Date of Award

Summer 8-7-2012

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Solomon I. Okosun

Second Advisor

Dr. Richard Rothenberg


Background: Recently across the United States, chronic diseases have been becoming more prevalent and compliance rates to recommendations have been declining. Non-adherence to health professionals recommendations creates a greater risk of complications for the patient.

Objective: The objective of this study is to discover which populations have the highest prevalence of chronic disease and compare adherence to physicians’ recommendations throughout those populations. If a physician tells a patient to complete a certain behavioral change to improve health, a physician would assume that the adherence level should be nearly 100%, but it is clear adherence levels do not reach those levels. Different demographic factors play a role in adherence: gender, age, race, socioeconomic status, education status, marital status, medical insurance coverage, and comorbidity of chronic diseases.

Methods: The 2007-2008 National Health and Nutrition Examination Survey (NHANES), a secondary data source, was used for data collection. The total number of people who participated in the 2007-2008 NHANES study was 5,687. Data analysis was performed with the statistical software program SPSS 19.0. A number of descriptive analyses, cross tabulations, correlations, and binary logistic regression were used to conduct a univariate and multivariate analysis of the subjects. The chronic diseases chosen to assess were hypercholesterolemia, hypertension, and diabetes. The different recommendations were made to all the patients included: eating less fat, control weight, increase exercise, and take a prescription medication for each specific condition

Results: The 5,687 participants were included in the study. The prevalence of hypertension was 21.2%, hypercholesterolemia was 19.3%, and diabetes was 8.7% among those who were surveyed. Among those who were told to eat less fat, control weight, increase exercise and take prescription to control their chronic disease condition, adherence levels ranged greatly. The significance of a physician recommending a behavioral change had the biggest impact on whether a patient would adhere. No significance was seen between any of the demographic variables except for marital status for those who were told to take a prescription to control hypercholesterolemia.

Discussion: The study has proven physician recommendations to control chronic disease are usually to take a medication. An individual’s demographics have a small impact on whether he or she will adhere to the advice of the physician. Additional research needs to be completed to understand the patient to physician relationship, which seems to have the biggest impact on behavioral change. Furthermore, new interventions are needed to increase adherence to 100%. Increasing chronic disease adherence across the United States will result in decrease spending in health care costs in the United States.