Behavioral Risk Factors in Emergency Department Patients: A Multisite Survey

Abstract

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-

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