Abstract P156: Health Literacy and Health Behaviors Associated with Racial Disparities in Blood Pressure

Abstract

Introduction: Racial disparity in cardiovascular disease has prompted efforts to improve cardiovascular outcomes through patient education and health behavior promotion. However, little is known about the long-term effects of health literacy and health behaviors on cardiovascular disease outcomes. Hypothesis: This study aims to explore whether racial differences in long-term blood pressure outcomes are associated with baseline levels of health literacy, mediated through longitudinal patterns of health behaviors. Methods: This study used a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) project, funded by NHLBI. Blood pressure was measured by trained CARDIA researchers at seven examinations between 1985 and 2005. Self-reported health behaviors (including smoking, binge drinking, overweight and sedentary lifestyle) were obtained at each examination. Cardiovascular health literacy was assessed as part of the 1990 observation. We used growth curve modeling to explore racial disparities in blood pressure and to examine if blood pressure outcomes could be explained by participants’ health literacy and their health behavior change. This study included 3,546 CARDIA study participants who remained in the most recent examination at year 2005, with 47% African Americans and 43% males. Results: Racial disparities were observed in participants’ initial blood pressure, blood pressure progression rate, health literacy and health behaviors. African Americans had higher blood pressure at baseline (systolic: 109 vs. 105; diastolic: 70 vs. 67 P<0.0001) and greater increases over time. Caucasians had a higher health literacy score (4 vs. 3.5 P<0.0001) and reported fewer risk behaviors on average. There was a positive relationship between health literacy, education attainment, parents’ education attainment, family income, having health insurance and having fewer risk behaviors. Participants with fewer risk behaviors had lower blood pressure. Blood pressure improved in years with fewer risk behaviors. Higher baseline health literacy was associated with having fewer risk behaviors in the following fifteen years. Overall, the results indicated that blood pressure outcomes were indirectly influenced by baseline health literacy through longitudinal patterns of risk behaviors. This relationship was stronger in Caucasians. Conclusions: This study suggests that racial differences in blood pressure are associated with both health literacy and health behaviors. In response to these findings, important gaps in hypertension preventive care and health behavior promotion should be identified and addressed through efforts to improve cardiovascular health literacy. For minority and high risk populations, multifaceted approaches in addition to patient education may be needed to initiate behavior change.