Abstract. Background: Many people rely on EDs for routine health care. Often, however, screening and counseling for health risks are not provided. Objective: To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a random sample of ED patients in 3 cities. Methods: A prospective survey was conducted a t 3 hospital EDs in Akron, OH, Boston, MA, and Denver, CO. A modified version of the national Behavioral Risk Factor Surveillance Survey was administered by trained researchers to a convenience sample of noncritically 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 unmarried (68%). Thirty-eight percent had no access to primary care. Injury-prone behaviors were prevalent: 53% of the respondents did not wear seat belts regularly; 15% had no working smoke detector; 3% kept loaded, unlocked handguns in their homes; 11% had attempted suicide; 23% had a positive CAGE screen for alcoholism; 3% had operated a motor vehicle in the preceding month while alcohol-intoxicated; and 11% had ridden in an automobile with an intoxicated driver. Cancer and chronic disease risks were also common: 48% smoked; 16% had not received a blood pressure check in the preceding year; and 4% reported unsafe sexual practices. Among women aged >50 years, 42% had not received a Pap test in the prior 2 years and 14% had never had mammography. Many prevalence rates and access to care varied among the 3 sites. However, for most risk factors, prevalence rates did not differ in patients with and without access to primary health care. Conclusions: ED patients have high rates of injury and chronic disease risks, and many have no other source 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. Key words: risk factor surveillance; injury prevention; emergency medicine; screening. ACADEMIC EMERGENCY MEDICINE 1998; 5~781-787 ACH YEAR >90 million patients seek care in E hospital-based EDs.'.* Many of the conditions for which they seek treatment, including falls, traffic-related injuries, alcohol and drug intoxication, interpersonal violence, tobacco-related illnesses, and sexually transmitted diseases, arise from high-risk behaviors and lifestyles and are preventable. In 1994 SAEM concluded that emergency care "include[sl preventive and educational, as well as curative, medical s e r~i c e s . "~ SAEM as-

ISIS and other international terrorist organizations rely on the Internet to disseminate their extremist rhetoric and to recruit people to their cause, particularly through popular online social media applications. Any meaningful counterterrorism strategy must, therefore, account for the ways in which terrorist organizations use the Internet to prey on young, manipulable minds who are drawn to radical ideas and propaganda and to the desire to serve a cause larger than themselves. This article outlines the ways in which extremist organizations use the Internet to ensnare new recruits, analyzes the implications of cyber-recruitment on existing counterterrorism techniques, and suggests ways in which the U.S. government can work with Internet service providers and other major cyber corporations to better address this growing threat.

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