BEHAVIORAL RISK-FACTORS IN EMERGENCY DEPARTMENT PATIENTS - A MULTISITE SURVEY

Background: Many people rely on EDs for routine health care. Often, ho wever, screening and counseling for health risks are not provided. Obj ective: To determine prevalence rates of chronic disease and injury ri sk factors and access to routine health care in a random sample of ED patients in 3 cities. Methods: A prospective survey was conducted at 3 hospital EDs in Akron, OH, Boston, MA, and Denver, CO. A modified ver sion of the national Behavioral Risk Factor Surveillance Survey was ad ministered by trained researchers to a convenience sample of non-criti cally ill patients during randomly selected shifts. Results: Of 1,143 eligible patients, 923 (81%) agreed to participate. Their mean age was 39 (range = 17-96) years. Most were female (58%), white (60%), and un married (68%). Thirty-eight percent had no access to primary care. Inj ury-prone behaviors were prevalent: 53% of the respondents did not wea r seat belts regularly; 15% had no working smoke detector; 3% kept loa ded, unlocked handguns in their homes; 11% had attempted suicide; 23% had a positive CAGE screen for alcoholism; 3% had operated a motor veh icle in the preceding month while alcohol-intoxicated; and 11% had rid den in an automobile with an intoxicated driver. Cancer and chronic di sease risks were also common: 48% smoked; 16% had not received a blood pressure check in the preceding year; and 4% reported unsafe sexual p ractices. Among women aged > 50 years, 42% had not received a Pap test in the prior 2 years and 14% had never had mammography. Many prevalen ce rates and access to care varied among the 3 sites. However, for mos t risk factors, prevalence rates did not differ in patients with and w ithout access to primary health care. Conclusions: ED patients have hi gh rates of injury and chronic disease risks, and many have no other s ource of routine health care. Research is needed to determine whether ED-based programs, designed to reduce injury and chronic disease risks , are feasible and cost-effective.