Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Healthcare workers (HCWs) represent an important group in which to study individual health behaviors, both because they are more knowledgeable than others about health care choices and because they serve as role models for patients.1,2 We sought to describe the prevalence of preventative and lifestyle behaviors among HCWs in a nationally representative sample of American adults.
The Behavioral Risk Factor Surveillance System (BRFSS)3 is an annual telephone survey of the adult US population conducted by the Centers for Disease Control and Prevention. We included all respondents to the question “Do you provide direct patient care as part of your routine work?” asked in 2008 and 2010. Overall response rates were 53.3% in 2008 and 54.6% in 2010. The Beth Israel Deaconess Medical Center committee on clinical investigations (Boston, Massachusetts) approved our analyses.
We assessed 6 preventative health behaviors and 14 lifestyle factors as binary variables (Table), defining outcomes as less desirable behaviors. We used logistic regression to estimate risk ratios (RR) when outcomes wereuncommon (prevalence <25%), and Poisson regression when more common.4 We created a first multivariate model adjusted for age, age squared, sex, race, state, and education, and a second that added income and employment.
The study population included 260 558 participants, including 21 380 HCWs. The Table shows the prevalence and weight-adjusted RRs for selected health behaviors and lifestyle factors, comparing HCWs with non-HCWs. As anticipated, HCWs reported more desirable behaviors than non-HCWs for several outcomes: HCWs were more likely to have a personal physician, to have a checkup within 2 years, to have exercised within 30 days, and to deny recent heavy or binge drinking.
However, for many behaviors, HCWs demonstrated no difference in the likelihood of the outcomes. We observed no significant differences in the likelihood of having a recent Papanicolaou test or dental visit, ever having a sigmoidoscopy or colonoscopy, being overweight or obese, drinking and driving, failing to wear a seatbelt, smoking, using smokeless tobacco, engaging in human immunodeficiency virus (HIV) risk behaviors, getting sunburned, or being dissatisfied with life. Most surprisingly, female HCWs were significantly more likely to report not having a mammogram within the past 2 years.
Since HCWs include individuals with a wide range of professional training, we performed analyses stratified by college graduate status. While HCWs were more likely to have seen a personal physician in the past year than non-HCWs, this advantage was significantly greater among HCWs with less education. In contrast, the lower likelihood of overweight and obesity among HCWs seemed limited to those with at least a college education (P < .001 for both interactions). No outcomes demonstrated significant interaction by sex.
In this large, population-based survey of Americans, HCWs seemed to be better than other Americans at maintaining a healthy lifestyle in some areas, but there were many other areas in which they reported performing no better than other Americans in adhering to health guidelines. Notably, female HCWs were less likely to undergo regular mammography screenings than non-HCWs.
To our knowledge, ours is the first nationally representative report about a full range of health care practices of HCWs. A key question for our study is whether our findings should be viewed as reassuring. It is reassuring to know that, as expected, HCWs performed better in several aspects. More immediate access to health care may have influenced the likelihood of having a personal physician or a recent checkup. However, access alone cannot be the only explanation since similar health care behaviors (eg, colonoscopy) were not always more common among HCWs. Healthcare workers were less likely to report heavy or binge drinking, consistent with previous studies.5
There were many areas, however, where HCWs performed no differently than other Americans and have substantial opportunities to perform better. Where absolute rates of adverse behaviors were low, such as HIV risk behaviors, most Americans adhere to public health recommendations, and the lack of difference between HCWs and other Americans is reassuring.
Perhaps most surprisingly, female HCWs older than 50 years were less likely to adhere to the guidelines of having a mammogram within the past 2 years. Other studies have also observed this paradoxical, unexplained finding.6
Among respondents who were not college graduates, HCWs were more likely to have a personal physician than non-HCWs, an association absent among graduates. If confirmed, working in health care may improve access preferentially among individuals at greatest risk for not having a regular provider.7
Specific limitations should be mentioned. The BRFSS is limited to self-reported information, which cannot be externally confirmed. Because HCWs did not report their specific positions, we cannot differentiate between physicians, nurses, aides, and other HCWs.
In conclusion, HCWs adhered variably to healthy life choices, often no differently and, for mammography, even less than other Americans. Interventions directed toward HCWs or their employers may improve overall adherence rates.8 Despite serving as role models, HCWs frequently do not “practice what they preach.”
Correspondence: Dr Mukamal, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon St, Second Floor, Brookline, MA 02446 (firstname.lastname@example.org).
Published Online: December 17, 2012. doi:10.1001/2013.jamainternmed.1039
Author Contributions: Mr Helfand had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Helfand and Mukamal. Acquisition of data: Helfand and Mukamal. Analysis and interpretation of data: Helfand and Mukamal. Drafting of the manuscript: Helfand. Critical revision of the manuscript for important intellectual content: Helfand and Mukamal. Statistical analysis: Helfand. Study supervision: Mukamal.
Conflict of Interest Disclosures: None reported.
Additional Information: This work is dedicated to the memory of Joshua Bryan Inouye Helfand. This manuscript contains original data.
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