title: The influence of obesity, alcohol abuse, and smoking on utilization of health care services.
abstract: OBJECTIVE
  There is extensive evidence relating individual behavioral risk factors to adverse health outcomes and associated costs; however, more-comprehensive assessments have been limited. Our objective was to examine the relative effects of obesity, alcohol abuse, and smoking on health care use and associated charges.
  
  
  METHODS
  New adult patients (n=509) were randomly assigned to primary care physicians, and their utilization of medical services was monitored for 1 year. Variables measured included sociodemographics, self-reported health status, Beck Depression Index, measured body mass index, Michigan Alcohol Screening Test results, and smoking history.
  
  
  RESULTS
  Controlling for health status, depression, age, education, income, and gender, obesity was associated with the mean number of primary care visits, diagnostic services, and primary care clinic charges. Alcohol abuse was related to the mean number of emergency department visits and diagnostic services. Smoking was associated with the mean number of specialty clinic visits and hospitalizations. Smoking also predicted charges for emergency department visits, hospitalizations, and total health care charges.
  
  
  CONCLUSIONS
  The economic burden of smoking is significant, even after only 1 year. Health care providers should focus attention on smoking prevention and cessation programs as an approach for managing medical costs.
authors.affiliation: Department of Family and Community Medicine, University of California, Davis, CA 95817, USA. kdbertakis@ucdavis.edu
authors.forename: Klea D
authors.initials: KD
authors.lastname: Bertakis
authors.forename: Rahman
authors.initials: R
authors.lastname: Azari
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States