Date of Graduation


Document Type


Degree Type



School of Pharmacy


Pharmaceutical Sciences

Committee Chair

Carole V Harris


Although modifiable risk factors for coronary heart disease (CHD) can be favorably impacted by healthful diet and physical activity, health care providers face a population that generally exhibits unhealthy eating habits and sedentary lifestyles. Identifying strategies to improve the effectiveness of health care provider guidance is urgently needed to reduce CHD risk. The objective of this series of studies was to determine the association between CHD knowledge, perceived risk, and delay discounting and diet and physical activity (PA) levels in adults. The research design was cross-sectional and the methods included an online survey to obtain information regarding CHD knowledge, perceived risk, and preventive behaviors and a binary choice discounting procedure to elicit degree of discounting for hypothetical monetary and health rewards in an Appalachian population. The specific aims of the studies were: (1) To determine the association between knowledge and perceived risk of CHD and diet and PA in Appalachians, and (2) To evaluate the association between the degree of discounting of future health and diet and PA. In the first two studies, overall knowledge of CHD was positively correlated with both healthfulness of diet and PA levels, but these associations were no longer significant after controlling for demographic factors and other components of the HBM, including perceived risk of CHD, perceived severity of CHD, perceived benefits and barriers to preventive behaviors, self-efficacy, and cue to action. Contrary to the direction of association predicted by the HBM, perceived risk was negatively associated with diet and PA behaviors. Age, perceived barriers, self-efficacy and physician recommendations for lifestyle changes may also play a role based on their significance as predictors of dietary or PA behaviors. In the third study, degree of delay discounting was not associated with CHD preventive behaviors, specifically diet and PA. Perceived risk was negatively associated with preventive behaviors, but no association with degree of discounting was shown. When associations between value of the future and preventive behaviors were explored by BMI category, a positive correlation was demonstrated between value of the future and dietary behavior in underweight/healthy participants, but no association was found in overweight/obese participants.