Adapting Andersen’s Behavioral Model of Health Service Use to Examine Risk Factors for Hypertension Among U.S. MSM

Sabina Hirshfield, Martin J. Downing, Keith J. Horvath, James A. Swartz, Mary Ann Chiasson

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Hypertension affects nearly a third of U.S. adult males and is a leading risk factor for cardiovascular disease, but there is a paucity of hypertension research among men who have sex with men (MSM). Andersen’s model of health service use was adapted to examine factors associated with hypertension among MSM. In 2008, 7,454 U.S. MSM completed an online survey. Overall, 16.5% of the sample reported a lifetime diagnosis of hypertension. In hierarchical logistic regression, Black MSM had increased odds of reporting hypertension (adjusted odds ratio [AOR] = 1.79, 95% confidence interval [CI] [1.24, 2.60]) compared with White MSM, as did men aged 30 years and older (age 30-39: AOR = 2.46, 95% CI [1.84, 3.29]; age 40-49: AOR = 3.76, 95% CI [2.85, 4.97]; age 50+: AOR = 6.40, 95% CI [4.78, 8.58]; Reference: 18-29 years). Health conditions associated with hypertension included diabetes (AOR = 3.62, 95% CI [2.81, 4.68]), heart disease (AOR = 5.19, 95% CI [3.99, 6.75]), depression (AOR = 1.38, 95% CI [1.17, 1.63]), anxiety (AOR = 1.30, 95% CI [1.09, 1.57]), and being overweight (AOR = 2.23, 95% CI [1.91, 2.59]). Having a primary care provider (AOR = 2.19, 95% CI [1.64, 2.93]) and residing in South Atlantic (AOR = 1.39, 95% CI [1.12, 1.74]) or South Central (AOR = 1.59, 95% CI [1.27, 2.00]) regions was also associated with reporting hypertension. Study findings are consistent with those in the literature for the general population. To address health care inequities, the Internet could serve as a potential access point for health screening and referral for care.

Original languageEnglish (US)
Pages (from-to)788-797
Number of pages10
JournalAmerican Journal of Men's Health
Issue number4
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Centers for Disease Control and Prevention (CDC) through a federal cooperative agreement (UR6 PS000415). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Publisher Copyright:
© 2016, The Author(s) 2016.


  • LGBT health
  • health behavior
  • health disparities
  • hypertension
  • men who have sex with men

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