Health Belief Model Predicts Likelihood of Eating Nutrient-Rich Foods among U.S. Adults.

Despite decades of messaging, most Americans still consume excess fats and sugars, but inadequate fiber, potassium, and calcium. Nutrient-rich foods (NRFs) have a high density of favorable nutrients related to calories. Choosing NRFs could lower risk of nutrition-related chronic diseases and aid in their control. We hypothesized that having greater knowledge of NRFs, the presence of a nutrition-related chronic disease or risk factor, and positive Health Belief Model (HBM) views would be predictive of the likelihood of eating NRFs. Through a national online survey panel, 976 adults aged 18-80 completed demographic, health, NRF knowledge, attitudes, and HBM construct questions. Participants were 77% White, 52% women, and 55% had a nutrition-related disease or risk factor. Multivariable HBM scales were generated by theory, principal components, and reliability analysis. NRF knowledge was significantly higher for women, Whites, households without children, and persons without a nutrition-related disease (all p ≤ 0.015). 'Likelihood of eating NRFs' was significantly higher for persons with a nutrition-related disease, Whites, married participants, main food shoppers, and households with children (all p ≤ 0.022). Regressing demographic and HBM constructs on the 'likelihood of eating NRFs' resulted in R2 of 0.435. Nutrition-related disease and HBM constructs of self-efficacy, perceived benefits, and cues to action were predictive of the likelihood of eating NRFs, but higher NRF knowledge was negatively associated.

Assessing the Mental Model State of Emergency Responders in the Context of Radiological Dispersal Device (RDD) Incidents: A Multi-state Study.

ABSTRACT: Hazardous Materials (HAZMAT) Technicians' notions of mental model, or cognitive representations of their understanding and beliefs regarding Radiological Dispersal Devices (RDDs) incidents, have not been previously explored. A prior study developed an Expected Mental Model State (EMMS) framework specific to RDD incident response for HAZMAT technicians. The work herein presents the development of a derivative of this framework, the EMMS Diagnostic Matrix, to evaluate the actual Mental Model State (MMS) of HAZMAT technicians in the context of RDD incidents. The EMMS Diagnostic Matrix was administered via a survey and simulation activity in four U.S. states representing the Northeast, West, South, and Midwest regions. Data were collected and coded using grounded theory methodology. Reflexive thematic analysis was employed to identify themes across related areas where the notions of mental model for the HAZMAT technician responders' actual MMS differed from the EMMS. The analysis of the collected data revealed four significant themes representing incomplete notions of the mental model spanning various EMMS conceptual domains: Overestimation of Radiation Dose and Health Effects, indicating misunderstandings about the health impacts of radiation exposure, Acute Radiation Syndrome (ARS), particularly in the lower range of radiation doses; Overreliance on Responder Protection [personal protective equipment (PPE)/self-contained breathing apparatus (SCBA)], highlighting gaps in understanding radiation principles and radioactive material dispersal properties from a radiological dispersal device; Misunderstanding Radiation Detection and Units, signifying confusion about radiation units and differentiation between dose rate and accumulated dose; and Incomplete Understanding of Radiation Characteristics and Dispersal Properties, outlining a limited grasp of inhalation risks from radiation and the dispersal traits of a radiological dispersal device. The interconnectedness of these technical misunderstandings can guide the development of a strategic plan to evaluate and modify existing training, aiming at these specific themes to improve the efficiency of HAZMAT technicians in emergency situations and to identify areas for further research.

Development of a Nutrition Environment Assessment Tool for Latino Ethnic Stores.

The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen's kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82-1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.

Effects of COVID-19 on University Student Food Security.

During COVID-19 restrictions in spring 2020, college students experienced closed dormitories and increased unemployment and many students moved in with their families. College students were vulnerable to food insecurity pre-pandemic and this study examined how the living situations and food security status changed for Midwestern university students due to COVID-19 restrictions. An email survey administered to Iowa State University students between the ages of 18 and 30 who physically attended campus prior to its closure produced 1434 responses. Students living with a parent or guardian increased by 44% and were less likely to experience food insecurity or less likely to work. They had lower stress and ate more home-cooked meals. Students living on their own had higher rates of food insecurity, greater stress, poorer health status, higher cooking self-efficacy, and worked more hours. Seventeen percent of all students were food insecure; related factors were non-White ethnicity, lower cooking self-efficacy, undergraduate status, receipt of financial aid, employment, stress, living in the same situation as before the campus closure, and consumption of more take-out or fast food. These individuals had more barriers to food access. Knowledge of these factors provide useful information to inform future support services for this population in similar conditions.

Predictors of Plant-Based Alternatives to Meat Consumption in Midwest University Students.

OBJECTIVE: To assess the prevalence of plant-based alternatives to meat consumption in students at a Midwest university, describe associations between demographics, environmental concern attitudes, and consumption, and determine variables statistically associated with trying the plant-based alternatives. DESIGN: Descriptive cross-sectional convenience sample; self-administered online surveys. SETTING: College students at a Midwest university. PARTICIPANTS: Currently enrolled students aged 18-30 taking courses on campus as of March 2020. MAIN OUTCOME MEASURES: Plant-based alternative consumption; demographics; vegetarian status; environmental attitudes; influences on food choices; and trusted sources of food information. ANALYSIS: Bivariate comparisons for consumption of plant-based alternatives; logistic regression analysis. RESULTS: Fifty-five percent had tried a plant-based meat alternative. Top reasons were enjoying new foods and curiosity about the products. Out-of-state residency, vegetarian status, and 10 of 11 environmental attitude statements were significantly associated with plant-based alternative consumption (P < 0.05). About 30% of consumers indicated they wanted to eat less meat and that plant alternatives were better for the environment. Nonconsumers had less favorable views of meatless meals. CONCLUSIONS AND IMPLICATIONS: This study supports that positive environmental attitudes were predictive of plant-based alternative consumption among college students. Increased awareness and familiarity could encourage consumption among this population.

Food Security Characteristics Vary for Undergraduate and Graduate Students at a Midwest University.

The study objective was to determine prevalence of food insecurity and its associations with socioecological model (SEM) characteristics for undergraduate and graduate students. An online questionnaire was distributed to a convenience sample of students aged 18-34 at a Midwestern university. Of the 938 responses, 675 were complete for analysis. Outcome measures included demographics, food security level, housing, food access barriers, coping strategies, and food assistance program usage. Results found that predictors associated with undergraduate food insecurity included non-White race, receipt of financial aid, lower self-reported health status, living off-campus, employment, and food cost (p < 0.001). Graduate student food insecurity was associated with Asian self-identification, employment, food cost, no time to prepare foods, and lack of foods for dietary needs (p < 0.001). Students with food insecurity were more likely to buy cheap food (p < 0.001). Almost 50% of food-insecure undergraduates asked friends or family to help buy food. Food-insecure students were more likely to want information on meal preparation and budgeting. More graduate students were likely to know of and use food pantries. Overall, food insecurity was higher among undergraduate than graduate students. Universities should consider institutional and policy changes tailored to the separate populations to mitigate the prevalence of campus food insecurity.

Pulse Knowledge, Attitudes, Practices, and Cooking Experience of Midwestern US University Students.

Many American college students fail to meet dietary guideline recommendations for fruits, vegetables, and fiber. Pulses are a subgroup of legumes, harvested solely for dry grain seeds within a pod. Commonly consumed pulses include dry beans, dry peas, lentils, and chickpeas. Pulses are high in shortfall nutrients and could fill some nutritional gaps of college students. However, little is known about pulse intakes among young adults. The study aims were: (1) to identify knowledge, attitudes, and practices regarding pulse consumption; and (2) to describe experiences of preparing dry pulses among college students. A convenience sample of 1433 students aged 18-30 enrolled at a Midwestern university in the United States completed an online survey in April 2020. Demographic and attitude variables were compared by the monthly count of pulse types eaten using chi-square, analysis of variance, and logistic regression modeling to predict pulse type intakes. Higher numbers of pulse types eaten was associated with being White, vegetarian/vegan, higher cooking self-efficacy, positive attitudes toward pulses, and greater daily intake of fruits, vegetables, and fiber. Knowledge and experience of cooking dry pulses was low, with canned pulses purchased more often. College students may not be consuming pulses due to unfamiliarity with them, low knowledge of nutrition benefits, and a general lack of cooking self-efficacy. Increased familiarization and promotion surrounding pulses may increase their consumption.

Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions.

Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.

Dry Bean Preferences and Attitudes among Midwest Hispanic and Non-Hispanic White Women.

Bean (Phaseolus vulgaris L.) intakes in the United States (US) lag behind dietary recommendations despite their positive nutrition profile, health benefits for reducing chronic disease risk, and inclusion in nutrition assistance programs. Low-income groups, including Hispanics, have an increased risk of cardiovascular disease, type 2 diabetes, obesity, and some cancers. Hispanic dietary quality and bean consumption may decline with increasing acculturation. Intakes at recommended levels could improve health in all vulnerable low-income populations. The study objectives were to describe dry and canned bean preferences, consumption frequency, and attitudes among low-income Hispanic and non-Hispanic white women, and to assess if these characteristics differed by ethnicity and acculturation level among the Latinas. A convenience sample of 158 women, aged 18⁻65 years, completed a written survey in English or Spanish at two healthcare clinics, one Special Supplemental Nutrition Program for Women, Infants and Children office, and five County Extension nutrition education and outreach programs in Iowa. Less acculturated Latinas consumed beans more often, preferred dry to canned, bought in bulk, valued color and shape in dry bean selection, and held less positive attitudes toward canned beans in contrast to bicultural/more acculturated and non-Hispanic white women. Ethnicity and acculturation level have a role in varying purchase patterns and attitudes regarding dry and canned beans. Culturally-held differences should be considered in nutrition programs and leveraged to increase consumption and improve health.

Factors Influencing Dietary Intake Frequencies and Nutritional Risk among Community-Residing Older Adults.

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p ≤ .001) and vegetable (p = .021) DIF, age influenced processed meat DIF (p = .001), and gender influenced NR (p = .006), vegetable (p = .022), and processed meat (p = .033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.

Health Behaviors among Low-income Hispanic and Non-Hispanic White Women.

OBJECTIVES: We determined relationships between food behaviors and health-risk factors by acculturation among limited-income Hispanic and non-Hispanic white women. METHODS: Women aged 18-49 years were recruited from income-based programs in metro-Phoenix, Arizona. Self-administered surveys in English or Spanish included demographics, a 10-item food behavior checklist, health-risk factors, food security, and acculturation. Differences by 4 acculturation/ethnicity categories were assessed with chi-square and analysis of variance (ANOVA). We created a food behavior scale. RESULTS: Eighty-two percent self-identified as Hispanic (N = 358), with 45% Hispanic-dominant, 25% bicultural, 12% English-dominant, and 18% non-Hispanic white for acculturation status. Food behavior checklist results showed that English-dominant Hispanic and non-Hispanic white women were more likely to feed their children soon after waking, refrigerate meat/dairy promptly, not add salt to food, smoke cigarettes and be food insecure (p < .001). Education, not acculturation, was a significant predictor of the food behavior scale. BMI did not differ by acculturation, but 33% of Hispanic-dominant Latinas did not know their height and/or weight. These less acculturated Latinas had significantly greater food security, but lacked health insurance and years of education. CONCLUSIONS: Program outreach tailored by acculturation that considers educational level is needed to emphasize existing positive behaviors and address knowledge gaps among low socioeconomic women to improve health and reduce disparities.

A Community-Based Exergaming Physical Activity Program Improves Readiness-to-Change and Self-Efficacy Among Rural-Residing Older Adults.

Rural-residing older adults (OA) are not meeting physical activity (PA) recommendations, such that identifying methods of increasing PA among OA remains an ongoing challenge. This study evaluated the effect of a community-based exergaming program on PA readiness-to-change and self-efficacy among rural-residing OA (n = 265). There was a significant (p = .008) increase in readiness-to-change classification from PRE to POST. Significant increases in self-efficacy, or confidence in their ability to be physically active for a prescribed period of time, were detected for 35 (p = .011) and 40 min (p = .035) of continuous PA. PA self-efficacy change for 35 min of continuous PA (F [3,137] = 3.973, p = .010) and 40 min of continuous PA (F [3,137) = 2.893, p = .038) were influenced by the interaction between PRE self-reported health and PRE PA readiness-to-change levels. Results suggest that an exergaming-themed PA intervention is effective at increasing PA participation and self-efficacy for PA among rural-residing OA.

Interaction of Beta-Hydroxy-Beta-Methylbutyrate Free Acid and Adenosine Triphosphate on Muscle Mass, Strength, and Power in Resistance Trained Individuals.

Lowery, RP, Joy, JM, Rathmacher, JA, Baier, SM, Fuller, JC Jr, Shelley, MC II, Jäger, R, Purpura, M, Wilson, SMC, and Wilson, JM. Interaction of beta-hydroxy-beta-methylbutyrate free acid and adenosine triphosphate on muscle mass, strength, and power in resistance trained individuals. J Strength Cond Res 30(7): 1843-1854, 2016-Adenosine-5'-triphosphate (ATP) supplementation helps maintain performance under high fatiguing contractions and with greater fatigue recovery demands also increase. Current evidence suggests that the free acid form of ß-hydroxy-ß-methylbutyrate (HMB-FA) acts by speeding regenerative capacity of skeletal muscle after high-intensity or prolonged exercise. Therefore, we investigated the effects of 12 weeks of HMB-FA (3 g) and ATP (400 mg) administration on lean body mass (LBM), strength, and power in trained individuals. A 3-phase double-blind, placebo-, and diet-controlled study was conducted. Phases consisted of an 8-week periodized resistance training program (phase 1), followed by a 2-week overreaching cycle (phase 2), and a 2-week taper (phase 3). Lean body mass was increased by a combination of HMB-FA/ATP by 12.7% (p < 0.001). In a similar fashion, strength gains after training were increased in HMB-FA/ATP-supplemented subjects by 23.5% (p < 0.001). Vertical jump and Wingate power were increased in the HMB-FA/ATP-supplemented group compared with the placebo-supplemented group, and the 12-week increases were 21.5 and 23.7%, respectively. During the overreaching cycle, strength and power declined in the placebo group (4.3-5.7%), whereas supplementation with HMB-FA/ATP resulted in continued strength gains (1.3%). In conclusion, HMB-FA and ATP in combination with resistance exercise training enhanced LBM, power, and strength. In addition, HMB-FA plus ATP blunted the typical response to overreaching, resulting in a further increase in strength during that period. It seems that the combination of HMB-FA/ATP could benefit those who continuously train at high levels such as elite athletes or military personnel.

Associations between cognitive and gait performance during single- and dual-task walking in people with Parkinson disease.

BACKGROUND: Cognitive impairments in Parkinson disease (PD) manifest as deficits in speed of processing, working memory, and executive function and attention abilities. The gait impairment in PD is well documented to include reduced speed, shortened step lengths, and increased step-to-step variability. However, there is a paucity of research examining the relationship between overground walking and cognitive performance in people with PD. OBJECTIVE: This study sought to examine the relationship between both the mean and variability of gait spatiotemporal parameters and cognitive performance across a broad range of cognitive domains. DESIGN: A cross-sectional design was used. METHODS: Thirty-five participants with no dementia and diagnosed with idiopathic PD completed a battery of 12 cognitive tests that yielded 3 orthogonal factors: processing speed, working memory, and executive function and attention. Participants completed 10 trials of overground walking (single-task walking) and 5 trials of overground walking while counting backward by 3's (dual-task walking). RESULTS: All gait measures were impaired by the dual task. Cognitive processing speed correlated with stride length and walking speed. Executive function correlated with step width variability. There were no significant associations with working memory. Regression models relating speed of processing to gait spatiotemporal variables revealed that including dual-task costs in the model significantly improved the fit of the model. LIMITATIONS: Participants with PD were tested only in the on-medication state. CONCLUSIONS: Different characteristics of gait are related to distinct types of cognitive processing, which may be differentially affected by dual-task walking due to the pathology of PD.

Adolescents' health behaviors and obesity: Does race affect this epidemic?

This study explores the influence of health behaviors and individual attributes on adolescent overweight and obesity using data from Wave II (Add Health). Structural equation model/path analysis using maximum likelihood estimation was utilized to analyze the relationships of health behaviors and attributes with obesity. Results of the model reveal that the causal paths (adolescents' attributes and health behaviors) for overweight and obesity were different for African American and Caucasian adolescents. Generally, African Americans were more susceptible to overweight and obesity than Caucasians. Although increasing levels of vigorous physical activities lowers the risk for obesity among African American and Caucasian adolescents alike, low family SES and being sedentary were associated with overweight and obesity among Caucasians. No significant associations were found among African Americans. Increased hours of sleep at night relate positively with obesity among African Americans. These findings suggest important elements in the consideration of race in developing effective intervention and prevention approaches for curbing the obesity epidemic among U.S. adolescents.

Personal, health, academic, and environmental predictors of stress for residence hall students.

The authors studied contributors to stress among undergraduate residence hall students at a midwestern, land grant university using a 76-item survey consisting of personal, health, academic, and environmental questions and 1 qualitative question asking what thing stressed them the most. Of 964 students selected at random, 462 (48%) responded to the survey. The authors weighted data to reflect the overall university-wide undergraduate population (55% men, 12% minority or international, and 25% freshmen). Women and US citizens experienced greater stress than did men and non-US citizens, respectively. Frequency of experiencing chronic illness, depression, anxiety disorder, seasonal affective disorder, mononucleosis, and sleep difficulties were significant stress predictors. Although alcohol use was a positive predictor, drug use was a negative predictor of stress. Both a conflict and a satisfactory relationship with a roommate, as well as a conflict with a faculty or staff member, were also significant predictors of stress.

Comparing three measures of depressive symptoms among American Indian adolescents.

This study examined the measurement of depressive symptoms among American Indian adolescents as assessed by the Center for Epidemiologic Studies Depression Scale (CES-D), Youth Self Report (YSR), and the Tri-Ethnic Center's for Prevention Research Depression Scale (TEDS). This analysis demonstrated that the TEDS had good internal consistency, demonstrated construct validity, and shared a commonality with the other two measures, but had limited predictive validity. The YSR had strong predictive validity but, like the CES-D, showed weakness in construct validity. Unexpectedly, the CES-D and YSR revealed enculturated youth were at risk of depressive symptoms. These findings do not generate unequivocal support for any one measure, but suggest that their strengths and potential shortcomings should be taken into account when assessing depressive symptoms among American Indian youth.

Relationship among risk factors for nephrolithiasis, cardiovascular disease, and ethnicity: focus on a law enforcement cohort.

This cross-sectional study determined the prevalence of nephrolithiasis and common cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and evaluated the relationship of nephrolithiasis with several CVD risk factors, including the possible effect of ethnicity. Self reported nephrolithiasis and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to other men in the same states (n = 9,650). Of the LEOs, 6.2% (n = 174) self reported at least one kidney stone (range = 1 to 12, mean 2.3 6 2.1 stones). Twenty five percent of Native American LEOs (n = 7 of 28) self reported a history of stones. In LEOs with a history of nephrolithiasis, overweight defined as body mass index . 25 kg/m2 (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.04, 3.11), hypercholesterolemia (OR = 1.53, 95% CI = 1.09, 2.15), and hypertension (OR = 1.46, 95% CI = 1.02, 2.11) were associated with the disease. These results suggest officers with common CVD risk factors are also at an increased risk for nephrolithiasis. Native American LEOs have a disproportionately higher prevalence of nephrolithiasis than do other ethnic groups.

Management practices as antecedents of safety culture within the trucking industry: similarities and differences by hierarchical level.

PROBLEM: A homogeneous perception of safety is important for the achievement of a strong safety culture; however, employees may differ in their safety perceptions, depending on their position and/or hierarchical level within the organization. Moreover, there is limited information on the antecedents of safety culture. This study examines how safety training, driver scheduling autonomy, opportunity for safety input, and management commitment to safety influence individuals' perceptions of safety culture. METHOD: Data for this study were drawn from 116 trucking firms, stratified by three safety performance levels. The data were collected from drivers (lowest hierarchical level), dispatchers (medium hierarchical level), and safety directors (highest hierarchical level), regarding their perceptions of their respective corporate safety cultures. Perceptions of safety culture were analyzed through a linear regression using dummy variables to differentiate among the three hierarchical groups. The resulting model allowed for examination of the specific antecedents of safety culture for the three employee groups and the extent to which the hierarchical groups were in agreement with each other. RESULTS: Driver fatigue training, driver opportunity for safety input, and top management commitment to safety were perceived to be integral determinants of safety culture in all three groups. IMPACT ON INDUSTRY: Trucking firms seeking to strengthen employees' perceptions of safety culture might begin by improving these safety management practices while appreciating that they may have a different impact depending on the employee's hierarchical position (e.g., drivers' perceptions of safety culture are more influenced by top management commitment and driver fatigue training). A fourth safety practice examined, driver scheduling autonomy, was not found to be instrumental in shaping safety culture for any of the three hierarchical levels. Consistent with previous research, implementation of stronger safety cultures should result in fewer accidents.

Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort.

It is unclear to what extent law enforcement officers (LEOs) experience increased prevalence of cardiovascular disease (CVD; defined as coronary heart disease, myocardial infarction, angina, or stroke) and, if so, whether perceived stress affects this relationship. First, self-reported CVD risk factors among currently employed male LEOs from 9 states (n = 2818) were compared to CVD risk factors among similarly-aged males with similar incomes in the same states (n = 8046). Second, CVD prevalence was compared among LEOs (n = 1791) and similarly-aged males with similar incomes (n = 2575) from four of these states. Finally, among the LEOs only, the possible effect of perceived stress on the relationship between CVD prevalence and CVD risk factors was assessed. LEOs reported higher prevalence of hypertension, hypercholesterolemia, tobacco use, and elevated body mass index. CVD prevalence did not differ significantly between the LEO group and the general population (2.3% +/- 15% versus 3.1% +/- 17%; P = 0.095). In the LEO-only group, the best predictors of CVD were: time in the profession (OR = 1.07; 95% CI = 1.03-1.11), perceived stress (OR = 1.05; 95% CI = 1.00-1.10), and hypertension (OR = 0.33; 95% CI = 0.18-0.62). In the LEO-only group, perceived stress was associated with CVD (P = 0.008), and three CVD risk factors were significantly affected by perceived stress: cholesterol, hypertension, and physical activity. Perceived stress was affected by duration of time in the profession (P = 0.004), independent of an age effect (P = 0.353). Among susceptible officers, perceived stress may contribute to CVD directly and through potentiating several CVD risk factors.