Self-reported Cardiovascular Risk Factors Research Articles

Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups.

Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.

Self-Reported Cardiovascular Risk Factors among Medical Students

Cardiovascular diseases are the leading cause of death in the world, with smoking, diabetes, high blood pressure, dyslipidemia and a sedentary lifestyle being among the main risk factors. The objective of this study was to evaluate the self knowledge about cardiovascular risk factors among medical students. Methodology: Observational and cross-sectional study on students from the first to the eighth semester of medicine using anonymous questionnaires containing questions about cardiovascular risk factors. Results: A total of 288 students paticipeted. There was a higher percentage of self-declared emotional stress (p<0.001), and high blood pressure (p=0.007), family history of coronary heart disease (CAD) or stroke (0.049) in the female group; The group under 20 years old practiced more physical activity (p=0.023) and reported a balanced diet (p=0.047), the age group between 20 and 29 years old reported a higher percentage of smoking (p=0.001) and alcohol consumption (p=0.048), those older than 30 years old reported a higher knowledge about family history of CAD or stroke.

Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study.

BackgroundThere are currently more than 200 million smartphones in Brazil. The potential of mobile technologies for favorable changes in health behavior such as physical activity has been previously described in the literature. Results of surveys in developed countries indicate that applications (APPs) are developed for people who are better educated, younger, and with higher incomes compared to non-users. However, the profile of users in developing countries like Brazil is not well-known. Understanding the profile of APP users might ease the development turned to physically inactive people and those at higher cardiovascular risk. Furthermore, the physiological and functional factors associated with the use of such APP are unknown.ObjectivesTo characterize the profile of APP users to monitor the physical activity level (PAL) and assess the demographic, socioeconomic, clinical, physiological, and functional characteristics associated with the use of smartphone APPs to monitor physical activity in Brazilian adults.MethodsWe assessed 176 asymptomatic men and 178 women (43 ± 12 years; 27 ± 5 kg/m2). We initially asked participants about their current use of a smartphone APP containing PAL monitoring functionality, such as exercise session logs and/or step counts. In a cross-sectional design, we investigated schooling, socioeconomic status (Critério Brasil), and classic self-reported cardiovascular risk factors. We evaluated several physiological and functional variables such as maximum O2 consumption on a treadmill (VO2 max), blood pressure, body composition (bioelectrical impedance), handgrip strength, and isokinetic muscle strength of the dominant lower limb. Participants used a triaxial accelerometer for 7 days to quantify daily physical activity. We also assessed health-related quality of life (WHOQOL BREF), perceived stress (PSS14 Scale), and the built environment (NEWS Scale). We compared continuous variables using the Student's t-test and categorical variables using the χ2 test, between APP users and non-users. After univariate analysis, we included the main variables associated with the use of APP in a multiple logistic regression model.ResultsOne hundred and two participants (28.3%), unrelated to gender, reported using a smartphone APP for physical activity at the time of assessment. Except for perceived stress and the built environment that were not associated with the use of APP, users of APP were younger and had higher education, lower cardiovascular risk, better socioeconomic status, a better quality of life, better cardiorespiratory function, better body composition, greater physical fitness and more moderate to vigorous physical activity in daily life. The results of the multiple logistic regression showed that age, hypertension, VO2 max, socioeconomic status (Critério Brasil), and quality of life (WHOQOL BREF total score) were the variables most significantly associated with the use of the APP.ConclusionsOur results indicate that smartphone APPs to monitor physical activity are developed for younger adults with better socioeconomic status, lower cardiovascular risk, higher quality of life, and greater cardiorespiratory fitness. Greater efforts are needed to develop a science-based APP for people who most need this technology, enabling greater potential to prevent undesirable health outcomes in asymptomatic adults.

Cardiovascular Risk Factor and Disease Measures from the Population Assessment of Tobacco and Health (PATH) Study.

Background: Cardiovascular disease is a key health condition associated with tobacco use; however, clinical measures are not typically possible in population-based studies. In this paper, we assess the reliability and validity of self-reported cardiovascular risk factors and diseases in a large nationally representative study of tobacco use and health outcomes. Methods: This paper analyzes self-reported cardiovascular risk factors and disease among adults age 40 years and older based on U.S. nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study. Prevalence of cardiovascular risk factors (self-reported high blood pressure, high cholesterol, diabetes and family history of premature heart disease, BMI ≥ 35, and tobacco use) and cardiovascular disease (self-reported heart attack, stroke and/or congestive heart failure (CHF)) were considered along with ratings of physical functioning, fatigue, and general health. Results: Self-reported cardiovascular disease was found to be associated with functional health measures (walking up a flight of stairs) and general ratings of health. Prospective analyses found strong correlations between sequential data collection waves for history of hypertension, elevated cholesterol and CHF, while more modest correlations were noted for stroke and heart attack. The overall prevalence of cardiovascular disease and hypertension was comparable to those from the National Health and Nutrition Examination Survey (NHANES). Conclusions: These analyses suggest reliability and concurrent validity regarding self-reported cardiovascular risk factors and disease assessed in the PATH Study.

Feasibility and Utility of a Cardiovascular Risk Screening Tool in Women Undergoing Routine Gynecology Evaluation

The goals of this multicenter survey were to examine the prevalence and patient awareness of cardiovascular risk factors, and the association between history of adverse pregnancy outcomes (APO—including gestational hypertension, gestational diabetes, and preeclampsia) and prevalence of cardiovascular risks among women presenting to outpatient obstetrics/gynecology (OB/GYN) clinics. We surveyed 2,946 female patients attending 16 outpatient OB/GYN clinics across the United States between January 2010 and January 2012. Main outcome measures were self-reported cardiovascular risk factors and symptoms such as angina and dyspnea. Mean age of the patients was 51 ± 13.6 years. Cardiovascular risks and symptoms were highly prevalent (86.0% and 40.1%, respectively). Many patients did not know if they had common risk factors such as hypertension, hypercholesterolemia, or diabetes (18.4%, 32.0%, and 17.9%, respectively). Women with a history of APO were slightly more likely to be aware of common risk factors, including abnormal blood pressure (17% vs. 18.6%), high cholesterol (31.7% vs. 32%), and obesity/elevated body mass index (43.9% vs. 49.7%). Compared with patients with no history of APO, patients with APO (n = 380, 12.9%) were more likely to have risk factors (89.5% vs. 83.9%, p = 0.002) and symptoms (45.5% vs. 39.3%, p = 0.02). Awareness of cardiovascular risk factors and symptoms among all women surveyed in this study was poor, although awareness for some risk factors was relatively higher among patients with APO. This study demonstrates the feasibility of cardiovascular assessment in OB/GYN clinics using a simple questionnaire and its potential role for early recognition and timely intervention.

Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

ObjectiveTo describe social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain. MethodWe used data from 20,406 individuals aged 18 or older from the 2017 Spanish National Health Survey. We measured socioeconomic position using occupational social class and used data on self-reported cardiovascular risk factors: high cholesterol, diabetes, hypertension, obesity, and smoking. We estimated the relative risk of inequality using Poisson regression models. Analyses were stratified by men and women and by region (autonomous communities). ResultsOverall, the relative risk of inequality was 1.02, 1.13, 1.06, 1.17 and 1.09 for high cholesterol, diabetes, hypertension, obesity, and current smoking, respectively. Ocuupational social class inequities in diabetes, hypertension, and obesity was stronger for women. Results showed a large regional heterogeneity in these inequities; some regions (e.g. Asturias and Balearic Islands) presented wider social inequities in cardiovascular risk factors than others (e.g. Galicia, Navarra or Murcia). ConclusionIn Spain, we found marked social inequities in the prevalence of cardiovascular risk factors, with wide regional and women/men heterogeneity in these inequities. Education, social, economic and health policies at the regional level could reduce health inequities in cardiovascular risk factors and, thus, prevent cardiovascular disease.

Association between sex hormones and ambulatory blood pressure.

Higher levels of total testosterone and lower levels of sex hormone-binding globulin (SHBG) have been associated with increased blood pressure (BP) in women with an inverse association between total testosterone and BP among men. Fewer studies have examined associations with 24-h ambulatory blood pressure (ABP), blunted nocturnal BP decline or the role of dehydroepiandrosterone sulfate (DHEAS), a precursor to androgens. Baseline blood samples were assayed for 229 normotensive men (≥50 years) and women (≥55 years) participating in the VITamin D and OmegA-3 TriaL. Standardized seated BP (SBP and DBP) and 24-h ABP were measured by trained technicians. Self-reported cardiovascular risk factors and sociodemographic variables were reported on baseline questionnaires. Sex stratified linear regression models adjusted for age, race/ethnicity, BMI, smoking and alcohol estimated the association between each sex hormone and measures of BP and 24-h ABP. Logistic regression used to estimate associations with blunted nocturnal decline (>10% reduction in SBP or DBP during sleeping hours). Total testosterone and SHBG demonstrated significant inverse correlations with SBP whereas DHEAS was not significantly associated with BP. Among men, in multivariable analyses, each 10% increase in DHEAS was associated with a 0.41 mmHg higher seated DBP (β = 4.29, 95% CI 0.84-7.73) and each 10% increase in total testosterone and SHBG was associated with a 0.54 mmHg (β = -5.65, 95% CI -10.45 to -0.84) and 0.60 mmHg (β = -6.30, 95% CI -11.38 to -1.21) decrease in seated DBP, respectively. No significant associations were observed among women. Among men only, we observed statistically significant inverse cross-sectional associations between total testosterone and SHBG with seated DBP, and a significant positive association with DHEAS levels.

Validity of Self-Report of Cardiovascular Risk Factors in a Population at High Risk for Stroke

Screening for vascular risk factors is commonly assessed through self-report, despite reports of low sensitivity using this approach in healthy populations. The validity of self-reported vascular risk factors in a population at high risk for stroke has yet to be explored. This study investigated the validity of self-reported cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, and type II diabetes mellitus) in a population of patients with a recent history of high-risk transient ischemic attack or minor stroke. Data were extracted from patient questionnaire responses and medical records (n = 101). Agreement between self-report and clinical measures (blood pressure, fasting blood glucose, lipid profile, and active medications) was assessed using estimates of sensitivity, specificity, and positive and negative predictive values for each vascular risk factor. Forty-nine percent of the study population inaccurately self-reported at least 1 vascular risk factor. Sensitivities of self-report for hypertension, hypercholesterolemia, and diabetes were 84.5% (confidence interval [CI]: 72.1-92.2), 57.5% (CI: 44.1-69.7), and 77.8% (CI: 57.3-90.6), respectively, while specificities were 76.7% (CI: 61.0-87.7), 83.3% (CI: 67.3-93.2), and 95.4% (CI: 87.8-98.9), respectively. Accuracy of self-report for hypercholesterolemia was significantly lower than that for diabetes (P < .001) and hypertension (P < .05), with 42.6% of those with high cholesterol under-reporting their diagnosis. Logistic regression revealed that odds of accurate self-report were greater among younger adults and males. These results highlight the need for clinicians, scientists, and epidemiologists to be cautious when screening for vascular risk factors using self-report measures as cross validation against objectives measures reveals poor sensitivity. Our results also highlight a lack of public education concerning these significant conditions.

Public knowledge of heart attack symptoms and prevalence of self-reported cardiovascular risk factors in Ilorin, Nigeria

Background and objectives: Despite reduction in door-to-balloon time in the management of acute myocardial infarction (AMI), prehospital delay by the patients has remained a major concern as benefits derivable from reperfusion treatments are time dependent. This study aimed at evaluating knowledge and perception of warning signs of heart attack among civil servants in Ilorin, Nigeria. Materials and Methods: A pretested structured questionnaire was designed to obtain relevant information on knowledge and perception of heart attack symptoms; and action to be taken if one experiences the condition. Results: Questionnaires from 601 subjects consisting of 312 (51.9%) males and 289 (48.1%) females were analyzed. Although, 78% of the respondents have heard about heart attack, only 44.4% could discriminate a heart attack symptom from other conditions. Higher proportion of women (50.2%) than men (39.1%) could identify a core symptom of heart attack (P 0.05). Higher percentage of women reported prior cardiovascular disease/risk factors than men. Conclusion: We concluded that participants have low knowledge of heart attack symptoms with women being more knowledgeable than their male counterparts. There is the need for community education on heart attack warning signs and the need for early hospital presentation by affected individuals.

Prevalence of Self-reported Cardiovascular Risk Factors among Saudi Physicians: A Comparative Study.

Cardiovascular disease (CVD) is a leading cause of death worldwide. CVD-related mortality can be substantially reduced by modifying risk factors. In this cross-sectional study conducted in King Abdulaziz Medical City, Riyadh, we estimated and compared prevalence of self-reported risk factors for CVD among physicians and a comparative group of non-physician health workers. We postulated that prevalence of CVD risk factors would be significantly lower in physicians. Participants filled in a structured self-administered questionnaire on CVD risk factors. The study included 200 participants (100 respondents each group). Participants in the two groups were of similar age (P = 0.46) and Body Mass Index (BMI) P = 0.11. There was no statistical difference in smoking, frequency and length of physical exercise per week (P = 0.53, 0.57, 0.47 respectively). Diet habits showed daily intake of more protein, less fat and highly processed food, and similar vegetables, fruit and carbohydrate among physicians. Health status (presence of hypertension, diabetes, or dyslipidemia, or other diseases) didn't differ between the two groups. Physicians showed a significantly higher familial cardiovascular risk, with mothers and siblings having more dyslipidemia, but there was no significant difference in parental dyslipidemia, diabetes or hypertension. These findings indicate that high awareness of CVD and associated risk factors alone is not enough to prevent their occurrence. Programs to routinely screen these risk factors and improve the lifestyle of physicians are needed.

Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery

To estimate the pre-pregnancy prevalence of overweight/obesity, smoking, hypertension, dyslipidemia and diabetes mellitus, in women who delivered a live born. In a birth cohort study, puerperae were consecutively recruited at five public maternities of Porto, Portugal (2005–2006). We included 7,381 women with complete data for the current analysis. Socioeconomic characteristics, smoking habits, pre-pregnancy weight and chronic diseases diagnosis were self-reported and height was measured. Before pregnancy, 21.3% of women were overweight and 8.8% were obese, 26.6% smoked and 11.2% were former smokers. The prevalence of hypertension, dyslipidemia and diabetes mellitus was 1.7, 1.7 and 0.6%, respectively, with an evident tendency to cluster. The prevalence of all cardiovascular risk factors, except smoking, increased with age and body mass index. Education and income were inversely associated with excessive weight. Current smokers were younger, thinner and in a lower socioeconomic position, whereas former smokers were older and in a higher socioeconomic position. Despite the low prevalence of hypertension, dyslipidemia and diabetes, their tendency to cluster and the increased prevalence among overweight/obese women highlight the high level of risk of this young female population.

Self‐Reported Cardiovascular Risk Factors in Immigrants and Swiss Nationals

The purpose of this study was to investigate whether the prevalence of self-reported cardiovascular risk factors differs between immigrants and Swiss nationals. This study is a secondary data analysis of the Swiss Health Survey 2002, a cross-sectional survey. In total, 19,249 individuals living in Switzerland were included. The prevalence of hypertension, high cholesterol level, smoking, diabetes, overweight, low fruit and vegetable intake, and physical inactivity were calculated for major immigrant groups and Swiss nationals. Demographic data were used to control for age and socioeconomic status. Major immigrant groups were people from Italy, Germany, former Yugoslavia, Spain, Portugal, France, and Turkey. Compared with Swiss women, women from former Yugoslavia were more likely to have hypertension, and women from Germany were more likely to have high cholesterol levels. Women from Italy, former Yugoslavia, Spain, Portugal, and Turkey were more likely to show physical inactivity and (except Turkish women) to be overweight. Men from these countries (except Spanish men) were more likely to be overweight than Swiss men. Differences exist in the prevalence of modifiable cardiovascular risk factors between Swiss nationals and many of the immigrant groups. Age and socioeconomic status could only partly explain the differences.

Trends from 1995 to 2006 in the prevalence of self-reported cardiovascular risk factors among elderly Spanish diabetics

In this study, we examined the trends from 1995 to 2006 in cardiovascular risk factors (CVRF) in Spaniards aged 65 years or older with diabetes. We looked at the individual data from adults aged > or =65 years from the Spanish National Health Surveys of 1995 (n=1117), 1997 (n=1111), 2001 (n=4328), 2003 (n=6134) and 2006 (n=7835). Those classified as having diabetes had answered the two following questions in the affirmative: Has your doctor told you that you currently have diabetes? Have you taken any medication to treat diabetes in the last two weeks? The CVRF of interest included high blood pressure (HBP), high cholesterol levels, obesity (BMI > or =30 kg/m(2)), smoking and sedentarity, which were estimated and compared for prevalence by survey year, age group and gender. Progression over time was analyzed using logistic-regression models. During the study period, the prevalences of all of the CVRF of interest were significantly higher among the elderly with diabetes compared with those without diabetes, except for current smoking, which was less frequent. The percentages of diabetic patients with HBP and obesity increased from 49.6 and 17.1%, respectively, in 1995 to 64 and 30.6%, respectively, in 2006 (adjusted ORs: 1.95 for HBP; 2.22 for obesity). Overall, the self-reported prevalence of CVRF among elderly patients with diabetes did not improve during 1995-2006 but, instead, showed significant increases in self-reported obesity and HBP. This lack of improvement calls for further investigations, and the dedicated attention of both healthcare providers and the diabetic patients themselves.

Self-Reported and Clinical Measurement of Three Chronic Disease Risks among Low-Income Women in West Virginia

This study assessed the validity of several self-reported cardiovascular risk factors among low-income women aged 40-64 years in West Virginia. A cross-sectional survey was conducted of 733 women participating in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to examine agreement between self-report and clinical screenings in the prevalence of risk factors related to coronary heart disease (CHD). Women participating in the study were interviewed face-to-face before administration of clinical screenings that assessed height, weight, Quetelet's index, high blood pressure (systolic > or =140 mm Hg or diastolic > or =90 mm Hg), and elevated total cholesterol concentrations (> or =200 mg/dL and > or =240 mg/dL). The overall results showed high sensitivity and specificity for each of the risk factors examined; for overweight/obesity, the sensitivity was 96% and specificity was 93%; for cholesterol > or =240 mg/dL, sensitivity was 85% and specificity was 67%; for hypertension, sensitivity was 77% and specificity was 86%. Using a threshold value of > or =240 mg/dL for hypercholesterolemia led to higher sensitivity but a lower specificity than for a value of > or =200 mg/dL. This study found that among low-income women at higher risk for cardiovascular disease (CVD), self-reported values for high body mass index (BMI), hypercholesterolemia, and hypertension were well correlated with clinical measures, as indicated by high sensitivity values. Thus, self-reported values can be used for surveillance, targeted screenings, and health promotion activities, including lifestyle changes.

Fruit and vegetable intake and serum cholesterol levels: a cross-sectional study in the Diet, Cancer and Health cohort

SummaryThe aim of this study was to investigate, in a cross-sectional study, whether the intake of fruits and vegetables was associated with lower serum cholesterol levels. The groupings of interest for this study were apples, other fruits, and vegetables. A cross-sectional study was conducted among 42,972 men and women included in the Diet, Cancer and Health cohort (1993 – 1997). This population excluded persons with self-reported cardiovascular risk factors, in order to ensure a “heart-healthy” population. Among men, both apple and vegetable intake was found to be associated with significantly lower serum cholesterol levels. An increase in apple intake of 50 g d−1 was associated with a 0.04 mmol l−1 lower serum cholesterol level. Furthermore, analyses combining vegetable and alcohol intake showed lower serum cholesterol levels in men with a low alcohol intake (≤ 10 g d−1). For women, the same pattern was seen for apples and vegetables, albeit to a lesser extent for apples. Analyses combining vegetable intake and waist circumference measurements showed that women with a smaller waist circumference had lower levels of serum cholesterol. Our findings thus provide some support for previous inverse associations found between higher apple intake and lower serum cholesterol levels.

1385 Health disparities? Comparing prevalence of self-reported cardiovascular risk factors between immigrants and Swiss nationals

1385 Health disparities? Comparing prevalence of self-reported cardiovascular risk factors between immigrants and Swiss nationals

A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients [ISRCTN61739603

BackgroundFamily physicians can play an important role in encouraging patients to participate in community-based health promotion initiatives designed to supplement and enhance their in-office care. Our objectives were to determine effective approaches to invite older family practice patients to attend cardiovascular health awareness sessions in community pharmacies, and to assess the feasibility and acceptability of a program incorporating invitation by physicians and feedback to physicians.MethodsWe conducted a prospective randomized trial with 1 family physician practice and 5 community pharmacies in Dundas, Ontario. Regular patients 65 years or older (n = 235) were randomly allocated to invitation by mail or telephone to attend pharmacy cardiovascular health awareness sessions led by volunteer peer health educators. A health record review captured blood pressure status, monitoring and control. At the sessions, volunteers helped patients to measure blood pressure using in-store machines and a validated portable device (BPM-100), and recorded blood pressure readings and self-reported cardiovascular risk factors. We compared attendance rates in the mail and telephone invitation groups and explored factors potentially associated with attendance.ResultsThe 119 patients invited by mail and 116 patients contacted by telephone had a mean age of 75.7 (SD, 6.4) years and 46.8% were male. Overall, 58.3% (137/235) of invitees attended a pharmacy cardiovascular health awareness session. Patients invited by telephone were more likely to attend than those invited by mail (72.3% vs. 44.0%, OR 3.3; 95%CI 1.9–5.7; p < 0.001).ConclusionWhile the attendance in response to a telephone invitation was higher, response to a single letter was substantial. Attendance rates indicated considerable interest in community-based cardiovascular health promotion activities. A large-scale trial of a pharmacy cardiovascular health awareness program for older primary care patients is feasible.

Cardiovascular risk factors and socioeconomic status in African American and Caucasian women.

Self-reported cardiovascular risk factors of obesity, physical inactivity, and smoking in African American and Caucasian women in North Carolina were compared, controlling for socioeconomic status (SES). Participants were 1,945 women aged 23 to 53 years; 20.1% African American and 79.9% Caucasian. Of the African American women, 38.8% were obese, 51.7% were inactive, and 31.2% smoked; of the Caucasians, 19.9% were obese, 31.2% were inactive, and 33.8% smoked. SES differed significantly by race (p < .001). Low and middle SES African American women were much more likely than high SES African Americans to be obese, inactive, and smokers. Among Caucasian women, those with low SES had the greatest prevalence for all three risk factors. After controlling for income and education, African American women were more than twice as likely as Caucasian women to be obese and to be inactive, but were only half as likely to smoke.