Research and Funding

HANDLS—Bringing health disparity research to the neighborhood

October 15, 2009

(Published in LINKS: Minority Research & Training - Fall 2009)

African American doctor and patientNIA’s research portfolio includes a variety of research projects aimed at better understanding health disparities in hopes of one day closing these gaps. Research on diversity is funded nationwide as well as conducted by NIA’s intramural scientists in Baltimore, Maryland. One notable example of this intramural research is the Healthy Aging in Neighborhoods of Diversity across the Life Span or HANDLS study. Now in its fifth year, HANDLS researchers investigate the differences in rates and risks for diseases and other conditions associated with aging among approximately 4,000 African American and White participants of low and higher socioeconomic status (SES). The study also looks for differences in longevity.

“What makes HANDLS unique is its community-based approach. Instead of expecting participants to come to a study site, the study site comes to them via a mobile medical research vehicle. We are able to reach non-traditional research participants that way,” explains Michele Evans, M.D., Co-Principal Investigator of HANDLS and Deputy Scientific Director of NIA’s Intramural Research Program.

Another unique feature of HANDLS is that participants (who were between the ages of 30 and 64 when they entered the study) are followed over time, or longitudinally. The plan is to reexamine participants every 3 years over the course of 20 years. Observing participants as they age will help researchers determine the influence of socioeconomic status and race on age-related changes. In HANDLS, low SES is defined by an income below 125% of poverty level. These observations will also help identify early biomarkers of age-related health disparities that could prevent or ameliorate the severity of diseases such as hypertension or diabetes. Ultimately, researchers hope to use the longitudinal data collected about participants’ cognitive, psychophysiological, and physical function to characterize the relationship between race, socioeconomic status, and health outcomes.

In the paper, “Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning,” published in the Journal of the International Neuropsychological Society (July 2009), HANDLS researchers present some new findings pertaining to the relationship between reading ability and cognitive function. The analysis found that for both low- and higher-SES African Americans and low-SES Whites, reading ability is a stronger predictor of cognitive function than years of education. Traditionally, years of education have been used in neuropsychological tests for establishing norms and as a demographic correction in overall performance. This research is another step in helping to clarify how quality of education may be more important than years of education.

“Our findings perhaps relate to a larger issue facing African Americans and low-SES Whites. That is, people from certain backgrounds are more likely to have poor-quality education for a variety of reasons. Consequently, quality of education—reflected by reading level—could be more important than quantity of education for predicting cognitive function,” says Alan Zonderman, Ph.D., Co-Principal Investigator of HANDLS and Chief of NIA’s Intramural Cognition Section.

As HANDLS moves forward, researchers continue to develop new research questions and ways to strengthen the study. For example, several years ago investigators started a second wave of HANDLS: The Association of Personality and Socioeconomic Status with Health Status—An Interim Follow-up Study.

Researchers examine if there is any relationship between personality, the conditions where people are raised, and health. In this second wave, researchers also hope to learn more about participants’ eating habits and examine the effects of race and socioeconomic status on nutrition.

“By looking more closely at nutritional habits and personality—defined as emotions, thoughts, preferences—and behaviors unique to a person, we hope to learn more about the natural course of certain diseases. This may help us understand why some Americans have higher rates and more severe manifestations of those diseases,” shares Zonderman.

HANDLS researchers recently began wave 3 of the study, the first follow-up examination on the mobile medical research vehicles. During this wave, researchers will look at changes in health status over time that are associated with race and socioeconomic status.

To learn more about HANDLS and the paper, “Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning,” please visit the study website at

Page last updated: February 26, 2015