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Title:Health management of adult hypertension in the United States: results from the National Health and Nutrition Examination Survey (NHANES)
Author(s):Kim, Hyun
Director of Research:Andrade, Flavia
Doctoral Committee Chair(s):Andrade, Flavia
Doctoral Committee Member(s):Alston, Reginald; Chodzko-Zajko, Wojtek; Powers, Elizabeth
Department / Program:Kinesiology & Community Health
Discipline:Community Health
Degree Granting Institution:University of Illinois at Urbana-Champaign
Degree:Ph.D.
Genre:Dissertation
Subject(s):Hypertension
Health Behaviors
National Health and Nutrition Examination Survey (NHANES)
Abstract:This research is a comprehensive study that describes how individuals with hypertension do their health behaviors and how their behaviors change over time based on their diagnostic status and the duration of hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is a widely used dietary recommendation for individuals with hypertension. Even though adherence to the DASH diet has been shown to be effective, it is unclear whether hypertension diagnosis has an impact on adherence to the DASH diet and nutrient intake. This study examined the association between hypertension diagnosis and the nutrient intake using the seemingly unrelated regression (SUR) method. The data came from the 2007-2008, 2009-2010 and 2011-2012 cross-sectional National Health and Nutrition Examination Survey (NHANES) which is a sample of the civilian, non-institutionalized adult population in the United States. The outcome was accordance with the DASH recommended intake of nine nutrients (0 to 9 point DASH score). Study findings indicated that, regardless of diagnostic status, individuals with hypertension did not seem to follow the DASH guidelines. Compared to undiagnosed individuals, individuals diagnosed with hypertension were less likely to adhere to the DASH guidelines with higher intake of cholesterol. Individuals both diagnosed and undiagnosed with hypertension showed no difference in their nutrient intake to control their blood pressure, but those diagnosed with hypertension had significantly higher intake of cholesterol than those not diagnosed. Overall, regardless of diagnostic status, individuals with hypertension did not seem to follow the DASH guidelines. The DASH diet is a widely used dietary recommendation for individuals with hypertension. This study examined how age at hypertension diagnosis and time since its diagnosis were associated with the DASH nutrient intake. The data came from the 2007-2008, 2009-2010 and 2011-2012 cross-sectional National Health and Nutrition Examination Survey (NHANES). Seemingly unrelated regression (SUR) method was used to estimate adherence to the DASH diet by age at hypertension diagnosis and time since diagnosis. The outcome was accordance with the DASH recommended intake of nine nutrients (0 to 9 point DASH score). Age at diagnosis of hypertension was significantly associated with the DASH nutrients. Older age at diagnosis was associated with significant decreases in intake of sodium, cholesterol, saturated fat, total fat, protein, calcium and magnesium and increased intake of fiber. Similarly, duration of hypertension was positively associated with intake of sodium, cholesterol, saturated fat, total fat, protein, calcium and magnesium, and individuals with shorter duration were likely to have lower DASH score and less satisfied the DASH target score of 4.5 points. Despite the study findings that individuals with hypertension improved their diet a little with increased duration of disease, their diet was not still accordant to the DASH diet based on age at diagnosis and its duration. In order to achieve it and deliver more tailored educational messages, it is important to first understand what barriers individuals with hypertension have to engage in healthy diet. Regular physical activity, smoking cessation, and moderate alcohol consumption are important lifestyle behaviors that can be adopted to manage hypertension. Our goal was to determine the effect of a hypertension diagnosis among individuals with hypertension on their lifestyle behaviors. Data came from the three repeated cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES) in 2007-2008, 2009-2010 and 2011-2012. Lifestyle behaviors in the analysis included smoking status, alcohol consumption, and physical activity. Multinomial logistic regression models were used to estimate the relative risk (RR) of adopting adequate lifestyle behaviors. A diagnosis of hypertension was positively associated with an individual’s past smoking status, but it was not significantly associated with current smoking status. Among individuals with hypertension, a diagnosis of hypertension was not significantly associated with physical activity status. Individuals with diagnosed hypertension were more likely to quit smoking than those with undiagnosed condition, but they tended not to engage in physical activity. The prevalence of current unhealthy lifestyle behaviors is an important predictor of the future burden of these-related diseases such as hypertension and cardiovascular diseases, so a variety of risk factors, many of which are modifiable, play an interactive role in the development of hypertension. Health professionals will be able to help individuals with or at risk for hypertension to adopt long-term healthier lifestyle behaviors through initial directions and guidance about proper management and prevention of other health complications, because behavioral modifications can be the most important for primary and secondary prevention of hypertension.
Issue Date:2016-07-13
Type:Thesis
URI:http://hdl.handle.net/2142/92940
Rights Information:Copyright 2016 Hyun Kim
Date Available in IDEALS:2016-11-10
Date Deposited:2016-08


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