Fewer than 50 percent of adolescent medical checkups include preventive health counseling, despite the demonstrated effectiveness of doctor-delivered advice in promoting healthy behavior as well as reducing risky behavior in teens.
These findings, from a Stanford University School of Medicine study, come more than a decade after the American Medical Association issued clear recommendations for yearly health counseling targeting teen smoking, unintended pregnancy and other preventable woes.
The results, published in the May issue of the Journal of Adolescent Health, come from the first national review of trends in an array of teen health counseling services. The study focused on outpatients aged 13-18.
"When we look at the services these adolescents are receiving, we simply find they are not receiving many services that are strongly recommended," said co-author Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center.
Among the significant findings were:
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Teens were most likely to be counseled on diet and exercise: About one-quarter of all checkups included these health-promoting discussions.
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Skin cancer was least likely to come up: About 3 percent of teens' checkup visits mentioned the dangers of sun worship.
- About 5 percent of all checkups included counseling related to HIV and other sexually transmitted diseases. The rate for family planning discussions was about 8 percent.
The study also found the most common reason for teen girls' medical visits was prenatal care, and the most common diagnosis was pregnancy. "That's really alarming," especially in light of the low counseling rates for sexual behaviors, said lead author Jun Ma, MD, RD, PhD, research associate at the Stanford Prevention Research Center.
Ma and Stafford, along with statistician Yun Wang, examined health services teens received during almost 337 million outpatient visits between 1993 and 2000, as reported in two national databases from the National Center for Health Statistics. One dataset reported health-care services provided by office-based physicians; the other documented visits to hospital outpatient departments.
Ma said the teen counseling rates are much lower than the research team expected, based on the clear guidelines for regular preventive counseling. "We know adolescence is a key transition stage," she said.
"Research is clear that adolescents are at risk for adopting health-compromising behaviors." At the same time, research shows teens tend to trust doctors' advice. So physician visits offer a valuable opportunity to nudge adolescents towards healthy behaviors.
In 1992, the AMA called for a shift from teen crisis intervention to problem prevention, and it issued specific guidelines for clinical practice. It recommended, for example, that teens receive yearly guidance on diet and exercise, sexual behaviors, substance abuse, and injury reduction. To help implement the guidelines, it issued questionnaires for clinicians to use with teens: "Do you eat fruits and vegetables every day?" "Have you ever used marijuana?"