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Addressing multiple risk factors for certain diseases rather than just one may promote healthier lifestyles

Heavy alcohol use, smoking, sedentary lifestyle, and an unhealthy diet all increase an individual's risk of developing coronary heart disease, diabetes, and other problems. Authors of a series of papers in a supplement to the American Journal of Preventive Medicine suggest that clinicians and researchers adopt a more comprehensive and integrated approach to promoting healthier lifestyles in place of the current practice of addressing individual risk factors one at a time. The authors document the prevalence of multiple risk factors, summarize what is known and what is not known about how to identify and intervene to address risk factors, and suggest an agenda for moving research and policy forward.

The intuitive logic of a more integrated approach is certainly appealing, note David Atkins, M.D., M.P.H., of the Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, and AHRQ Director Carolyn M. Clancy, M.D., in a commentary in the supplement. Because risk is often multiplied when more than one risk factor is present, reducing several risk factors at once should magnify the health benefits that accrue from small changes in behavior. Changing one behavior often sparks changes in others. For example, adopting a healthier diet may empower a person to become more active and vice versa.

Also, available interactive systems make it easier for clinicians to collect information on a variety of risks and augment clinical interventions. Because the research base on multiple interventions is more limited than it is for single interventions, it is less clear whether, or in which situations, multiple risk factor interventions are more effective or efficient at reducing risk than targeted single interventions. Also, existing studies do not resolve how well interventions will work in a typical primary care practice. The Prescription for Health Program, funded by AHRQ and the Robert Wood Johnson Foundation, is testing innovative approaches in AHRQ's Practice-Based Research Networks and other real-world settings.

More details are in "Multiple risk factors interventions: Are we up to the challenge?" by Drs. Atkins and Clancy, in the American Journal of Preventive Medicine 27(2S), pp. 102-103, 2004.

Reprints (AHRQ Publication No. 04-R063) are available from the AHRQ Publications Clearinghouse.

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