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Volume 8: No. 6, November 2011

ORIGINAL RESEARCH
A Latent Class Modeling Approach to Evaluate Behavioral Risk Factors and Health-Related Quality of Life

This diagram shows how the indicators, domains, outcomes, and sociodemographic characteristics are related. Twenty-four manifest dichotomous health indicators (represented by rectangles) are grouped into 4 domains (circles) that are related to 2 outcomes after adjustment for sociodemographic characteristics. The first 5 indicators measure the domain risky behaviors; the next 8 indicators, health conditions; the next 5 indicators, health care access; and the remaining 6 indicators, use of preventive services. The outcomes, frequent physical distress and frequent mental distress, are then regressed on these 4 domains and on age group, sex, race/ethnicity, education level, and employment status.

Figure 1. Indicators, health domains, outcomes, and covariates for latent class modeling approach to analyze 2008 data from the Rhode Island Behavioral Risk Factor Surveillance System. Abbreviations: BMI, body mass index; PSA, prostate-specific antigen; Pap, Papanicolaou.

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Behavior Class 3: High Risk (9.1% of Population), % Class 2: Intermediate Risk (31.0% of Population), % Class 1: Low Risk (59.9% of Population), %
Does not always wear seatbelt 28.6 40.1 7.2
Current smoking 33.9 31.0 7.8
Binge drinking 99.5 17.4 5.1
Heavy drinking 53.8 2.5 2.1
Drinking and driving 29.5 3.4 0.4

Figure 2. Probabilities of risky behaviors by latent class, Rhode Island Behavioral Risk Factor Surveillance System, 2008. Behaviors refer to the past 30 days. Binge drinking defined as ≥5 drinks for men or ≥4 drinks for women on 1 occasion. Heavy drinking defined as ≥3 drinks/d for men or ≥2 drinks/d for women.

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Condition Class 3: Multiple Conditions (5.7% of Population), % Class 2: Intermediate Conditions (18.1% of Population), % Class 1: Few Conditions (76.2% of Population), %
Asthma 15.6 20.0 8.0
Diabetes 33.0 20.4 2.4
Obesity 41.0 39.6 16.5
Disability 58.7 55.5 9.7
≥6 teeth removed 54.4 37.5 4.9
Angina 63.3 2.1 0.8
Heart attack 64.3 0.0 0.4
Stroke 17.2 5.2 0.5

Figure 3. Probabilities of health conditions by latent class, Rhode Island Behavioral Risk Factor Surveillance System, 2008. Health conditions defined as having ever been told by a health professional that they had the condition. Obesity defined as body mass index ≥30 kg/m2

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Access Indicator Class 3: Limited Access (10.2% of Population), % Class 2: Intermediate Access (7.3% of Population), % Class 1: Has Access (82.5% of Population), %
No regular provider 44.2 97.2 0.0
No routine checkup in past year 61.3 55.8 12.9
No dental visit in past year 58.3 22.1 16.2
No health coverage 68.3 19.2 2.9
Does not see doctor due to cost 73.7 0.1 4.8

Figure 4. Probabilities of health care access by latent class, Rhode Island Behavioral Risk Factor Surveillance System, 2008.

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Service Class 3: Lower Use (21.1% of Population), % Class 2: Intermediate Use (51.6% of Population), % Class 1: Higher Use (27.3% of Population), %
No pneumonia vaccine ever 85.3 94.0 28.5
No flu vaccine in past year 74.9 70.9 20.5
No PSA test in past 2 y, ages ≥40 y 98.8 33.3 11.5
No sigmoidoscopy or colonoscopy ever, ages ≥50 y 76.6 33.3 12.4
No mammogram in past 2 y, ages ≥40 y 81.4 3.2 6.0
No Pap test in past 3 y 48.4 0.1 13.6

Figure 5. Probabilities of use of preventive services by latent class, Rhode Island Behavioral Risk Factor Surveillance System, 2008. The prostate-specific antigen (PSA) test question was only asked of men. The mammogram and Papanicolaou (Pap) test questions were only asked of women.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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