health disparities; United States Mainland; United States territories; Healthy Lifestyle Characteristics


Geography | Social and Behavioral Sciences


Background: No studies have compared the lifestyle behaviors between Puerto Rico, Guam, and the U. S. Virgin Islands to that of the United States mainland. Documenting and addressing health disparities between these geographically and culturally distinct areas are important public health objectives. Differences in health status between and among the United States mainland and territories merit systematic and careful analyses. Methods: Four key healthy lifestyle characteristics include tobacco use, body mass index, physical activity, and fruit/vegetable consumption. Data from the 2009 Behavioral Risk Factor Surveillance System (N=420,481) were used to examine United States mainland and territorial differences among the four key healthy lifestyle behaviors. Descriptive statistics were summarized with chi-square tests for independence and multiple adjusted logistic regression models were used to examine differences in health compliance rates while controlling for age, gender, income, and education. Frequencies determined whether Healthy People 2010 goals were met by each location. Results: Differences were found between the United States mainland and territories for smoking rates, body mass index, physical activity, and consumption of fruit/vegetables. None of the countries met all four Healthy People 2010 goals. Discussion: Even though, each location had unique challenges, Puerto Ricans’ health behaviors were significantly less favorable than residents in the other countries. We document prevalence rates and differences by country for each of the four healthy lifestyle characteristics. This study highlights the need for more research in these understudied areas as well as the importance of effective health promotion and disease prevention programs for all United States citizens including the mainland and all territories.

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