html. Accessed December 12, 2008.
3. Palloni A, Arias E. Paradox lost: explaining the Hispanic adult mortality
advantage. Demography. 2004;41:385–415.
4. Hunt KJ, Resendex RG, Williams K, Haffner SM, Stern MP, Hazuda HP.
All-cause and cardiovascular mortality among Mexican-American and
non-Hispanic white older participants in the San Antonio Heart Study
devidence against the ‘‘Hispanic Paradox.’’. Am J Epidemiol.
2003;158:1048–1057.
5. Sorlie PD, Backlund E, Johnson MJ, Rogot E. Mortality by Hispanic status
in the United States. JAMA. 1993;270:2464–2468.
6. Franzini L, Ribble JC, Keddie AM. Understanding the Hispanic paradox.
Ethn Dis. 2001;11:496–518.
7. Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292:2860–2967.
8. Ledogar RJ, Penchaszadeh A, Iglesias-Garden CC, Garden-Acosta L.
Asthma and Latino Cultures: Different prevalence reported among groups
sharing the same environment. Am J Public Health. 2000;90:929–935.
9. Singh GK, Miller BA. Health, life expectancy, and mortality patterns
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10. Gans KM, Burkholder GJ, Upegui DI, Risica PM, Lasater TM, Fortunet R.
Comparison of baseline fat-related eating behaviors of Puerto Rican,
Dominican, Colombian, and Guatemalan participants who joined a cholesterol education project. J Nutr Educ Behav. 2002;34:202–210.
11. Working Group (Chairs Amelie Ramirez and Michael Stern). Epidemiologic Research in Hispanic Populations, Opportunities, Barriers and Solutions, 2003. Available at: http://www.nhlbi.nih.gov/meetings/workshops/
hispanic.htm.
12. Hispanic Community Health Study. About the Study/Public Manuals and
Docs, Manual 1 Study Protocol, General Description and Study Management. Available at: http://www.cscc.unc.edu/hchs. Accessed December 5,
2008.
13. U.S. Census Bureau: American community Survey 2005–2007. Available at:
http://factfinder.census.gov/servlet/DatasetMainPageServlet?_programZ
ACS&_submenuIdZ&_langZen&_tsZ. Accessed December 12, 2008.
14. Cargo M, Mercer S. The value and challenges of participatory research:
Strengthening its practice. Ann Rev Public Health. 2008;29:325–350.
15. Lavange LM, Kalsbeek W, Sorlie PD, Avile´s-Santa LM, Kaplan RC,
Barnhart J, et al. Sample design and cohort selection in the Hispanic
Community Health Study/Study of Latinos. Ann Epidemiol. 2010;20:
642–649.
16. Hispanic Community Health Study. About the Study/Public Manuals and
Docs, Manual 2 Field Center Procedures v 2.0. Available at: http://www.
cscc.unc.edu/hchs. Accessed December 5, 2008.
17. Hispanic Community Health Study. About the Study/Public Manuals and
Docs, Manual 07 Biospecimen Collection and Processing. Available at:
http://www.cscc.unc.edu/hchs. Accessed December 5, 2008.
18. Hispanic Community Health Study. About the Study/Public Manuals and
Docs, Manual 11 Diet and Supplements v2.0. Available at: http://www.
cscc.unc.edu/hchs. Accessed December 5, 2008.
19. Hispanic Community Health Study. About the Study/Public Manuals and
Docs, Manual 15 Endpoints. Available at: http://www.cscc.unc.edu/hchs.
Accessed December 12, 2008.
20. Hispanic Community Health Study. About the Study/Ancillary Studies.
Available at: http://www.cscc.unc.edu/hchs. Accessed December 12, 2008.

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APPENDIX
Acknowledgements
The HCHS/SOL study acknowledges the complete team of
personnel list below for their dedication and commitment to
the success of this study.
HCHS INSTITUTIONS AND STAFF
Field Centers
Bronx Field Center – Albert Einstein School of Medicine
Investigators, Managers and Coordinators
Robert Kaplan, Principal Investigator
Sylvia Wassertheil-Smoller, Co-Principal Investigator,
(former Principal Investigator)
Janice Barnhart, Co-Investigator, Medical Director
Mindy Ginsberg, Co-Investigator
Carmen Isasi, Co-Investigator
Yasmin Mossavar-Rahmani, Co-Investigator
Elizabeth Lee-Rey, Co-Investigator
Raanan Ahrens, Co-Investigator
Victor Badner, Co-Investigator
Elizabeth Dinces, Co-Investigator
Robert Ostfeld, Consulting Cardiologist
Christian Schumacher, Co-Investigator
Nereida Correa, Co-Investigator
Tom Aldrich, Co-Investigator
Neomi Shah, Co-Investigator
Madeline Crespo-Figueroa, Clinic Manager
Emelinda Blanco, Recruitment Manager
Jessica Clemente, Community Outreach & Follow-Up
Manager
Adelyn Alvarez, Community and Outreach Coordinator
(former)
Gregory Aidinov, Data Manager
Kwabena Bosompem, Data Manager
Yvonne Raiford, Director of Research
Rosalyn Graves, Nurse Manager/Clinic Nurse
Anna Mayer, Study Nursing Coordinator
Elena M. Stefanizzi, Administrator
Laura Tocci, Audiologist
Gladys Valdivieso, Community Liaison
Nancy Flores, Senior Recruiter
Jhack Sepulveda, Lead Nutritionist
Maria Rocio-Gilman, Lead Interviewer
Lizette Rosario, Lead Medical Technician
Mary Valle, Outcomes Coordinator
Joann Casado, Chair, Community Advisory Board
Rosa Agosto, Advisor
Celia Alfalla, Advisor
Melissa Cebollero, Advisor
Lyla Correoso, Advisor
Ivy Fairchild, Advisor

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637

Marian Feinberg, Advisor
Maxine Golub, Advisor
Nancy Manus, Advisor
Minerva Santiago, Advisor
Hal Strelnick, Advisor
Reid Strieby, Advisor
Lillian Velazquez, Advisor
Clinic, Laboratory, Recruitment, and Administrative
Staff
Christine Abreu
Laura Avelino
Carlos Blanco
Rainey Cruz
Mariana Bucovsky
Christopher Canzone
Georgina Cedano
Marilyn Colon
Zenobia Colon
Marisol Diaz-Castellano
Walkiria Dilone
Minerva Foglia
Yanette Fuentes
Carlos A. Garcia
Jessalyn Gines
Olga Gonzalez
Jose Guzman
Sherifa Heron
Victor Kamensky
Sofia Kavakoglou
Shir Lerman
Daniel Lopez
Aleny Lora
Jose Luciano
Phyllis Marti
Jacqueline Martinez
Rafael Martinez
Alejandro Molina
Natasha Muriel
Marlen Murillo-Pimentel
Michael Ortega
Wanda Pacheco
Serenidad Quintana
Leonides Ramos
Isidra Sabio
Ruth Santizo
Vanessa Sessoms
Leonid Strizhevskiy
Solomon Torres
Evelyn Torres-Ferrara
Darwin Tracy
Joel Valez
Lydiannette Vazquez

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Chicago Field Center – All listed are from Northwestern
University unless identified as UIC (University of Illinois
Chicago)
Investigators, Managers and Coordinators
Martha L. Daviglus, Principal Investigator
Aida L. Giachello, Co-Principal Investigator (UIC)
Kiang Liu, Co-Principal Investigator
Catalina Ramos, Project Manager (UIC)
Karen Mancera-Cuevas, Study Coordinator
Susan Giovanazzi, Clinic Manager
Duanny Alva, Assistant Clinical Coordinator
Claudia Chambers, Assistant Clinical Coordinator
Louis Martos, Assistant Clinical Coordinator
Carlos Sanchez, Assistant Clinical Coordinator
Mayra Vargas, Assistant Clinical Coordinator
Jose Manuel Correa, Events and Follow-up Coordinator
Rigoberto Angulo, Recruitment Field Coordinator
(UIC)
Jesse Cano, Recruitment Field Coordinator (UIC)
Jeannie B. Concha, Recruitment Field Coordinator
(UIC)
Sylvia Gutierrez, Assistant Recruitment Field Coordinator
Francisco Moreno, Recruitment Manager (UIC)
Rosemary George, Recruitment Grant Manager (UIC)
Daniel B. Garside, Research Programming Manager
Cesar Alvarado, Recruitment Field Coordinator (UIC)
Michael Aponte, Data Entry (UIC)
Niki Gernhofer, Nutrition Supervisor
Angela Herrell, Research Administrator
Natalie Meza, Community Relations and Outreach
Coordinator (UIC)
Sujata Archer, Investigator
David W. Baker, Investigator
Virginia Bishop, Investigator
Jose Arrom, Investigator (UIC)
Mercedes Carnethon, Investigator
James P. Choca, Investigador
Pablo Denes, Investigator
Sumitrajit Dhar, Investigator
Pamela Fiebig, Investigator
David Green, Investigator
Donald Lloyd-Jones, Investigator
Mary McDermott, Investigator
Sanjiv Shah, Investigator
Lewis Smith, Investigator
Jeremiah Stamler, Investigator
Lu Tian, Investigator
Linda Van Horn, Investigator
Phillis Zee, Investigator
Shirley Beaver, Consultant
Patricia Canessa, Consultant
Victoria Persky, Consultant

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Esther Sciamarella, Consultant
Rosemary Sokas, Consultant
Clinic, Laboratory, Recruitment, and Administrative
Staff - UIC
Adriana Garcia
Gonzalo Lozano
Marc Noble
Christian Rodriguez
Veronica Angulo
Ericka Garduno
Ricardo Corcoles
Rebecca DaVila
Paula Rodriguez
Karina Vera
Adela Busso
Chantal Payano
Aracelis Englund
Martha Prado Gonzalez
Lourdes Garduno
Armando Saleh
Victor Abundis
Consuelo Garcia Herreros
Pablo Gomez
Jessica Luna Ramos
Cassandra Rodriguez
Diana Silva
Jeannette Marchan
Abel Rosas
Manuel Abundis
Araceli Cisneros
Gonzalo Lozano
Pablo Bernhardt
Reynaldo Guerrero
Rosario Delgado
Aleida Rodriguez
Dora Trevino
Clinic, Laboratory, Recruitment, and Administrative
Staff - NU
Liliana Bolanos
Gabriella Bovio
Juan Pablo Correa
Martha Cruz
Leticia Diaz
Olga Garcia
Jose Garcia
Georgette Garside
Mary Harris
Veronic Herzog
Dolores Lopez
Liliana Medina
Horacio Peralta-Marinkovic
Maybelline Pereda

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Jessica Ramos-Luna
Evita Sanchez
Lavinia Sinetian
Carla Valdez
Sandra Valdez
Soraya Valencia
Delia Vazquez
Cheryl Westbrook
Caroline Zee
Miami Field Center – University of Miami
Investigators, Managers and Coordinators
Neil Schneiderman, Program Director/Principal
Investigator
David Lee, Co-Principal Investigator
Leopoldo Raij, Co-Principal Investigator
John Ryan, Co-Principal Investigator
Marc Gellman, Project Manager
Brendaly Rosemond, Communications Specialist
Melanie Ashby-Laboratory manager
Maria Pattany, Clinic Manager
Elizabeth Balbin, Recruitment Manager
Robert Fifer, Investigator
Jesus Gomez, Investigator
Maria Llabre, Investigator
Armando Mendez, Investigator
Frank Penedo, Investigator
Matthias Salathe, Investigator
Ralph Sacco, Investigator
Daniel Santisteban, Investigator
Gail Shor-Posner, Investigator
Lisa Baumbach-Investigator
David Seo-Investigator
William Wohlgemuth-Investigator
William Arguilles-Predoctoral Fellow
Clinic, Laboratory, Recruitment, and Administrative
Staff
Melanie Ashby
Joaquin Bassols
Jenny Bello
Carlos Benitez
Cristalis Capielo
Karen Cardenas
Marcela Castiglioni
Claudia Chambers
Nora Cobo
Ivette DePool
Nayomy Figueroa
Jacqueline Gomez
Blair Hall
Elsa Hernandez

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639

Vanessa Hernandez
Anne Hoey
Rosanne Kolaczynski
Tilky Lopez- Blanco
Roberto Manzano
Fredy Mejia
Eleana Mendes
Degnis Mendez
Silvia Mirabal
Mairim Mise
Juan Moreiras
Liannet Nieves
Jose Ortiz
Ester Parra
Maria Pattany
Nubia Pelusso
Andre Perwin
Katherine Pozo
Concepcion Ramos
Omar Rivero
Manuel Rodriguez
Jared Sharon
Daniel Suarez
Patricia Tondo
Mayra Vargas-Rivera
Jeanneth Velarde
Maria Velarde
Enrique Zayas
Feng Zhao
San Diego Field Center – All listed are from San Diego
State University unless identified as UCSD (University of
California San Diego), or SYHC (San Ysidro Health
Center)
Investigators, Managers and Coordinators
Greg Talavera, Principal Investigator
John Elder, Co-Principal Investigator
Matthew Allison, Co-Principal Investigator (UCSD)
Michael Criqui, Co-Principal Investigator (UCSD)
Elva Arredondo, Investigator
Guadalupe X. Suchi Ayala, Investigator
Linda Gallo, Investigator
Ming Ji, Investigator
Cindy Knott, Investigator (UCSD)
Sheila LaHousse, Investigator
Jose Loredo, Investigator (UCSD)
Peter Torre, Investigator
Andrew Ries, Investigator (UCSD)
Cheryl Rock, Investigator (UCSD)
Ana Talavera, Program Manager
Johanne Blouin-Herna´ndez-Clinic Manager
Rosalinda Rodriguez, Recruitment/Retention Manager

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Brenda Money, Pulmonary Technician-Consultant
(UCSD)
Karen Becerra, Lead Dentist /Examiner(SYHC)
Jonathon Rudin, Dentist/Examiner Research (SYHC)
Rick Cuadra, Oral Health Examiner Research (SYHC)
Erika Velazco, Outcomes Coordinator (UCSD)
Julie Denenberg (Research Administrator) (UCSD)
Paulina Martinez, MPH Candidate Student
Vanessa Torres, Outreach SYHC
Field Research Center, Laboratory, Recruitment, and
Administrative Staff
Juan Astorga
Blanca Carrillo
Yasmina Cortez
Carmen Lopez-Administrative Assistant
Martha Mun˜iz
Alejandra Oceguera
Bianca Perdomo
Tanya Perdomo
Maria Del Carmen Porras
Nora Ramirez
Patricia Richardson
Gerald Rivera
Maria Luisa Rivera
Elizabeth Sanchez
Maria Mercedes Sierra
Carlos Vera
Gabriela Villavicencio
Sylvia Andrade
Rosa Cortez
Olga Villasen˜or
Elizabeth Flores
Andrea Hernandez
Cecilia Lopez
Guillermina Macias
Luis Miquirray
Karla Nun˜ez
Esthela Escobar
Hiram Cardoza
Tanya Cornejo
Jessica Gomez-Padilla
Elizabeth Zamudio
Rodrigo Leon-Alvarez
Martha Navarro
Coordinating Center – University of North Carolina
Department of Biostatistics, Gillings School of Global
Public Health
Collaborative Studies Coordinating Center
Lisa LaVange, Principal Investigator
Gerardo Heiss, Co-Principal Investigator
Diane Catellier, Co-Principal Investigator

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Robert Agans, Co-Investigator
Shrikant Bangdiwala, Co-Investigator
James Beck, Co-Investigator
Lloyd Chambless, Co-Investigator
William Kalsbeek, Co-Investigator
Sally Mauriello, Co-Investigator
Robert McMurray, Co-Investigator
Krista Perreira, Co-Investigator
Barry Popkin, Co-Investigator
Wayne Rosamond, Co-Investigator
Anna Maria Siega-Riz, Co-Investigator
June Stevens, Co-Investigator
Eric Whitsel, Co-Investigator
Marston Youngblood, Project Manager
Maria de los Angeles Abreu, Research Specialist
Chris Anderson, Business Manager
Vidya Antony, Applications Analyst
Jim Bartow, Applications Specialist
Hope Bryan, IT Manager
Forrest DeMarcus, Research Assistant
Paula Gildner, Research Specialist
Franklyn Gonzalez, Statistician
Annie Green Howard, Graduate Research Assistant
Max Kramer, Student Intern
James Locklear, Applications Specialist
Dianne Mattingly, Research Associate
Monica Miles, Research Assistant
Jeff Oberhaus, Research Assistant
Fang-Shu Ou, Graduate Research Assistant
Kathy Roggenkamp, Statistical Computing Manager
Ping Shen, Applications Analyst
Yanping Teng, Statistician
Central Laboratory – University of Minnesota
John H. Eckfeldt, M.D., Central Laboratory Principal
Investigator
Bharat Thyagarajan, Central Laboratory Co-Investigator
Catherine Leiendecker-Foster, Project Manager
Central Reading Centers
Audiometry Center - University of Wisconsin
Karen J. Cruickshanks, Principal Investigator
Ted S. Tweed, Co-Investigator
Dayna S. Dalton, Co-Director
Thomas Dugolenski, Audiologist
ECG Reading Center – Wake Forest University
Elsayed Soliman, Principal Investigator
Zhu-Ming Zhang, Co-Investigator
Neurocognitive Reading Center – University
of Mississippi Medical Center
Thomas Mosley, Principal Investigator
Margaret Pearson, Statistician

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Christianne Pinell-Jansen, Psychometrist
Nutrition Reading Center – University of Minnesota
John H. Himes, Principal Investigator
Lisa Harnack, Co-Investigator
Mary Stevens, Service Center Manager
Aida Miles, Project Nutritionist
Susan Seftik, Quality Control
Brenda Nolan, Assistant Project Nutritionist

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Janet Pettit, Database Nutritionist
Pulmonary Reading Center – Columbia University
R.Graham Barr, Principal Investigator
John Hankinson, Co-Investigator
Paul L. Enright, Co-Investigator
Sleep Center – Case Western Reserve University
Susan Redline, Principal Investigator
Sanjay Patel, Co-Investigator

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