Folsom AR, Sprafka JM, Luepker RV, Jacobs DR Jr.
Beliefs among black and white adults about causes and prevention of cardiovascular disease: the Minnesota Heart Survey.
Am J Prev Med 1988;4(3):121-7.

This study assessed the public's beliefs about cardiovascular disease (CVD) and possible racial differences in these beliefs. Data for this study were collected during the 1985-1986 Minnesota Heart Surveys. These surveys included a random sample of black residents from urban Minneapolis and a random sample of white residents of the Twin Cities metropolitan area. The target age group was 35 to 74 years of age. Face to face interviews included a series of questions about symptoms, beliefs, and knowledge of cardiovascular disease.

In general, blacks were less knowledgeable about symptoms of a heart attack. Whites were significantly more likely to list five of seven symptoms and were less likely to not know any symptoms of a heart attack. Blacks were also less knowledgeable about risk factors for cardiovascular disease. Whites were significantly more likely to list six of nine specific risk factors and were less likely to not be able to name any risk factors. These differences persisted after stratifying by educational level. Specific patterns with regard to knowledge about risk factors were informative. A large proportion (32% of blacks and 54% of whites) was aware that smoking was harmful, but hypertension (29% of blacks and 19% of whites) and high blood or dietary cholesterol (25% of blacks and 39% of whites) were mentioned less often. (Note that blacks were more likely than whites to know that high blood pressure is a risk factor for CVD.)

Only 65% of black respondents compared with 76% of white respondents were able to name at least one of the three key modifiable risk factors for CVD: 46% of blacks versus 45% of whites named only one of these factors; 17% versus 27% named only two; and 2% versus 4% named all three. The percentage naming major risk factors increased with education, but the racial difference was present for each educational stratum. There was very little difference by sex or age.

Finally, whites tended to have more accurate beliefs about CVD prevention. Most respondents (over 70%) knew that animal fats do not lower blood cholesterol, that almost everyone can benefit from lower blood pressure, and that most fruits and vegetables do not contain fat and cholesterol. About half of the respondents answered other questions correctly, with the exception of those questions regarding the benefit of soft versus solid margarines in lowering cholesterol, stress not being the most important cause of heart attack and stroke, and the benefit of fiber, all of which had much lower response accuracy.

Women and men reported different risk factors. Women were more likely to mention being overweight, having high blood pressure, bad diet and heredity as causes of cardiovascular disease and less likely to report smoking or overexertion than men. Educational level was related to beliefs about the causes of cardiovascular disease. Those mentioning no beliefs were rare and most frequently those who did not finish high school.

While health knowledge and beliefs are not the only factors influencing cardiovascular risk behaviors, it is likely that individuals' understanding about risk factors plays a role in the effectiveness of preventive efforts. This study indicates that there are differences in health beliefs and knowledge by sex, education, and race. The level of formal education was significantly and positively related to cardiovascular health knowledge and beliefs, with the exception of hypertension, which was more often mentioned by less educated participants. This pattern is consistent with what we might have expected to find, given the lower CVD risk factors levels and disease rates among better-educated individuals. Additionally, blacks tended to show more knowledge about hypertension than whites in specific questions (but less knowledge in other areas). This might be explained by research studies and targeted programs on blood pressure control that are known to have occurred in black communities.

The authors conclude that educational efforts for CVD prevention may be most effectively targeted toward minorities and less-educated groups.