U.S. adolescents receive suboptimal preventive counseling during ambulatory care

Ma, Jun; Wang, Yun; Stafford, Randall S.

doi:10.1016/j.jadohealth.2004.08.024

Cited by 113 publications

(85 citation statements)

References 28 publications

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“…Physicians and health care staff only reported providing counseling/education during 39% of "general medical/physical examination" adolescent visits. 45 The counseling/ education rates for exercise (22%) and STI/HIV screening (5%) were ϳ2 and 7 times lower, respectively, than rates reported in the Bethell et al 43 survey of adolescents enrolled in managed care, which suggests that discussions perceived to be counseling/education by adolescents may not be coded as counseling/education CPSs by providers.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 80%

“…30 During illnessrelated visits, rates of assessing immunization status (43%) and administering immunizations if eligible (23%) were substantially lower than well visits but were still higher than rates of providing some of the counseling CPSs during general medical visits. 30,45 Another survey of pediatricians and family physicians in 1999 showed that providers were more likely to assess immunization status of their younger adolescent patients (11-to 13-year-olds), when indicated, compared with older patients (19-to 21-year-olds); providers reported administering indicated vaccines to 96% and 77% of younger and older adolescents, respectively. 46 Taken together, these studies of adolescent health care services suggest that most adolescents have annual health care visits.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

“…Lack of knowledge about preventive care 49 Low levels of perceived susceptibility, severity, response efficacy, and self-efficacy 49 Confidential and private care 43,49,50 Underutilization of care (including access to care) 45,49 "Barrier" is defined as identified by Ն16% of physicians (range: 16%-74%).…”

Section: Challengesmentioning

confidence: 99%

See 2 more Smart Citations

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes. Pediatricians have a unique opportunity to influence adolescents and their families by helping young people build a strong foundation of good health that will continue into their adult lives.American Academy of Pediatrics (AAP) 1 D ELIVERING PREVENTIVE services to US adolescents* is a public health priority. 2,3 Although most US adolescents are healthy, millions of adolescents initiate behaviors and lifestyles that can adversely affect their immediate and long-term health. 4 Potentially modifiable adolescent behaviors include failure to use seat belts, unsafe operation of motor vehicles, carrying weapons, using alcohol and other drugs, unprotected sex, inactivity, and overeating. These behaviors are directly linked to injuries and death, as well as to sexually transmitted infections (STIs), unintended *The definition of "adolescent" differs across studies and organizations; in this report, an adolescent is a person aged 11 to 18 years, unless otherwise specified.www.pediatrics.org/cgi

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Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 80%

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

See 1 more Smart Citation

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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“…4 Even after the release of the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS) 5 and Bright Futures, 6 which recommend preventive health services for adolescents, few improvements have been observed in the counseling of male teenagers regarding the prevention of sexually transmitted infections (STIs) or HIV infection. 7,8 Furthermore, data from outpatient ambulatory medical records show that primary care providers are 3 times more likely to take sexual health histories from female than male patients and twice as likely to counsel female patients on the use of condoms. 9,10 Thus, it is important for primary care providers to have an understanding of what sexual/reproductive health care means for the male adolescent.…”

Section: Introductionmentioning

confidence: 99%

Male Adolescent Sexual and Reproductive Health Care

Marcell¹,

Wibbelsman²,

Seigel³

2011

Pediatrics

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Male adolescents' sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related to male adolescents' sexual and reproductive health care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations. Pediatricians should provide these services to male adolescent patients in a confidential and culturally appropriate manner, promote healthy sexual relationships and responsibility, and involve parents in age-appropriate discussions about sexual health with their sons. Pediatrics 2011;128:e1658-e1676

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“…Ma et al 13,14 used the National Ambulatory Medical Care Survey to investigate trends in diet and physical activity in adults and adolescents from 1992 to 2000. They found that there was a modest increasing trend in counseling for both adults and adolescents, but overall it was quite low.…”

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confidence: 99%

The Association of BMI Status With Adolescent Preventive Screening

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Guidelines ask providers to target adolescent diet and physical activity counseling by BMI status, but providers do not consistently provide this service and often rely on inspection alone versus calculating BMI percentile. WHAT THIS STUDY ADDS:This study investigated whether providers target adolescent preventive screening on the basis of BMI status, with a focus on overweight adolescents, given recent guidelines. The study is strengthened by the use of adolescent self-report versus relying on provider or parent report. abstract OBJECTIVE: To examine the relationship between BMI status (normal, overweight, and obese) and preventive screening among adolescents at their last checkup. METHODS:We used population-based data from the 2003-2007 California Health Interview Surveys, telephone interviews of adolescents aged 12 to 17 years with a checkup in the past 12 months (n ϭ 9220). Respondents were asked whether they received screening for nutrition, physical activity, and emotional distress. BMI was calculated from self-reported height and weight: (1) normal weight or underweight (Ͻ85th percentile); (2) overweight (85th-94th percentile); and (3) obese (Ͼ95th percentile). Multivariate logistic regression models tested how screening by topic differed according to BMI status, adjusting for age, gender, income, race/ethnicity, and survey year. RESULTS:Screening percentages in the pooled sample (all 3 years) were higher for obese, but not overweight, adolescents for physical activity (odds ratio: 1.4; P Ͻ .01) and nutrition (odds ratio: 1.6; screening did not differ P Ͻ .01). Stratified analysis by year revealed higher screening for obese (versus normal-weight) adolescents for nutrition and physical activity in 2003 and for all 3 topics in 2005. However, by 2007, screening did not differ according to BMI status. Overall screening between 2003 and 2007 declined for nutrition (75%-59%; P Ͻ .01), physical activity (74%-60%; P Ͻ .01), and emotional distress (31%-24%; P Ͻ .01). CONCLUSIONS:Obese adolescents receive more preventive screening versus their normal-weight peers. Overweight adolescents do not report more screening, but standards of care dictate increased attention for this group. These results are discouraging amid a rise in pediatric obesity and new guidelines that recommend screening by BMI status.

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U.S. adolescents receive suboptimal preventive counseling during ambulatory care

Cited by 113 publications

References 28 publications

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Male Adolescent Sexual and Reproductive Health Care

The Association of BMI Status With Adolescent Preventive Screening

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