Abstract P516: Multilevel Factors Are Related to Blood Pressure in Native Hawaiian Communities

The association between blood pressure and cardiovascular disease events (e.g., stroke, heart attack) is continuous, consistent, and independent. Hypertension prevalence is 55% among Native Hawaiians, the indigenous people of Hawai‘i, compared to 23% among Whites. Native Hawaiians have high rates of physical inactivity and poor diet. Discrimination and acculturation have been associated with blood pressure in Native Hawaiians. Household characteristics (e.g., food insecurity) have been linked to hypertension in Hawai‘i. Areas with high proportions of Native Hawaiians have more fast-food outlets. Limited research has been done to examine how multilevel factors impact blood pressure in this high-risk population. The purpose of this study was to examine the contribution of individual-level behavioral, biological, psychosocial; household-level; and community-level factors in explaining variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Adult participants (n=150) were recruited from 6 predominantly Native Hawaiian communities across Hawai‘i. Height, weight, and blood pressure were measured using standardized protocols. Behavioral factors included consumption of foods measured by the NCI dietary screener questionnaire and physical activity category and sedentary time measured by the International Physical Activity Questionnaire. Psychosocial factors included cultural identity and perceived discrimination. Household factors included size, financial stability, and food insecurity. Community factors included neighborhood walkability. Sociodemographic factors were also assessed. Four multilevel models for SBP and DBP were developed. The level-1 model for both SBP and DBP included sociodemographic factors. The level-2 model for both SBP and DBP adds behavioral factors (e.g., BMI, physical activity, daily intake of diet components). The level-3 model adds financial stability, food insecurity for SBP and cultural identity and discrimination for DBP. The level-4 model adds walkability for SBP and financial stability, food insecurity, and family use of free school lunches for DBP. For SBP and DBP models, Akaike’s Information Criterion (AIC) decreased from 740.9 and 663.2 to 529.5 and 515.8, respectively, and Bayesian Information Criterion (BIC) decreased from 740.4 and 663.0 to 529.3 and 514.4, respectively. For SBP, each successive model produced a lower AIC and BIC, indicating that the inclusion of behavioral, household, and community factors improved the models’ ability to predict SBP. Similarly, for DBP, the inclusion of behavioral, psychosocial, and household-level factors improved the model's ability to predict DBP. These results illustrate the importance of including multilevel factors in research to understand and address hypertension and cardiovascular disease in Native Hawaiian communities.