To examine attitudes and practice patterns of primary care physicians in health promotion and to probe factors associated with active involvement, a nationwide cross-sectional postal questionnaire survey of randomly sampled Korean family physicians and internists was performed. The areas of health promotion examined were; smoking, alcohol consumption, stress, exercise, and diet. Overall response rate was 38.0% and an interview survey of sub-samples of non-responders found no differences in socio-demographic characteristics or survey results versus original responders, except for the rate of collecting information on smoking and diet. Smoking cessation was considered important by 92% of responders, while other lifestyle factors were considered important by less than 70%. Approximately 80% of responders believed in effectiveness of lifestyle counseling, except for stress. The frequency of collecting information, providing counseling, and the level of preparedness to undertake counseling were higher for smoking and alcohol than for other factors. Beliefs in effectiveness of health promotion and preparedness to undertake counseling were positively associated with frequency of information collection and providing counseling, even after adjusting for socio-demographic factors. Efforts should be made to change the physicians perception of effectiveness and importance of health promotion, and to improve physician's preparedness to actively intervene.