DISSERTATION THE PREVALENENCE AND CLUSTERING OF CARDIOVASCULAR RISK FACTORS IN COLLEGE STUDENTS Submitted by
THE PREVALENCE AND CLUSTERING OF CARDIOVASCULAR RISK FACTORS IN COLLEGE STUDENTS Cardiovascular disease (CVD) has been the leading cause of death in the United States for adult men and women for the last 80 years and is a major cause of disability. Additionally, CVD is the second leading cause of death in young adults ages 18 to 29. This chronic disease is typically associated with adults; however, recently CVD has been identified in the younger population as well. The literature on CVD risk
... tors and college students is very limited. College campuses serve as an ideal setting to examine risk factors for CVD among young adults. College life can lead to multiple changes in lifestyle including changes in activity patterns, dietary intake, sleep patterns, weight fluctuations, alcohol consumption, tobacco use, and drug use. Collectively, the impact of these behaviors sets the stage for the development of multiple risk factors associated with CVD. Therefore, the purpose of this investigation was to identify the prevalence and clustering of CVD risk factors with undergraduate students' age 18 -25 years old enrolled at Colorado State University (CSU), during the spring semester, 2017. A non-experimental, cross-sectional research design was used to identify the prevalence and clustering of CVD risk factors in the sample. Multiple screenings were centrally located on campus for student convenience. The screening included informed consent, health history questionnaire, resting blood pressure, lipid analysis, and health and wellness questionnaire. iii A total of 180 students were recruited for the study. The average age was 21.40 years with a range of 18 -25 year. Over half, 62.18 percent were female, 53.75 percent were seniors, and 81.88 percent were White. Although the study was open to the entire university, 78.62 percent were from the department of Health and Exercise Science. Students from 23 different academic departments were represented in the sample. A total of 706 CVD risk factors were identified including; 208 for nicotine use, 238 with family history of CVD, 42 for high LDLs, 32 for elevated SBP, 24 for elevated DBP, 22 for inactivity, 21 for elevated triglycerides, 20 for elevated total cholesterol, 20 for elevated blood glucose, 19 for low HDLs in males, 15 for low HDLs in females, 39 for BMI ≥ 25 kg/m 2 ), 4 for increase in waist circumference for females, and 2 for an elevated waist circumference in males. The range of CVD risk factors per student was from zero to six. The significance in totality of CVD risk factors in this apparently healthy undergraduate student sample is startling and warrants further examination. Male students showed statistically significant higher glucose, TCHOL/HDL, SBP, and DBP, and were more likely to use cigarettes e-cigarettes, cigars, and smokeless tobacco, anabolic steroids and beer than females. Female students had a statistically significant higher total cholesterol level, HDL, and wine consumption than males. White students had a higher prevalence of hookah and smokeless tobacco, wine, liquor, drinking up to five drinks in one setting, driving after drinking alcohol, and consuming marijuana edibles. Freshmen had a statistically significant lower SBP than sophomores, and seniors. A statistically significant difference was found with seniors consuming more beer than freshman and sophomores. Seniors were also more likely to drive after drinking alcohol than freshman, sophomores, and juniors. Lastly, juniors had a statistically significant higher consumption of marijuana edibles than sophomores did. iv CSU undergraduate students are more likely to rank their general health as "very good" or "excellent", less likely to have a history of elevated blood pressure, more likely to use hookah, and less likely be obese when compared to undergraduate college students across the nation. Multiple correlations were identified and followed up with simultaneous multiple regressions were completed to investigate the best predictors of tobacco use, hookah use, elevated SBP, elevated DBP, BMI, and elevated total cholesterol. K-means cluster analysis provided a visual display of various groupings for family history of CVD, blood lipids and general health, blood pressure, tobacco and marijuana use, alcohol use, and general health tobacco and alcohol use combined, and drug use. Data were standardized to Z-scores for comparison. The Z-scores greater than three included cigarettes, e-cigarettes, hookah, cigars, smokeless tobacco, cocaine, methamphetamines, and other illegal drugs. Collectively, these results indicate a significant prevalence of CVD risk factors and high alcohol and drug use among the CSU student sample. It is apparent that this undergraduate college student sample may be more at risk for developing subsequent CVD than previously thought and should be screened for CVD beginning at age 20 as recommended by health and medical experts. vii love and support throughout this process. Your encouragement has touched my heart in a profound way. Lastly, I would like to recognize my daughters Erin and Lauren.