title: Eligibility for interventions, co-occurrence and risk factors for unhealthy behaviours in patients consulting for routine primary care: results from the Pre-Empt study.
abstract: BACKGROUND
  Smoking, excessive drinking, lack of exercise and a poor diet remain key causes of premature morbidity and mortality globally, yet it is not clear what proportion of patients attending for routine primary care are eligible for interventions about these behaviours, the extent to which they co-occur within individuals, and which individuals are at greatest risk for multiple unhealthy behaviours. The aim of the trial was to examine 'intervention eligibility' and co-occurrence of the 'big four' risky health behaviours - lack of exercise, smoking, an unhealthy diet and excessive drinking - in a primary care population.
  
  
  METHODS
  Data were collected from adult patients consulting routinely in general practice across South Wales as part of the Pre-Empt study; a cluster randomised controlled trial. After giving consent, participants completed screening instruments, which included the following to assess eligibility for an intervention based on set thresholds: AUDIT-C (for alcohol), HSI (for smoking), IPAQ (for exercise) and a subset of DINE (for diet). The intervention following screening was based on which combination of risky behaviours the patient had. Descriptive statistics, χ2 tests for association and ordinal regressions were undertaken.
  
  
  RESULTS
  Two thousand sixty seven patients were screened: mean age of 48.6 years, 61.9 % female and 42.8 % in a managerial or professional occupation. In terms of numbers of risky behaviours screened eligible for, two was the most common (43.6 %), with diet and exercise (27.2 %) being the most common combination. Insufficient exercise was the most common single risky behaviour (12.0 %). 21.8 % of patients would have been eligible for an intervention for three behaviours and 5.9 % for all four behaviours. Just 4.5 % of patients did not identify any risky behaviours. Women, older age groups and those in managerial or professional occupations were more likely to exhibit all four risky behaviours.
  
  
  CONCLUSIONS
  Very few patients consulting for routine primary care screen ineligible for interventions about common unhealthy behaviours, and most engage in more than one of the major common unhealthy behaviours. Clinicians should be particularly alert to opportunities to engaging younger, non professional men and those with multi-morbidity about risky health behaviour.
  
  
  BACKGROUND
  ISRCTN22495456.
authors.affiliation: South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK. randelle@cardiff.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Randell
authors.affiliation: South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK. pickleste@cardiff.ac.uk.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pickles
authors.affiliation: MRC/CSO SPHSU, 200 Renfield Street, Glasgow, G2 3QB, UK. sharon.simpson@glasgow.ac.uk.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Simpson
authors.affiliation: School of Psychology, Faculty of Health & Social Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU, UK. clio.spanou@beds.ac.uk.
authors.forename: Clio
authors.initials: C
authors.lastname: Spanou
authors.affiliation: Department of Health Sciences, Seebohm Rowntree Building University of York, Heslington, York, YO10 5DD, UK. jim.mccambridge@york.ac.uk.
authors.forename: Jim
authors.initials: J
authors.lastname: McCambridge
authors.affiliation: South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK. hoodk1@cardiff.ac.uk.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6NW, UK. christopher.butler@phc.ox.ac.uk.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000437:Alcoholism / Q000453:epidemiology; D004032:Diet / Q000009:adverse effects; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014852:Wales / Q000453:epidemiology