title: Diet and physical activity counseling during ambulatory care visits in the United States.
abstract: BACKGROUND
  Research is limited regarding national patterns of behavioral counseling during ambulatory care. We examined time trends and independent correlates of diet and physical activity counseling for American adults with an elevated cardiovascular risk during their outpatient visits.
  
  
  METHODS
  The National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) provided 1992-2000 national estimates of counseling practices in private physician offices and hospital outpatient departments.
  
  
  RESULTS
  Rates of diet and physical activity counseling among visits by at-risk adults exhibited a modest ascending trend from 1992 to 2000, with the biggest growth found between 1996 and 1997. Throughout the 1990s, however, diet counseling was provided in <45% and physical activity counseling in < or = 30% of visits by adults with hyperlipidemia, hypertension, obesity, or diabetes mellitus. Lower likelihood of either counseling was significantly associated with patients who were > or = 75 years of age, seen by generalists, and those with fewer risk factors. Also, diet counseling was less frequently provided during visits by whites vs. ethnic minorities and by men vs. women.
  
  
  CONCLUSIONS
  Despite available national guidelines, diet and physical activity counseling remain below expectations during outpatient visits by adults with an elevated cardiovascular risk. Given recent trends, immediate, satisfactory improvement is unlikely without future innovative interventions.
authors.affiliation: Program of Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, CA 94305-5705, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Guido G
authors.initials: GG
authors.lastname: Urizar
authors.forename: Tseday
authors.initials: T
authors.lastname: Alehegn
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003376:Counseling; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000517:prevention & control; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D010045:Outpatients / Q000193:education / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology