Manuti et al. BMC Public Health 2010, 10:350 http://www.biomedcentral.com/1471-2458/10/350 among men and more than 1 drink per day during the previous 30 days among women (>30 drinks/month). Excessive alcohol use was defined on the basis of either heavy drinking (high average consumption), binge drink- ing (high per occasion consumption), or both [19]. The interview was also intended to collect the follow- ing data for each patient: socio-demographics (age, sex, marital status, number of persons in the household, education level, working activity), perception of health status and utilization of health services during the pre- vious year (specialist visits, emergency accesses, and hos- pital admissions). We used level of education as a proxy indicator for socioeconomic status (SES) for several reasons, such as ease of measurement, applicability to persons not in the active labor force (e.g. homemakers, unemployed, and retired), and stability over adult lifespan. We preferred this definition instead of measuring income, since sub- jects consider this information too sensitive, and as a result they may offer less truthful responses. The per- ception of health status was assessed by using two com- ponents, 12-Physical Component Summary (PCS-12) and 12-Mental Component Summary (MCS-12), from the Medical Outcomes Study’s 12-Item Short-Form Survey Instrument, SF-12, in its validated Italian version [20-22]. The study protocol was approved by Ethics Commit- tee of the “Mater Domini” Hospital of Catanzaro (Italy) (Prot. E.C. n. 127/2006). Statistical analysis Multivariate stepwise logistic regression analysis was performed. Six models were developed including those variables potentially associated with the following out- comes of interest: blood pressure check on all patients otherwise presenting for care at least once each year (Model 1) (0 = no, 1 = yes); colorectal cancer screening with sigmoidoscopy or colonoscopy within the previous 10 years received by subjects aged 50 to 80 (Model 2) (0 = no, 1 = yes); cervical cancer screening received within the previous 3 years by all sexually active women (Model 3) (0 = no, 1 = yes); breast cancer screening received in the previous 2 years by women aged 50 to 70 (Model 4) (0 = no, 1 = yes); influenza and pneumo- coccal vaccinations offered at recommended times to subjects aged 65 and over (Model 5) (0 = no, 1 = yes); alcohol problem screening received by all subjects (Model 6) (0 = no, 1 = yes). In all models the explana- tory variables included were the following: gender (male = 0, female = 1) when appropriate, age (continuous), marital status (married = 0, other = 1), additional per- sons in the household (ordinal: none = 0, 1 = 1, >1 = 2), education level (ordinal: no formal education = 1, primary school = 2, secondary school = 3, high school Page 3 of 10 or higher = 4), working activity (housewife/student/ unemployed/retired = 1, other = 2), chronic disease (none = 0, ≥1 = 1), PCS score (continuous), MCS score (continuous), current tobacco use (ordinal: not at all = 0, some days = 1, every day = 2), excessive alcohol use (no = 0, yes = 1), PCP accesses in the previous year (<1 time per month = 0, ≥1 time per month = 1), PCP med- ical visits in the previous year (ordinal: none = 0, <1 time per month = 1, ≥1 time per month = 2), specialist visits in community health services (none = 0, ≥1 = 1), private specialist visits (none = 0, ≥1 = 1), emergency accesses in the previous year (none = 0, ≥1 = 1) and hospital admissions in the previous year (none = 0, ≥1 = 1). The significance level for variables entering the logis- tic regression models was set at 0.2 and for removal from the model at 0.4. Adjusted odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. The data were analyzed using the Stata software program, version 10.1 (Stata Corporation. College Station, TX) [23]. Results Of 1716 adults who were eligible for the study, 1467 agreed to participate and were enrolled, for a response rate of 85.5%. The main characteristics of the study population regarding socio-demographic profile, health condition and utilization of health services are presented in Table 1. Of all participants, 50.7% were current or ex-smokers; current drinkers (with an average of 1.5 drinks) and excessive drinkers were 58.1% and 8.3%, respectively. The mean score of perceived health status was 45.9 for PCS-12 and 44.9 for MCS-12. Of the parti- cipants, 46.7% had access at least monthly to a PCP, 39.3% and 47% had at least one specialist visit to the public or private sector, respectively; 23% and 12.8% reported at least one emergency visit and one hospital admission, respectively. Regarding recommendations of PCPs on specifically reducing behavioral risk factors related to high blood pressure, 97% of the subjects claimed to have been advised on the use of drugs, almost 90% in the reduc- tion of salt consumption, more than 80% in changing eating habits and augmenting physical activity, while fewer than three quarters were advised about reducing alcohol consumption (Table 2). Tables 2 and 3 show, respectively, the rates of delivery and the relationship between patients’ characteristics and access to selected clinical preventive services strati- fied by multivariate analysis. Providing health habits pre- ventive services was extremely low (less than 20%); those participants who were screened for drinking problems (16%) were significantly more likely to be males, exces- sive drinkers, less educated and frequent users of health services (PCP’ and public specialist’ medical visits). Blood pressure check in nonhypertensives showed