Health promotion in primary care: a survey of U.S. family practitioners.

A national sample of family practice physicians reported on the treatments and referrals they provide for each of three behavioral health risks--cigarette smoking, obesity, and insufficient exercise--and on obstacles to effective office-based health promotion. Most respondents reported regular health education and advice, but infrequent systematic treatment or referral for the substantial proportions of their patients who smoke cigarettes (40%), are obese (40%), or get too little exercise (70%). Results confirm past impressions that primary-care physicians (a) are somewhat reluctant to treat such problems, (b) overutilize relatively ineffective risk education strategies, and (c) underutilize potentially more effective behavioral or psychological treatments, either in their practices or via referral to outside programs and specialists. Physicians' pessimism about their patients' abilities to change health lifestyles, a lack of confidence in their own and outside treatments, and perceived patient rejection of referral for lifestyle change treatment, appear the major contributors to this underutilization along with the known financial and organizational obstacles to office-based health promotion and a lack of time and training for these activities. Suggestions for improving primary-care training and supports for health-promotion services are offered.