Smoking, nutrition, alcohol, physical activity (SNAP)

☰ Table of contents

This guide has been designed to assist general practitioners (GPs) and practice staff (the GP practice team) to work with patients on the lifestyle risk factors of smoking, nutrition, alcohol and physical activity (SNAP). Organisations working with general practices, such as primary care organisations, public health services and other agencies that provide resources and training for primary healthcare staff, may also find this guide valuable.

The SNAP guide covers:

  • why these risk factors are important and why general practice is a key location to influence SNAP risk factor behaviour in adults
  • how to assess whether a patient is ready to make lifestyle changes
  • a five-step model, the 5As (ask, assess, advise, assist, arrange), for detection, assessment and management of SNAP risk factors
  • effective clinical strategies for SNAP risk factors (including overweight and obesity) using the 5As model
  • establishing the business case for assessing and managing lifestyle-related risk factors in the general practice setting
  • practical business strategies to apply the SNAP approach to general practice
  • useful resources, tools and referral services.

The SNAP guide does not specifically examine risk factors in children and adolescents.

Development of the SNAP guide

The SNAP guide is based on the best available evidence at the time of publication. It adopts the most recent National Health and Medical Research Council (NHMRC) levels of evidence and grades of recommendations. Recommendations in the tables are graded according to levels of evidence and the strength of recommendation. The levels of evidence are coded by the roman numerals I–IV, while the strength of recommendation is coded by the letters A–D. Practice points (PP) are employed where no good evidence is available.

Further information on preventive care in general practice can be found in the RACGP’s Guidelines for preventive activities in general practice (8th edition) (the Red book).

Table 1. Coding scheme used for levels of evidence and grades of recommendation

Levels of evidence




Evidence obtained from a systematic review of level II studies


Evidence obtained from a randomised controlled trial (RCT)


Evidence obtained from a pseudo-RCT (ie alternate allocation or some other method)


Evidence obtained from a comparative study with concurrent controls:

  • non-randomised, experimental trial
  • cohort study
  • case-control study
  • interrupted time series with a control group.


Evidence obtained from a comparative study without concurrent controls:

  • historical control study
  • two or more single arm study
  • interrupted time series without a parallel control group.


Case series with either post-test or pre-test/post-test outcomes

Practice point

Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

Grades of recommendations




Body of evidence can be trusted to guide practice


Body of evidence can be trusted to guide practice in most situations


Body of evidence provides some support for recommendation(s) but care should be taken in its application


Body of evidence is weak and recommendation must be applied with caution