Date of Award

Spring 5-17-2019

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Rebecca Ellis


INTRODUCTION: Insufficient physical activity, poor diet, tobacco use, and excessive alcohol consumption are each associated with the prevalence of chronic diseases such as hypertension. However, the clustering or co-occurrence of these chronic disease risk behaviors with the prevalence of hypertension among different racial/ethnic groups has not been fully investigated. Understanding the significance of this relationship is essential for efforts in prevention, as well as the alleviation of disparities in hypertension.

AIM: To examine racial/ethnic differences in the relationship between clustered chronic disease risk behaviors and hypertension.

METHODS: Data was obtained from the 2015-2016 National Health and Nutrition Examination Survey. Only participants that identified as Hispanic American, non-Hispanic Black, and non-Hispanic White who were ≥21 years old were eligible. Odds ratios from univariate and multivariate logistic regression were applied to the data to measure the association between risk behaviors and hypertension.

RESULTS: Pearson chi-squared test showed non-Hispanic Blacks had a significantly higher prevalence of hypertension (62.9%) than Hispanic Americans (53.6%) and Non-Hispanic Whites (53.7%; P< .001). In those with hypertension, a large proportion (40.2%) presented two risk behaviors; the most frequent combination being lack of sufficient physical activity and poor diet (41.2%). After adjusting for age, poverty income ratio, education, and body mass index; increase in the number of risk behaviors presented an association with increased odds of having hypertension in all racial/ethnic groups. Hispanic Americans were found to have significantly higher odds for having hypertension with an increased number of risk behaviors (1, 2 and 3 risk behaviors). Also, non-Hispanic Blacks were found to have a considerably higher risk for hypertension with increased age and body mass index. With the exception for Non-Hispanic Whites, increased poverty income ratio was associated with decreased odds for having hypertension.

DISCUSSION: The findings of this study confirm a positive relationship between multiple risk behaviors and increased odds of having hypertension. Interventions should focus on the prevention of co-occurring risk behaviors and the promotion of healthy lifestyle choices; specifically, in non-Hispanic Blacks and Hispanic Americans to decrease racial/ethnic disparities in hypertension. In addition, to address the context in which these risk behaviors occur, efforts should incorporate social and behavioral change theories and frameworks.

Available for download on Wednesday, April 29, 2020