Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Eileen Stuart-Shor

Second Advisor

Laura Hayman

Third Advisor

Ling Shi


Cardiovascular Disease is the leading cause of morbidity and mortality globally. Cardiovascular disease causes 30% of total deaths globally; 82% of these deaths take place in low- and middle-income countries (WHO, 2012). Sub-Saharan Africa is now facing a double burden of disease with a rising wave of non-communicable diseases such as cardiovascular disease along with the current communicable diseases epidemic. Behavioral factors that have been shown to increase risk of developing cardiovascular disease include: physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.

The purpose of this study was to examine the prevalence, distribution and association of cardiovascular disease behavioral risk factors (physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol) in Sub-Saharan Africa (Kenya, Ghana, South Africa and Senegal).

Secondary analysis was conducted on data generated from a 2003 population-based survey (World Health Survey) by the World Health Organization (WHO) with a sample consisting of 13,851 individuals. In addition, secondary analysis was conducted on data from the World Health Organization Framework Convention on Tobacco Control to determine if there is any association between implementation of country-specific tobacco control policies and self-reported tobacco use prevalence in Kenya, Ghana, South Africa and Senegal.

This study documented a high prevalence of unhealthy diet (67% overall) that is relatively similar to unhealthy diet prevalence in the U.S (75%). In the countries of interest, the overall prevalence of physical inactivity, tobacco use and harmful use of alcohol (12%, 14%, and 6%) respectively were lower as compared to developed countries. Implementation of country-specific tobacco policies was associated with a higher reduction in the rate of country reported tobacco use prevalence.

Results showed that there was variability in prevalence and distribution of the four examined cardiovascular disease behavioral risk factors. The study showed that there were both within-country and between-country differences. These risk factors varied by age, gender, living location and level of education attainment. A trend of increased behavioral risk factors associated with increased age, male gender and lower education attainment was observed which places older adults, males and those with lower education attainment at increased risk for developing cardiovascular disease.


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