Purpose: Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization.
Design: Cross-sectional telephone survey.
Setting: All United States and Territories.
Subjects: 246 801 adults aged 18-64.
Measures: The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined.
Analysis: Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions.
Results: The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25-35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior.
Conclusion: Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.
Keywords: alcohol; health risk behaviors; multiple health risk behaviors; primary care; primary care utilization; smoking.