mates that in the United States, 700,000 people are infected with chlamydia, and 350,000–400,000 are infected with HIV (CDC, 2003).

Homicides and physical abuse. Homicide is a major cause of death in the United States and is the leading cause of death among Hispanic and non-Hispanic blacks aged 15–24 (CDC, 2002a). Major behavioral and psychosocial factors associated with homicide and domestic violence include poverty, firearm availability, alcohol abuse, drug abuse, and cultural acceptance of violent behavior (Brook et al., 2003). Physical intimidation and violent behavior may occur in the workplace, schools, and the home. Emergency department personnel or patients’ personal physicians (e.g., pediatrician or gynecologist) are often the first responsible persons not belonging to the family to become aware that physical abuse is occurring.

Domestic violence is frequently underrecognized in medical practice (Reid and Glasser, 1997). Physicians should regularly inquire about domestic physical abuse because of its high prevalence and high rate of morbidity (Alpert, 1995; Gin et al., 1991; Hamberger et al., 1992; Warshaw, 1997; Warshaw and Alpert, 1999). A history of sexual and physical abuse is common among female patients with functional gastrointestinal disorders and leads to increased rates of health care utilization and medically unexplained symptoms. However, these women rarely disclose this history unless they are asked directly (Leserman and Drossman, 1995; Leserman et al., 1998; Walker et al., 1995). Thus, it is important that physicians be able to ask about such a history comfortably and sensitively when appropriate. Physician education and the simple inclusion of a single question about domestic abuse during the patient interview can significantly improve the rates of recognition of this behavior (Freund et al., 1996; Kripke et al., 1998; Thompson et al., 2000).

Unintentional injuries. Another leading cause of death in the United States is accidents, which peak at ages 15–24 and then rise again after age 60 (NCHS, 2003a). Nearly half of all deaths among young people are related to motor vehicles, whereas falls are the leading cause of unintentional injuries among older people. Young men in particular are prone to unintentional injury, which is often related to high-risk behaviors and alcohol use (Holtzman et al., 2000).

Principles of Behavior Change

Mounting evidence indicates that primary care physicians can be effective in changing patient behavior by using a variety of techniques (Beresford et al., 1997; IOM, 2001b; Nawaz et al., 2000; Wadden et al., 1997; Walker et al., 1981). Often, however, physicians have not received training in such techniques and therefore cannot appreciate how theoretical concepts of behavior change can be operationalized through effective patient counseling. A number of conceptual



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