title: Are primary-care physician practices related to health behaviors likely to reduce social inequalities in health?
abstract: Our objective was to examine patients' health behaviors and the related practices of their primary-care physicians to determine whether physicians' actions might help to reduce the social inequalities in health behaviors among their patients. Fifty-two general practitioners, who were also medical school instructors in the Parisian area, volunteered to participate. A sample of 70 patients (stratified by sex) aged 40-70years was randomly chosen from each physician's patient panel and asked to complete a questionnaire about their social position and health behaviors: tobacco and alcohol use, diet, physical activity, and participation in breast and cervical cancer screening. Each physician reported their practices related to each such behavior of each patient. Mixed models were used to test for social differences. Questionnaires were collected in 2008-2009 from both patient and physician for 71% of the 3640 patients. Our results showed social inequalities disfavored those at the bottom of the social scale for all but one of the health behaviors studied among both men and women (exception: excessive alcohol consumption among women). Physicians' practices related to these health behaviors also appeared to be socially differentiated. Among men, this differentiation favored those with the lowest social position for all behaviors except physical activity. Among women, however, practices favored the most disadvantaged only for breast cancer screening. In all other cases, they were either socially neutral or unfavorable to the most disadvantaged. Physicians' practices related to their patients' health behaviors should focus more on those lowest in the social hierarchy, especially among women.
authors.affiliation: Sorbonne Paris Cité, Paris Descartes University, General Practice Department, Paris, France. Electronic address: jean-laurent.thebault@parisdescartes.fr.
authors.forename: Jean-Laurent
authors.initials: JL
authors.lastname: Thebault
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Ringa
authors.affiliation: LEDi, University of Burgundy, UMR CNRS 6307, Inserm U1200, Dijon, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Bloy
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Kremlin-Bicêtre, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pendola-Luchel
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Kremlin-Bicêtre, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Paquet
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Panjo
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Kremlin-Bicêtre, France.
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Delpech
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Kremlin-Bicêtre, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bucher
authors.affiliation: Department of General Practice, University of Lyon 1, Lyon, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Casanova
authors.affiliation: Sorbonne Paris Cité, Paris Descartes University, General Practice Department, Paris, France; Société de Formation Thérapeutique du Généraliste, Paris, France.
authors.forename: Hector
authors.initials: H
authors.lastname: Falcoff
authors.affiliation: Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France; Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Kremlin-Bicêtre, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Rigal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Health behavior; Primary-care physician; Social determinants of health