DR Miller, CHQOER, Bedford, MA; A Lee, CHQOER, Bedford, MA; D Kalman, CHQOER, Bedford, MA; A Spiro, CHQOER, Bedford, MA; L Kazis, CHQOER, Bedford, MA

Objectives: Risk of disease and overall patient health is influenced by lifestyle and health habits such as nutrition, physical activity, and use of tobacco and alcohol. Furthermore, the health care system can play an important role in assisting patients to modify such habits in order to improve health and reduce subsequent need for services. These factors may contribute substantially to the poor health of VHA patients. Using recently collected survey data, we report national prevalence estimates of behavioral risk factors, associated illness burden, and patient report of services to screen for and modify such factors.

Methods: In the 1999 Large Health Survey of Veterans, a stratified random sample of VA enrollees (~41%) were mailed questionnaires and 879,980 (61%) responded. Survey responses were weighted for sampling and response bias, and linked with patient medical records. Weighted survey estimates represent the entire population of VA users (3.4 million). Overall and stratified rates of behavioral risk factors are presented; where available, comparable estimates from BRFSS and NHIS for the U.S. general population are presented and VHA rates are age and sex standardized to the U.S. population.

Results: Nutritional problems are common among VHA enrollees: 45% are at risk of nutritional problems based on NSI checklist, 44% were obese (U.S. sex/age standardized: 43.0% for VHA vs. 32.3% for U.S. population), 83% eat less than recommended fruits or vegetables (82.1% vs. 75.1%), 53% report poor oral health, 25% usually eat less than 2 meals each day, 34% eat alone most of the time, 31% report recent weight change of 10+ pounds, and 16% are concerned about having enough food for themselves and their family (20.0% vs. 4.6%). Less than 30% of enrollees exercised regularly and only 40% regularly walk outside of the home. With respect to tobacco and alcohol use, 30% currently smoke (32.5% vs. 22.7%), 9% smoke 1+ pack a day (10.5% vs. 3.5%), 9% have 2+ alcoholic drinks per day (6.2% vs. 4.6%), and 3.5% drink 4+ per day (2.1% vs. 1.0%). Behavioral risk factor profiles varied somewhat with sex, age, race, priority category, and VISN. Adverse health habits are associated with higher disease prevalences, lower SF-36v scores, and higher health care costs. Many patients reported that, in the past year, a VA provider had asked about their diet (43.2%), physical activity (45.7%), smoking (71.8%), and alcohol drinking (52.3%), but few smokers (23.6%) and heavy drinkers (17.2%) were treated or referred and over 80% indicated they did not get the services that they needed to make the changes.

Conclusions: Behavioral risk factors represent a substantial burden on VHA patients and contribute to poor health and greater use of services. VHA patients have higher frequencies of adverse health habits, ranging from obesity, lack of physical activity, and poor food choices to food insecurity, physical and social impediments to good nutrition, and tobacco and alcohol abuse.

Impact: To the extent that these factors are amenable to change and they contribute to poor quality of life, more illness burden, and greater demand for health services, the VHA should pursue opportunities to expand services to assist patients in making the appropriate changes to improve their behavioral risk profile.