title: Primary and secondary prevention of alcohol problems: U.S. internist attitudes and practices.
abstract: OBJECTIVE
  To describe internists' involvement in primary and secondary prevention of alcohol-related problems, and to evaluate relationships between preventive practices and training, attitudes, and work patterns.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  A random sample of 152 board-certified internists, < or = 65 years old, who practiced primary care in the continental United States, was selected from the American Medical Association's master list. Ten were ineligible; 99 (70%) of the remaining 142 internists completed questionnaires.
  
  
  METHODS
  The authors evaluated the internists' preventive practices, including the frequency with which they assessed patients' alcohol consumption and advised patients about safe levels of alcohol consumption. The authors also evaluated the internists' opinions about safe levels of alcohol consumption, training and attitudes regarding advising patients about safe levels of consumption, and work patterns.
  
  
  RESULTS
  Ninety-four percent of the respondents believed they had a responsibility to advise all patients about safe levels of alcohol consumption (primary prevention), though only 30% often/always did so. Eighty percent often/always advised patients who drank three or more drinks daily about safe levels of alcohol consumption (secondary prevention), but many (45%) did not routinely ask patients how much they drank daily. Preventive practices correlated positively with the number of hours/week internists practiced primary care, and with their belief in the effectiveness of preventive advice about alcohol consumption.
  
  
  CONCLUSIONS
  Internists believe they have a responsibility for primary prevention of alcohol-related problems, but only a minority actively practice it. In contrast, many internists practice secondary prevention, offering advice about safe alcohol consumption to patients who drink three or more drinks daily. The effectiveness of such secondary prevention is limited, however, by incomplete screening regarding level of alcohol consumption.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Bradley
authors.forename: S J
authors.initials: SJ
authors.lastname: Curry
authors.forename: T D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: E B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D000437:Alcoholism / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D003376:Counseling; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention; D014481:United States