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Because unhealthy behaviors have been shown to predict premature mortality and quality of life is linked to chronic disease, it is plausible that there is a relationship between unhealthy behaviors and a patient's overall well-being.Baseline data from the Robert Wood Johnson Foundation's Prescription for Health initiative were used. Using various methods, 9 practice-based research networks collected common data about cigarette smoking, diet, exercise, and perceived physical and mental health from 5358 patients from 67 practices. Multilevel ordinal regression modeling was used to examine the relationship between risk behaviors and physical or mental unhealthy days.Smoking, unhealthy diet, and inactivity were associated with more self-reported unhealthy days after adjusting for clustering and significant covariates. Smoking was associated with increased odds of more unhealthy days (odds ratio [OR], 1.51; P < .0001), as was a poor diet (OR, 1.10; P < .0001). More exercise (OR, 0.96; P = .0005) was associated with decreased odds of physical or mental unhealthy days.Unhealthy patient behaviors were associated with increased odds of physical or mental unhealthy days, suggesting a further reason primary care clinicians should address behavior change with patients. Implementing a brief, 2-question, quality of life screening would target groups of primary care patients with a higher prevalence of unhealthy behaviors.