Fruits and vegetables intake and physical activity among hypertensive adults in the United States: behavioral risk factor surveillance system, 2003 and 2007

Association of hypertension-related distress with lack of self-care among hypertensive patients

Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.

Reporting of adherence to healthy lifestyle behaviors among hypertensive adults in the 50 states and the District of Columbia, 2013

Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to five healthy lifestyle behaviors related to hypertension management: having a "normal" weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all five healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all five healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all five healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography.

Prevalence of taking actions to control blood pressure among adults with self-reported hypertension in 18 states and the District of Columbia, 2009

The authors used 2009 Behavioral Risk Factor Surveillance System data to assess the prevalence of taking actions to control hypertension among adults with self-reported hypertension. Differences by descriptive characteristics (sex, age, race/ethnicity, access to health care, medication adherence), presence of other health risk factors (overweight/obesity, smoking, heavy drinking, inadequate fruit/vegetable intake, and physical inactivity), and comorbidities (diabetes, high cholesterol, coronary heart disease, and stroke) were compared. The prevalence of hypertension was 29.6%, and 75.0% of these patients reported taking antihypertensive medications, 73.1% changed eating habits, 72.8% decreased the use of salt, 78.8% reduced alcohol consumption, and 69.9% increased their physical activity. Overall, 87.2% reported taking two or more actions to reduce blood pressure. Patients taking antihypertensive medications were more likely to take two or more actions than their counterparts (90.6% vs 79.4%, P<.01). Those with at least one other health risk factor were 1.85 times as likely to take two or more actions as their counterparts (95% confidence interval, 1.18-2.92 times). More than 80% of hypertensive adults reported taking two or more actions to control blood pressure. The prevalence of taking actions differed significantly by descriptive characteristics, the presence health risk factors, and comorbidities.

Evaluation of a worksite wellness program designed to reduce cardiovascular risks

We evaluated a multifactorial worksite wellness program designed to improve lifestyle and reduce cardiovascular risks at a small professional services company. Program participation (N = 60 employees) consisted of an enrollment session, a 6-month period of wellness program activities, and a disenrollment session. Lifestyle and biometric measures were obtained at enrollment and disenrollment. Over 6-months, percentage of dietary fat intake decreased (P < .01); daily fruit and vegetable servings and fiber intake increased (P = .02); systolic and diastolic blood pressure decreased (P = .04 and 0.01, respectively), and high-density lipoprotein increased (P < .01). This worksite wellness program achieved meaningful improvements in dietary intake and reduction in cardiovascular risks.

Relationship between employment characteristics and obesity among employed U.S. adults

PURPOSE

This study examined associations between employment characteristics and obesity among a sample representing civilian noninstitutionalized U.S. adults.

DESIGN

Quantitative, cross-sectional study.

SETTING

Workplace.

SUBJECTS

The 2010 National Health Interview Survey data for 15,121 employed adults (≥18 years).

MEASURES

The outcome variable was weight status, and exposure variables were employment characteristics (number of employees, work hours, paid by the hour, paid sick leave, and health insurance offered).

ANALYSIS

Multivariate logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for employment characteristics associated with obesity (body mass index [BMI] ≥ 30 kg/m(2)) after controlling for age, sex, race/ethnicity, education, family income, fruit/vegetable intake, physical activity, smoking, and occupations.

RESULTS

Nationwide, 28% of employed adults were obese. From multivariate logistic regression, the odds of being obese was significantly greater among adults who worked at a company with 100 to 499 employees (OR = 1.19, 95% CI = 1.02-1.39) vs. with 1 to 24 employees and those who worked >50 hours/week (OR  = 1.32, 95% CI  = 1.05-1.65) vs. <30 hours/week.

CONCLUSION

Approximately 3 out of 10 employees were obese and 6 out of 10 were overweight or obese. A better understanding of why these employment characteristics are associated with obesity could help employers better develop and target interventions for obesity prevention and treatment in the worksites.

Physicians' health habits are associated with lifestyle counseling for hypertensive patients

BACKGROUND

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians' personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines.

METHODS

One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues.

RESULTS

The respondents' average age was 45.3 years, and 68% were male. In regards to physician behavior, 4.0% smoked at least once a week, 38.6% ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (92.2%), or cut down on salt (96.1%), or attain or maintain a healthy weight (94.8%), or limit the use of alcohol (75.4%), or be physically active (94.4%). Collectively, 66.5% made all 5 lifestyle modification recommendations. Nonsmoking physicians were more likely to recommend each lifestyle intervention to their hypertensive patients. Those who exercised at least 1 day per week were more likely to recommend limiting alcohol use.

CONCLUSIONS

The probability of recommending all 5 JNC VII interventions was greater for physicians who were nonsmoking and who exercised at least 1 day a week.