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. 2025 Jan 13;20(1):e0299781.
doi: 10.1371/journal.pone.0299781. eCollection 2025.

Sociodemographic and behavioral factors associated with diet quality among low-income community health center patients with hypertension

Jessica Cheng  1   2 , Katherine C Faulkner  2 , Ashlie Malone  2 , Kristine D Gu  3   4 , Anne N Thorndike  2   3
Affiliations

Sociodemographic and behavioral factors associated with diet quality among low-income community health center patients with hypertension

Jessica Cheng et al. PLoS One. .

Abstract

Objective: Identify the most important sociodemographic and behavioral factors related to the diet of low-income adults with hypertension in order to guide the development of a community health worker (CHW) healthy eating intervention for low-income populations with hypertension.

Design: In this cross-sectional analysis, dietary recalls were used to assess Healthy Eating Index-2020 (HEI-2020) total (range: 0 to 100 [best diet quality]) and component scores and sodium intake. Self-reported sociodemographic and behavioral data were entered into a Least Absolute Shrinkage and Selection Operator (LASSO) regression model to determine the relative importance of factors related to diet quality.

Setting: Five community health centers in Boston, Massachusetts.

Participants: Adults (>20 years old) with a hypertension diagnosis.

Results: Participants (N = 291) were mostly female (65.0%), on Medicaid (82.8%), food insecure (59.5%), and Hispanic (52.2%). The mean (95% CI) HEI-2020 score was 63.0 (62.3, 65.7) Component scores were low for sodium and whole grains; mean (SE) sodium intake was 2676.9 (45.5) mg/day. The most important factors associated with lower HEI-2020 scores were: not having own housing, male gender, tobacco use, marijuana use, and skipping meals; the most important factors associated with higher HEI-2020 scores were Hispanic ethnicity and receipt of community food resources (5-fold cross-validated R2 = 0.17).

Conclusions: In this population of low-income adults with hypertension, diet quality would be improved by reducing sodium and increasing whole grain intake. Healthy eating interventions among low-income populations should consider providing dietary guidance in the context of behavioral factors (e.g., meal skipping) and substance use (e.g., marijuana) and should address barriers to health eating through referral to community food resources (e.g., food pantries).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Factors related to HEI-2020 scores identified by LASSO.
Note: GAD, General Anxiety Disorders Questionnaire; PHQ, Patient Health Questionnaire; PROMIS, Patient-Reported Outcomes Measurement Information System. Factors are ranked from top to bottom in order of importance based on the absolute value of the model coefficients. A positive coefficient means that the reference value is associated with better diet quality. A negative coefficient means that the reference value is associated with worse diet quality.
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