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Prev Med. 2018 Jun;111:21-27. doi: 10.1016/j.ypmed.2017.12.009. Epub 2017 Dec 22.

Behavioral and mental health risk factor profiles among diverse primary care patients.

Author information

1
Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA. Electronic address: bglenn@ucla.edu.
2
Center for Cancer Prevention and Control Research, Department of Biostatistics, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
3
Division of Health Policy and Management, University of California, Berkeley School of Public Health, 50 University Hall, Berkeley, CA 94720, USA.
4
Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
5
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Chicago, IL 60611, USA.
6
New York Physicians against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, NY 10032, USA; Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, 6130 Executive Plaza, Bethesda, MD 20892, USA.
7
Department of Health Sciences Administration, Jefferson College of Health Sciences at Carilion Clinic, 101 Elm Avenue, Roanoke, VA 24016, USA; Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.
8
University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin Street, Houston, TX 77030, USA.
9
Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198, USA.
10
Doctor of Behavorial Health Program, College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, USA.
11
Department of Health Services Administration, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20742, USA.
12
Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Rockville, MD 20852, USA.
13
UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, NC 27599, USA.
14
Center for Population Health and Aging, Texas A&M Health Sciences Center, College Station, TX 77843, USA.
15
Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980251, Richmond, VA 23298, USA.

Abstract

Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n=1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a 'Mental Health Risk' class (prevalence=14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'Substance Use Risk' class (29%; highest tobacco, drug, alcohol use), a 'Dietary Risk' class (29%; high BMI, poor diet), and a 'Lower Risk' class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0-14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.

KEYWORDS:

Behavioral health; Latent class analysis; Multiple risk factors; Primary care

PMID:
29277413
PMCID:
PMC5930037
[Available on 2019-06-01]
DOI:
10.1016/j.ypmed.2017.12.009

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