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Medical Effectiveness Research Center for Diverse Populations

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Eliseo J. Perez-Stable, MD
Director, MERC
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400 Parnassus Ave., Suite 405
San Francisco, CA  94143
Box 0320
Ph (415) 476-4362
Fax (415) 476-7964

Eliseo J. Pérez-Stable, M.D. is Professor of Medicine at the University of California, San Francisco (UCSF) School of Medicine. He holds degrees from the University of Miami (B.A. and M.D.), trained in primary care general internal medicine at UCSF, and completed a Henry J. Kaiser Family Foundation fellowship in general internal medicine before being appointed Assistant Professor at UCSF in July 1983. Dr. Pérez-Stable's research has focused on health and health care disparities by race and ethnicity in the areas of tobacco use and cessation, cancer prevention and aging.  He has special expertise in development of risk factor reduction interventions for Latinos.  The areas of research include cigarette smoking, cancer screening and prevention and minority aging.

Cigarette Smoking in Minority Populations. 

Dr. Pérez-Stable developed a comprehensive research program focused on cancer prevention in Latino and minority populations and is a leading minority researcher in general internal medicine.  He leads a multidisciplinary team of social scientists and clinicians using theoretical models to describe similarities and differences by ethnicity in attitudes, beliefs, and behavior toward specific preventive medicine topics. Dr. Pérez-Stable has been the principal investigator (PI) of 10 NIH grants focused on minority health.  He was the Principal Investigator of the Hispanic Smoking Cessation Research Project (Programa Latino Para Dejar de Fumar) that was a community-based intervention to decrease nicotine dependence in San Francisco Latinos from 1985-1996. Data derived from these studies have led to the development and implementation of large prevention interventions targeting entire communities.  Based on studies evaluating similarities and differences between Latinos and Anglos in cigarette smoking attitudes, antecedents, and behavior, Perez-Stable directed a community-wide intervention to decrease smoking prevalence among San Francisco Latinos.  Significant changes occurred in awareness of the intervention and after three years smoking rates decreased, especially among women.   He was one of the first to show that ethnic communities could be successfully sampled using standard random digit dialing techniques. His group published the first association of depressive symptoms and cigarette smoking in Latinos. The Guia para Dejar de Fumar is a self-help booklet that has been published 3 times by the NCI, and is available on the NCI Planet website.

We completed a survey of California pediatricians and family physicians and compared their reported behavior in counseling adolescents about smoking cessation. For most evidence-based practices to promote smoking cessation, family physicians were significantly more likely to report these behaviors than pediatricians.   A national survey of primary care physicians (stratified by Latino and White ethnicity) is completed and shows poor adherence to recommended cessation practices.  I collaborate with Ricardo Muñoz, PhD on an innovative adaptation of a self-help smoking cessation intervention  (developed by our group) combined with mood management components for a web-based intervention to be evaluated in a randomized trial. Recently funded for a third cycle to further develop an Internet based research program. Preliminary findings from the web-based intervention indicate cessation rates similar to those obtained with quit lines.  A study of African American adolescents and a parent identified differential attitudes by tobacco exposure at home. 

In collaboration with the laboratory of Neal Benowitz, MD, we completed analyses of nicotine metabolism in 160 White, Latino, African American and Chinese American smokers.  Comparison of Latinos to Whites showed no significant differences in nicotine metabolism or consumption, but Chinese smokers had lower clearance compared to Whites.  Intake of nicotine per cigarette among Chinese smokers was significantly lower compared to Whites and Latinos (0.73 mg vs. 1.10 mg vs. 1,05 mg) and this may explain in part lower lung cancer rates in Chinese (ref #89).  In 2002 we were funded by the Fogarty International Center of the NIH for a collaborative tobacco program with  a university in Jujuy, Argentina.   We completed data collection on 2400 10 to 12 year old children enrolled in schools to ascertain factors that predict smoking initiation.  This is the first study of its type in Latin America.  We are also analyzing the tobacco documents to evaluate legislation, court cases and policy issues in Argentina. He showed that 25% of Mexican American smokers may be underreporting consumption by as much as 17 cigarettes per day, and that 12% of smokers had cotinine levels inconsistent with reported smoking levels.  Other analyses showed that African Americans metabolize nicotine more efficiently when compared to Whites and thus consume more nicotine per cigarette smoked. Chinese Americans were less efficient metabolizing and clearing nicotine (ref #10). These observations may help explain variance in lung cancer rates in different populations.

Cancer Screening and Prevention

Dr. Pérez-Stable also found that Latinos had substantially more misconceptions than Whites on knowledge and attitudes about cancer and these findings led to culturally appropriate interventions to promote early detection of cancer among Latinos. He led a project in the Pathways to Cancer Screening in Four Ethnic Groups NCI funded program project that included a community based intervention targeting Latina women in San Francisco to promote screening procedures for early detection of breast and cervical cancer. Dr. Pérez-Stable led the San Francisco site of the National Hispanic Leadership Initiative on Cancer (En Acción) and subsequently the Special Populations Network Program Redes en Accion. These were community-based interventions to promote smoking cessation, increased use of recommended cancer screening tests, and promote nutritional and physical activity changes to promote a healthier lifestyle. These projects are an extension of prior work that compared knowledge, beliefs, attitudes and practices of Latinos and Anglos in Alameda and San Francisco Counties in order to develop cancer prevention interventions promoting cancer screening tests.  As a result of these programs booklets for Spanish speaking population were produced including a guide for women to promote use of breast and cervical cancer screening tests (La Mujer y El Cancer) and a general information booklet on cancer prevention and control.  We are analyzing results of 970 interviews with women with an abnormal screening mammography examination stratified by four ethnic groups. The study is comparing psychological reactions, communication with the clinician, health related quality of life measures, and evaluation of index abnormality by four ethnic groups with adjustments for socioeconomic factors. We completed a survey of Latino leaders to identify priorities in cancer for Latinos, a national survey of Latino primary care physicians, and the role of support groups in Latinas with breast cancer.  We are collecting data on 1600 women stratified by language and ethnicity to identify perception of risk in considering chemo prevention of breast cancer, screening of colon cancer and stopping cervical cancer screening after age 65.  These data will address this question among four ethnic groups in cancer risk communication.

Minority Aging Research.

The Center for Aging in Diverse Communities (CADC) provides infrastructure support for developing human capacity among minority investigators to conduct aging research.  CADC funds 4 to 8 pilot studies per year and these have already led to publications.  In collaboration we have also addressed the importance of race/ethnicity in research, recruitment of minority patients with cancer,,  and attitudes in interval cancer screening.  We are currently conducting an evaluation of a video medical interpretation technology for limited English-proficient patients in three clinical settings and a church-based program to promote use of adult immunizations. Pérez-Stable has hypothesized the existence of language and culture-specific factors in communication between Latinos and Whites.

Publications Relevant to MERC

1. Pérez-Stable EJ, Marín BV, Marín G, Brody DJ, Benowitz NL.  Apparent underreporting of cigarette consumption among Mexican American smokers.  Am J Public Health 1990; 80: 1057-1061.

2. Pérez-Stable EJ, Marín BV, Marín G, Katz MH.  Depressive symptoms and cigarette smoking among Latinos in San Francisco.  Am J Public Health 1990; 80 (12): 1500-1502.

3. Pérez-Stable EJ, Marín G, Marín BV, Benowitz NL.  Misclassification of smoking status by self-reported cigarette consumption. Am Rev Respir Dis 1992; 145:53-57.

4. Pérez-Stable EJ, Sabogal F, Otero-Sabogal R, Hiatt RA, McPhee SJ. Misconceptions about cancer among Latinos and Anglos. JAMA 1992; 268:3219-3223.

5. Pérez-Stable EJ, Otero-Sabogal R, Sabogal F, McPhee SJ, Hiatt RA.  Self-reported use of cancer screening tests among Latinos and Anglos. Arch Intern Med 1994; 154:1073-1081.

6. Pérez-Stable EJ, Nápoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care 1997; 35 (12): 1212-1219.

7. Pérez-Stable EJ, Marín G, Posner SF. Ethnic comparison of attitudes and beliefs about cigarette smoking. J Gen Intern Med 1998; 13:167-174.

8. Pérez-Stable EJ, Benowitz NL, Herrera B, Jacob P.  Nicotine metabolism and intake in black and white smokers.  JAMA 1998; 280:152-156.

9. Marín G, Pérez-Stable EJ.  Effectiveness of disseminating culturally appropriate smoking-cessation information: Programa Latino Para Dejar de Fumar.  Monogr Natl Cancer Inst 1995; 18:155-163.

10. Benowitz NL, Pérez-Stable EJ, Herrera B, Jacob P. Slower metabolism and reduced intake of nicotine from cigarette smoking in Chinese-Americans compared to Latinos and Whites. J Natnl Cancer Inst 2002; 94:108-115.]

11. Walsh JME, Posner SF, Pérez-Stable EJ. Colon cancer screening in the ambulatory setting. Prev Med 2002; 35: 209-218.

12. González Burchard E, Ziv E, Coyle N, Gomez SL, Tang H, Karter AJ, Mountain JL, Pérez-Stable EJ, Sheppard D, Risch N. The Importance of Race and Ethnicity in Biomedical Research and Clinical Practice. N Engl J Med 2003; 348:1170-1175.

13. Karliner LS, Pérez-Stable EJ, Gildengorin G. The language-divide: The Importance of Training in the Use of Interpreters for Outpatient Practice. J Gen Intern Med 2004: 19: 175-183.

14. Fernández A, Schillinger D, Grumbach K, Rosenthal A, Stewart AL, Wang F, Pérez-Stable EJ. Physician Language Ability and Cultural Competence: An Exploratory Study of Communication with Spanish-speaking Patients. J Gen Intern Med 2004: 19: 167-174.

15. Daniels NA, Nguyen TT, Gildengorin G, Pérez-Stable EJ. Adult immunization in university-based primary care and specialty practices. Journal of the American Geriatrics Society 2004; 52: 1007-1012.

16. Ramirez AG, Gallion KJ, Suarez L, , Giachello AL, Marti JR,  Medrano MA, Pérez-Stable EJ, Talavera GA Trapido E.  A National Agenda for Latino Cancer Prevention and Control. Cancer 2005; 203: 2209-2215.

17. Karliner LS, Kaplan CP, Juarbe T, Pasick R, Pérez-Stable EJ. Poor patient comprehension of abnormal mammography results. Journal of General Internal Medicine 2005; May; 20(5):432-437.

18. Tong EK, Ong MK, Vittinghoff E, Pérez-Stable EJ.  Missed opportunities: Clinicians should ask and advise non-daily smokers to quit, American Journal of Preventive Medicine 2006; 30: 23-30.

19. Hou CE, Yaffe K, Pérez-Stable EJ, Miller BL. Frequency of dementia etiologies in four ethnic groups. Dementia and Geriatric Cognitive Disease, 2006,;22(1):42-47. Epub 2006 May 8.

20. Nguyen TT, Daniels NA, Gildengorin G, Pérez-Stable EJ. Ethnicity, language, specialty care, and quality of diabetes care. Ethn Dis. 2007 Winter;17(1):65-71