Self-Reported Receipt of Advice and Action Taken To Reduce Dietary Sodium Among Adults With and Without Hypertension — Nine States and Puerto Rico, 2015

Weekly / February 23, 2018 / 67(7);225–229

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Please note: An erratum has been published for this report. To view the erratum, please click here.

Puthiery Va, DO1,2; Cecily Luncheon, MD, DrPH2; Angela M. Thompson-Paul, PhD2; Jing Fang, MD2; Robert Merritt, MS2; Mary E. Cogswell, DrPH2 (View author affiliations)

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Summary

What is already known about this topic?

Hypertension is a major cardiovascular disease risk factor for which sodium reduction can be beneficial. Provision of sodium reduction advice by health professionals to persons with hypertension reduces their reported sodium intake.

What is added by this report?

Among participants with self-reported hypertension, the prevalence of receiving advice to reduce sodium intake from a health professional was 42% compared with 13% among participants without hypertension. Among those with hypertension, 81% of those who received advice to reduce sodium intake reported taking action to reduce sodium intake, compared with 56% of those with hypertension who did not receive this advice.

What are the implications for public health practice?

Most patients do not receive clinical advice to reduce sodium intake. Increasing the percentage of patients who receive this advice from their health care provider might provide increased opportunities for hypertension prevention and treatment.

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Tables

Table 1

Table 2

Table 3

Related Materials

Hypertension is a major cardiovascular disease risk factor (1,2). Advice given by health professionals can result in lower sodium intake and lower blood pressure (3).The 2017 Hypertension Guideline released by the American College of Cardiology and the American Heart Association emphasizes nonpharmacologic approaches, including sodium reduction, as important components of hypertension prevention and treatment (4). Data from 50,576 participants in the sodium module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS) in nine states and Puerto Rico were analyzed to determine the prevalence of reported sodium reduction advice and action among participants with and without self-reported hypertension. Among participants with self-reported hypertension, adjusted prevalence of receiving sodium reduction advice from a health professional was 41.9%, compared with 12.8% among participants without hypertension. Among those with hypertension, adjusted prevalence of reported action to reduce sodium intake was 80.9% among participants who received advice and 55.7% among those who did not receive advice. Among participants without hypertension, adjusted prevalence of taking action to reduce sodium intake was 72.7% among those who received advice and 46.9% among those who did not receive advice. The provision of advice on sodium reduction by health professionals is associated with respondent action to watch or reduce sodium intake. Fewer than half of patients with hypertension received this advice from their health professionals, a circumstance that represents a substantial missed opportunity to promote hypertension prevention and treatment.

BRFSS is an annual state-based, cross-sectional telephone survey of noninstitutionalized adults aged ≥18 years. In 2015, nine states (Alabama, Indiana, Iowa, Kentucky, Maine, Nebraska, North Carolina, Oregon, and Tennessee) and Puerto Rico completed the optional sodium-related behavior module. Median survey response rate for all states and territories included in this analysis was 51.3% (range = 42.6%–59.0%) (5). Among 63,955 participants from jurisdictions that implemented the sodium-related behavior module, 55,857 participants completed it. After 5,281 participants with missing information on sex, age, race/ethnicity, education, smoking status, body mass index, and reported comorbidities were excluded, data from 50,576 respondents (90.5% of all participants) were analyzed. Prevalence of sodium reduction advice and action was estimated by self-reported hypertension status. Hypertension was defined as an affirmative response to the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?” Women who answered “yes” but “only during pregnancy,” as well as those who were told that they were “borderline high or pre-hypertensive” were not included. Receiving health professional advice to reduce sodium intake was defined by an affirmative response to the question “Has a doctor or other health professional ever advised you to reduce sodium or salt intake?” Action to reduce sodium intake was defined by an affirmative response to the question “Are you currently watching or reducing your sodium or salt intake?”

Descriptive analyses were used to examine population characteristics by hypertension status. Multiple variable logistic regression was used to examine characteristics associated with advice and action and to estimate prevalence and 95% confidence intervals using predicted marginals adjusted for selected covariates (6). Covariates included sociodemographic characteristics (geographic location, sex, age/ethnicity, race, and education) and cardiovascular disease risk factors (smoking, obesity status, and reported associated comorbidities [diabetes, kidney disease, myocardial infarction, coronary heart disease, or stroke]). All estimates used sampling weights to account for the complex survey design and nonresponse. Chi-square tests were used to compare prevalence estimates. P-values <0.05 were considered statistically significant.

Participants with self-reported hypertension differed significantly from participants without hypertension for all characteristics examined (p<0.05 for all characteristics) (Table 1). Among participants with hypertension compared with those without hypertension, more participants were male (51.0% versus 48.6%), aged ≥65 years (37.0% versus 11.9%), non-Hispanic black (13.9% versus 9.6%), had less than a high school education (19.3% versus 11.6%), were current or former smokers (51.0% versus 41.0%), had obesity (45.1% versus 25.0%), or reported ≥1 comorbidity (39.8% versus 8.9%).

After adjusting for sociodemographic and cardiovascular risk factors, the prevalence of having received sodium reduction advice was 41.9% among participants with hypertension and 12.8% among those without hypertension (Table 2) (p<0.05 for difference overall and in each subgroup). Among participants with hypertension, the adjusted prevalence of receiving advice varied significantly by geographic location, ranging from 32.3% (Oregon) to 56.7% (Puerto Rico), and by sex, race/ethnicity, obesity status, and reported presence of ≥1 comorbidity, but not by age, level of education, or smoking status. By covariate, receipt of advice was higher, for example, among participants who were female (43.0%) versus male (40.8%); non-Hispanic black (54.1%) and Hispanic (46.1%) versus non-Hispanic white (39.1%); who had obesity (46.6%) versus those who did not have obesity (40.2%); and who had ≥1 comorbidity (53.4%) versus no comorbidity (40.0%) (Table 2). Among participants without hypertension, the prevalence of receiving advice ranged from 9.4% (Oregon) to 22.0% (Puerto Rico). Prevalence of receiving advice varied significantly by selected covariate (p<0.05), except sex. By covariate, the adjusted prevalence of advice was higher among non-Hispanic black (16.9%) and Hispanic participants (16.8%) than among non-Hispanic white participants (10.8%), among participants with a high school diploma (14.0%) or less than a high school education (14.9%) than among those with college or more (10.5%), among current or former smokers (13.9%) than among never smokers (11.9%), among those who had obesity (17.4%) versus those who did not (10.6%), and among those who reported ≥1 comorbidity (26.6%) than among those who did not (10.0%) (Table 2).

Overall, participants with hypertension who received advice had the highest adjusted prevalence of taking action to reduce sodium intake (80.9%), followed by those without hypertension who received advice (72.7%), those with hypertension who did not receive advice (55.7%), and those without hypertension who did not receive advice (46.9%) (p<0.05 for overall comparison across the four groups) (Table 3).

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Discussion

In 2015, fewer than half (42%) of BRFSS participants with self-reported hypertension from nine states and Puerto Rico (range = 32% [Oregon] to 57% [Puerto Rico]) reported receiving sodium reduction advice from a health professional independent of sociodemographic characteristics and cardiovascular disease risk factors. Among respondents without hypertension, 13% reported receiving advice to reduce sodium intake (range = 9% [Oregon] to 22% [Puerto Rico]). Yet, among participants with hypertension who received advice, 81% reported taking action to reduce sodium, compared with 56% of those with hypertension who did not receive advice. Similarly, among participants without hypertension 73% of those who received advice to reduce sodium intake reported taking action to reduce sodium, compared with 47% of those who did not receive advice. In this analysis, among participants with and without hypertension, receiving sodium reduction advice from a health professional was associated with reported respondent action to watch or reduce sodium intake.

This study provides the most recent multistate BRFSS data on sodium reduction advice and action. Comparing these results with previously published BRFSS and other data are difficult, given differences in sample size, number of states, and analytic method. Despite these differences, results were generally consistent with previous studies that found respondents with hypertension were more likely to receive advice and take action (7) and that the prevalence of taking action was highest among those who received advice (8).

Fewer than half of adults with hypertension in most locations, and even fewer adults without hypertension, reported receiving sodium reduction advice. Geographic patterns of prevalence of receiving advice appears to correspond with the pattern of self-reported “high blood pressure” diagnosis. For example, Puerto Rico, which had a prevalence of self-reported hypertension (42.2%) substantially higher than the national prevalence of 30.9% (9), had one of the highest prevalences of receiving advice and taking action. Similar to previous reports, in this study, the prevalence of receiving advice was significantly higher among persons with hypertension and obesity or other cardiovascular disease–associated comorbidity than among those with hypertension without these other risk factors. However, among adults with an elevated risk for cardiovascular disease, but without hypertension, reported advice to reduce sodium intake was <30%. Also consistent with earlier findings, more adults who received advice from a health professional to reduce sodium intake reported watching or reducing their sodium intake, irrespective of hypertension status or cardiovascular risk factors (7). Self-reported action to watch or reduce sodium intake might not result in achieving clinically meaningful sodium reduction (10); however, these findings suggest that a health professional’s advice can significantly affect awareness.

The findings in this report are subject to at least three limitations. First, BRFSS data are self-reported and subject to recall and social desirability bias, which affects prevalence estimates. Second, questions from BRFSS do not provide the extent of health professional advice or verify or detail the types of actions taken by respondents who report actively watching or reducing their sodium intake. Therefore, these questions might serve as a proxy for awareness of the need for sodium reduction rather than a measure of behavior change. Finally, responses were limited to nine states and Puerto Rico that elected to apply the sodium module during the 2015 BRFSS, and where response rates were approximately 50%; therefore, these results might not be generalizable to all U.S. adults and could be subject to response bias. Despite limitations, this report estimates sodium reduction advice and action using the latest BRFSS data and might provide a baseline for current practice as well as demonstrate opportunities for increasing the advice provided.

The findings from this analysis indicate that a higher percentage of BRFSS participants who reported receiving sodium reduction advice from a health professional reported taking action, across hypertension status and cardiovascular risk groups, underscoring the importance of health professional advice on potentially influencing sodium reduction awareness and behavior. Yet, fewer than half of respondents with self-reported hypertension and fewer respondents without hypertension reported receiving advice. In accordance with the 2017 hypertension guidelines (4) encouraging lifestyle modification, health professionals can encourage healthy food choices and support consumer and population efforts to reduce sodium intake, highlighting a potential opportunity for hypertension prevention and treatment.

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Conflict of Interest

No conflicts of interest were reported.

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Corresponding author: Puthiery Va, puthieryva@cdc.gov, 404-498-1505.

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1Epidemic Intelligence Service, CDC; 2Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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References

  1. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957–67. CrossRef PubMed
  2. US Department of Agriculture; US Department of Health and Human Services. Dietary guidelines for Americans, 2015–2020. 8th ed. Washington, DC: US Department of Agriculture; US Department of Health and Human Services; 2015. https://health.gov/dietaryguidelines/2015/guidelines/
  3. Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2014;18:CD009217. PubMed
  4. Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension; 2017. http://hyper.ahajournals.org/content/early/2017/11/10/HYP.0000000000000066
  5. CDC. Behavioral Risk Factor Surveillance System: 2015 summary data quality report. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/brfss/annual_data/2015/pdf/2015-sdqr.pdf
  6. Bieler GS, Brown GG, Williams RL, Brogan DJ. Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. Am J Epidemiol 2010;171:618–23. CrossRef PubMed
  7. Jackson SL, Coleman King SM, Park S, Fang J, Odom EC, Cogswell ME. Health professional advice and adult action to reduce sodium intake. Am J Prev Med 2016;50:30–9. CrossRef PubMed
  8. Fang J, Cogswell ME, Park S, Jackson SL, Odom EC. Sodium intake among U.S. adults—26 states, the District of Columbia, and Puerto Rico, 2013. MMWR Morb Mortal Wkly Rep 2015;64:695–8. PubMed
  9. CDC. BRFSS prevalence and trends data. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/brfss/brfssprevalence/
  10. Ayala C, Gillespie C, Cogswell M, Keenan NL, Merritt R. Sodium consumption among hypertensive adults advised to reduce their intake: national health and nutrition examination survey, 1999–2004. J Clin Hypertens (Greenwich) 2012;14:447–54. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=22747617&dopt=Abstract CrossRef

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Return to your place in the textTABLE 1. Unadjusted prevalence* of selected characteristics of adults aged ≥18 years by hypertension† status — Behavioral Risk Factor Surveillance System, nine states and Puerto Rico, 2015
Characteristic Hypertension status
% (95% CI)§
Self-reported hypertension
(n = 22,606)		 No self-reported hypertension
(n = 27,970)
Jurisdiction
Alabama 11.9 (11.4–12.3) 10.0 (9.6–10.4)
Indiana 12.1 (11.5–12.8) 14.5 (13.9–15.1)
Iowa 5.5 (5.3–5.8) 7.2 (6.9–7.5)
Kentucky 10.2 (9.8–10.7) 9.1 (8.7–9.5)
Maine 3.1 (2.9–3.3) 3.4 (3.3–3.6)
Nebraska 3.5 (3.3–3.7) 4.6 (4.4–4.8)
North Carolina 21.3 (20.5–22.1) 20.9 (20.3–21.5)
Oregon 7.2 (6.6–7.8) 9.6 (9.0–10.1)
Tennessee 14.7 (14.0–15.4) 12.1 (11.6–12.7)
Puerto Rico 10.6 (10.1–11.0) 8.6 (8.2–8.9)
Sex
Male 51.0 (49.9–52.0) 48.6 (47.6–49.5)
Female 49.0 (48.0–50.1) 51.5 (50.5–52.4)
Age group (yrs)
18–64 63.0 (62.1–63.9) 88.1 (87.6–88.5)
≥65 37.0 (36.1–37.9) 11.9 (11.5–12.4)
Race/Ethnicity
White, non-Hispanic 70.5 (69.6–71.5) 72.5 (71.7–73.3)
Black, non-Hispanic 13.9 (13.1–14.7) 9.6 (9.0–10.3)
Other, non-Hispanic 2.9 (2.5–3.4) 4.1 (3.7–4.5)
Hispanic 12.7 (12.1–13.3) 13.8 (13.2–14.4)
Education
Less than high school 19.3 (18.3–20.2) 11.6 (10.9–12.4)
High school 32.2 (31.2–33.1) 29.1 (28.2–30.0)
Some college 29.7 (28.8–30.7) 33.1 (32.2–34.0)
College or more 18.9 (18.2–19.6) 26.2 (25.5–26.9)
Smoking status
Current and former smoker 51.0 (50.0–52.0) 41.0 (40.1–41.9)
Never smoker 49.0 (48.0–50.0) 59.0 (58.1–59.9)
Obesity status
No 55.0 (53.9–56.0) 75.0 (74.1–75.8)
Yes 45.1 (44.0–46.1) 25.0 (24.2–25.9)
Comorbidities**
No 60.2 (59.1–61.2) 91.1 (90.6−91.5)
Yes 39.8 (38.8–40.9) 8.9 (8.5–9.4)

Abbreviation: CI = confidence interval.
* Unadjusted prevalence estimates weighted for survey design and nonresponse.
† Hypertension was defined as an affirmative response to the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?”
§ p-value <0.05 for differences (chi-square test) in percent distribution of covariates between participants with reported hypertension and without reported hypertension, accounting for complex survey design and weighted.
Obesity defined as body mass index ≥30 kg/m2.
** Includes self-reported diabetes, kidney disease, myocardial infarction, coronary heart disease, or stroke.

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Return to your place in the textTABLE 2. Adjusted* percentage of adults aged ≥18 years who reported receiving advice to reduce their sodium intake, by hypertension† status — Behavioral Risk Factor Surveillance System, nine states and Puerto Rico, 2015
Characteristic Reported receiving advice
Self-reported hypertension§ No self-reported hypertension
No. % (95% CI) p-value No. % (95% CI) p-value
Total 22,606 41.9 (40.8–43.0) — 27,970 12.8 (12.1–13.4) —
Jurisdiction
Alabama 3,048 39.8 (37.3–42.4) <0.05 3,159 12.7 (11.2–14.4) <0.05
Indiana 2,043 43.1 (39.9–46.3) 2,613 11.5 (9.8–13.5)
Iowa 1,884 37.9 (35.1–40.9) 2,857 11.3 (9.7–13.1)
Kentucky 3,372 40.3 (37.5–43.2) 3,473 11.2 (9.6–13.0)
Maine 1,941 44.8 (41.8–47.8) 2,740 13.6 (11.8–15.7)
Nebraska 2,758 33.3 (30.7–36.0) 4,376 9.6 (8.1–11.3)
North Carolina 2,152 43.7 (41.1–46.4) 2,909 12.1 (10.7–13.7)
Oregon 744 32.3 (28.2–36.7) 1,188 9.4 (7.0–12.6)
Tennessee 2,210 40.3 (37.1–43.6) 2,154 11.7 (9.8–13.9)
Puerto Rico 2,454 56.7 (51.2–62.1) 2,501 22.0 (18.5–26.0)
Sex
Male 9,548 40.8 (39.3–42.4) <0.05 11,582 12.9 (11.9–13.8) 0.980
Female 13,058 43.0 (41.5–44.4) 16,388 12.7 (11.9–13.5)
Age group (yrs)
18–64 11,264 42.7 (41.3–44.1) 0.582 21,439 11.4 (10.7–12.1) <0.05
≥65 11,342 42.6 (41.1–44.1) 6,531 20.2 (18.7–21.7)
Race/Ethnicity
White, non-Hispanic 16,928 39.1 (37.7–40.6) <0.05 22,016 10.8 (10.1–11.6) <0.05
Black, non-Hispanic 2,398 54.1 (50.6–57.6) 1,769 16.9 (14.4–19.6)
Other, non-Hispanic 570 40.2 (33.9–46.9) 881 15.3 (10.8–21.3)
Hispanic 2,710 46.1 (41.0–51.3) 3,304 16.8 (14.2–19.7)
Education
Less than high school 2,670 43.0 (40.0–46.0) 0.377 1,848 14.9 (13.0–17.0) <0.05
High school 7,610 41.8 (40.1–43.6) 7,882 14.0 (12.9–15.3)
Some college 6,128 41.3 (39.4–43.2) 7,966 12.2 (11.1–13.4)
College or more 6,198 42.9 (41.0–44.8) 10,274 10.5 (9.6–11.4)
Smoking status
Current and former smoker 10,938 41.2 (39.7–42.8) 0.245 11,358 13.9 (13.0–15.0) <0.05
Never smoker 11,668 42.7 (41.2–44.2) 16,612 11.9 (11.1–12.8)
Obesity Status**
No 12,966 40.2 (38.8–41.6) <0.05 21,037 10.6 (10.0–11.3) <0.05
Yes 9,640 46.6 (44.9–48.2) 6,933 17.4 (16.1–18.8)
Comorbidities††
No 13,231 40.0 (38.7–41.4) <0.05 24,674 10.0 (9.4–10.6) <0.05
Yes 9,375 53.4 (51.7–55.1) 3,296 26.6 (24.4–29.0)

Abbreviation: CI = confidence interval.
* Adjusted prevalence estimates were estimated from marginal predictions of separate multiple logistic regression models for each covariate with a term for the interaction between the covariate (e.g., sex) and hypertension status adjusted for all the other covariates in the table, accounting for survey design and survey weights. Significant interactions occurred between hypertension status and age, race/ethnicity, education, smoking status, obesity status, and comorbidities.
† Hypertension was defined as an affirmative response to the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?”
§ Across all participating locations and selected covariates, a higher prevalence of advice was reported among participants with hypertension compared with those without hypertension (p–value <0.05).
p-value obtained by Wald F test and p-value <0.05 were used to identify statistically significant differences in prevalence of advice among subgroups with hypertension and without hypertension.
** Obesity defined as body mass index ≥30 kg/m2.
†† Includes self-reported diabetes, kidney disease, myocardial infarction, coronary heart disease, or stroke.

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Return to your place in the textTABLE 3. Adjusted* percentage of adults aged ≥18 years who report taking action to reduce their sodium intake, by receipt of advice to reduce sodium intake and self-reported hypertension† status — Behavioral Risk Factor Surveillance System, nine states and Puerto Rico, 2015
Characteristic Took action to reduce sodium intake
Self-reported hypertension No self-reported hypertension
Advice No advice Advice No advice
No. % (95% CI) p-value§ No. % (95% CI) p-value§ No. % (95% CI) p-value§ No. % (95% CI) p-value§
Total 10,900 80.9 (79.5–82.2) — 11,706 55.7 (54.2–57.2) — 3,346 72.7 (70.1–75.2) — 24,624 46.9 (45.9–47.9) —
Jurisdiction
Alabama 1,481 80.5 (77.2–83.5) <0.05 1,567 56.5 (53.0–59.9) <0.05 424 75.3 (68.7–80.9) 0.330 2,735 45.2 (42.7–47.8) <0.05
Indiana 956 82.8 (79.1–86.0) 1,087 51.4 (46.9–55.8) 302 71.3 (62.3–78.9) 2,311 47.9 (45.0–50.9)
Iowa 763 82.4 (78.3–85.8) 1,121 52.3 (48.5–56.0) 278 69.7 (61.1–77.2) 2,579 42.1 (39.6–44.7)
Kentucky 1,664 76.1 (71.9–79.9) 1,708 54.3 (50.4–58.3) 402 72.2 (65.2–78.3) 3,071 42.2 (39.4–45.1)
Maine 908 85.0 (81.6–87.8) 1,033 57.9 (54.0–61.8) 306 74.9 (67.9–80.8) 2,434 46.0 (43.2–48.7)
Nebraska 1,063 82.9 (79.3–85.9) 1,695 51.0 (47.1–54.8) 344 68.3 (58.4–76.7) 4,032 39.2 (36.9–41.6)
North Carolina 1,095 83.9 (80.6–86.8) 1,057 59.2 (55.3–62.9) 321 71.4 (64.6–77.3) 2,588 49.5 (47.2–51.8)
Oregon 268 83.8 (77.3–88.7) 476 49.7 (43.4–55.9) 82 71.6 (55.0–83.9) 1,106 37.2 (33.4–41.1)
Tennessee 1,024 78.9 (74.4–82.7) 1,186 56.8 (52.5–61.1) 238 81.1 (72.4–87.6) 1,916 51.4 (48.0–54.7)
Puerto Rico 1,678 81.3 (77.4–84.8) 776 62.2 (56.0–68.1) 649 74.7 (68.9–79.8) 1,852 56.7 (51.8–61.4)
Sex
Male 4,467 79.3 (77.3–81.2) <0.05 5,081 51.0 (48.7–53.2) <0.05 1,419 70.9 (66.9–74.7) 0.077 10,163 43.1 (41.6–44.6) <0.05
Female 6,433 82.4 (80.6–84.0) 6,625 60.5 (58.6–62.4) 1,927 74.5 (71.2–77.7) 14,461 50.6 (49.2–51.9)
Age group (yrs)
18–64 5,519 79.5 (77.7–81.2) <0.05 5,745 55.1 (53.1–57.1) <0.05 2,230 69.8 (66.6–72.8) <0.05 19,209 44.5 (43.3–45.6) <0.05
≥65 5,381 85.9 (84.3–87.3) 5,961 61.2 (59.2–63.1) 1,116 84.1 (80.5–87.1) 5,415 56.6 (54.6–58.6)
Race/Ethnicity
White, non-Hispanic 7,381 80.3 (78.7–81.9) <0.05 9,547 53.1 (51.3–54.9) <0.05 2,177 73.3 (70.1–76.3) 0.281 19,839 43.5 (42.2–44.7) <0.05
Black, non-Hispanic 1,449 87.7 (84.5–90.3) 949 71.6 (66.7–76.0) 312 77.4 (69.0–84.1) 1,457 61.3 (57.6–65.0)
Other, non-Hispanic 270 81.2 (67.5–90.0) 300 49.5 (39.6–59.5) 97 84.0 (70.9–91.9) 784 46.3 (41.1–51.7)
Hispanic 1,800 79.8 (75.8–83.3) 910 57.8 (51.2–64.2) 760 70.2 (64.1–75.7) 2,544 53.4 (49.1–57.7)
Education
Less than high school 1,527 77.0 (72.9–80.5) 0.079 1,143 55.3 (50.7–59.7) 0.347 380 66.5 (58.5–73.6) 0.269 1,468 46.6 (42.7–50.5) 0.641
High school 3,684 80.4 (78.1–82.5) 3,926 54.9 (52.4–57.5) 1,088 74.0 (69.3–78.1) 6,794 46.3 (44.5–48.2)
Some college 2,885 83.7 (81.4–85.7) 3,243 57.6 (55.0–60.2) 916 72.0 (67.0–76.5) 7,050 47.5 (45.7–49.2)
College or more 2,804 81.0 (78.5–83.2) 3,394 53.9 (51.3–56.4) 962 76.3 (72.1–80.0) 9,312 47.1 (45.6–48.7)
Smoking status
Current and former smoker 5,146 79.9 (77.9–81.8) <0.05 5,792 55.0 (52.8–57.1) 0.514 1,454 72.0 (68.2–75.5) 0.210 9,904 46.0 (44.5–47.6) 0.172
Never smoker 5,754 81.8 (80.0–83.4) 5,914 56.3 (54.1–58.3) 1,892 73.4 (69.7–76.8) 14,720 47.6 (46.2–48.9)
Obesity status
No 5,843 82.5 (80.9–84.1) <0.05 7,123 53.6 (51.7–55.6) <0.05 2,160 73.0 (69.6–76.2) 0.971 18,877 45.8 (44.6–46.9) <0.05
Yes 5,057 79.8 (77.7–81.7) 4,583 59.3 (56.9–61.6) 1,186 72.6 (68.4–76.3) 5,747 49.4 (47.4–51.4)
Comorbidities**
No 5,520 80.1 (78.3–81.8) <0.05 7,711 55.2 (53.4–57.0) <0.05 2,423 70.3 (67.2–73.2) <0.05 22,251 45.1 (44.0–46.2) <0.05
Yes 5,380 84.6 (82.8–86.2) 3,995 59.8 (57.2–62.3) 923 82.1 (77.8–85.8) 2,373 55.0 (51.9–58.1)

Abbreviation: CI = confidence interval.
* Adjusted prevalence estimates were estimated from marginal predictions of separate multiple logistic regression models for each covariate with a term for the interaction between the covariate (e.g., sex) and hypertension status adjusted for all the other covariates in the table. Significant interactions occurred between the hypertension and advice with state, age, race/ethnicity, obesity status, and comorbidities.
† Hypertension was defined as an affirmative response to the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?”
§ p-value obtained by Wald F test and p<0.05 were used to identify statistically significant differences in prevalence of action among subgroups with hypertension and without hypertension by receipt of advice.
Obesity defined as body mass index ≥30 kg/m2
** Includes self-reported diabetes, kidney disease, myocardial infarction, coronary heart disease, or stroke.

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Suggested citation for this article: Va P, Luncheon C, Thompson-Paul AM, Fang J, Merritt R, Cogswell ME. Self-Reported Receipt of Advice and Action Taken To Reduce Dietary Sodium Among Adults With and Without Hypertension — Nine States and Puerto Rico, 2015. MMWR Morb Mortal Wkly Rep 2018;67:225–229. DOI: http://dx.doi.org/10.15585/mmwr.mm6707a5.

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