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.