Date of Award


Degree Type

Restricted Access Dissertation

Degree Name

Doctor of Public Health

Field of Study

Clinical Research and Education: Osteopathic Manipulative Medicine


School of Public Health

First Advisor

Sejong Bae

Second Advisor

Karan Singh

Third Advisor

Kristine Lykens


Kurian, Anita K., Racial and Ethnic Differences in Cardiovasular Disease Risk Factors in U.S. Older Women: Findings from the Behavioral Risk Factor Surveillance Survey, 2003 & 2004. Doctor of Public Health (Clinical Research), August 2006, 118 pp., 55 tables, 14 illustrations, references, 69 titles. Objectives- The study sought to determine if there were any significant racial and ethnic differences in six modifiable cardiovascular disease risk factors in women aged 65 years and older. It also examined the dynamic relationships of race/ethnicity, socioeconomic status and cardiovascular risk factors. Methods- Data were extracted from the merged 2003 & 2004 Behavioral Risk Factors Surveillance Survey (BRFSS). Prevalence estimates and 95% of each of the six cardiovascular disease risk factors considered (Hypertension, Diabetes, Obesities, Hypercholesterolemia, Smoking, and No leisure-time physical activity) were calculated by race/ethnicity. Multinomial (for indicator outcomes) and multiple logistic regression analyses (for binary outcomes) were performed. Path analysis was performed to assess the complex pathways by which race/ethnicity and socioeconomic status (SES) were associated with cardiovascular disease risk factors. Results- Of the 77,492 survey respondents included in the sample, there were 68,251 whites, 4,912 blacks, 3,656 Hispanics and 673 AIANs. The odds of the cardiovascular risk factors were higher in race/ethnicity minority women (non-Hispanic black, Hispanic, American Indian Alaskan Native) compared to white women aged 65 years and older. Socioeconomic status was found to be a moderator rather than a mediator of the relationship between race/ethnicity and cardiovascular disease risk factors. The re-specified model with the behavioral risk factors (smoking and no leisure-time physical activity) as mediators was deemed a good fit to the data. Age, race/ethnicity, SES, smoking and leisure-time physical activity were found to have significant direct, indirect and total effects on cardiovascular disease risk factors. Conclusions- There is a need to find better ways to measure race/ethnicity, and future research should consider the impact of more fundamental determinants of CVD risk factors. Area-based measures, such as neighborhood conditions, should also be given consideration for influencing these risk factors. Identification of potential mediating and moderating factors in these pathways (for example, sense of personal control or social support) will help clinicians and public health professionals to develop culturally sensitive intervention or prevention programs specifically targeted toward risk burdens in each of these populations.