Date of Award


Document Type

Open Access Thesis


Epidemiology and Biostatistics


The Norman J. Arnold School of Public Health

First Advisor

Angela D. Liese


Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; full food security, marginal food security, low food security and very low food security. Blood pressure readings were taken at the mobile examination centers. Blood pressure was categorized into normal, pre-hypertensive and hypertensive based on the eighth Joint National Committee (JNC) guidelines. Patients were excluded from the analyses if they were below the age of 20, were pregnant, and had missing data for blood pressure, food security and body mass index (BMI). Multinomial regression was used to examine the association between food insecurity and the prevalence of hypertension and pre-hypertension. Logistic regression was then used to examine the levels of ATC among hypertensive individuals and the association with food insecurity.

Results: A total of 9,871 participants were included in the prevalence analysis after exclusion criteria were applied. An elevated odds of hypertension was observed among individuals who were food insecure (Prevalence Odds Ratio = 1.61, 95% CI: 1.31 – 1.99) compared to food secure individuals. The ATC analyses included 3,413 hypertensive individuals. There were decreased odds of having controlled blood pressure among food insecure individuals (POR = 0.80, 95% CI: 0.67-0.96) compared to food secure individuals.

Conclusion: There was an increased odds of being hypertensive among food insecure individuals when compared to normotensive individuals who were food secure. Therefore, food insecure individuals are more likely to be hypertensive and less likely to have their high blood pressure under control. Future research needs to further examine lifestyle and environmental factors to fully understand the mechanisms behind this association.


© 2018, Alexandra N. Luttrell

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