Health Care of the Adolescent ~ Articles2day.Org

Health Care of the Adolescent
M. Rosa Solorio and Nancy G. Steven

Adolescents are the only age group in the United States whose health status has not improved over the past 30 years.1 In fact, 15- to 24-year-olds were the only age group in which mortality showed a marked increase between 1960 and 1980.2

Risky personal health choices are especially common among adolescents. One-third of high school seniors smoke regularly; one-fifth are smoking by age 11. By age 15 more than one-third of adolescents have been intoxicated; nine of ten seniors have used alcohol, two-thirds to excess. By age 18 one-fourth of young women have been pregnant. One-fourth of high school students have seriously considered suicide. Twenty-five percent of human immunodeficiency virus (HIV) infections are estimated to have been contracted during adolescence. Fifty percent of adolescent deaths are due to homicides, suicides, or motor vehicle accidents. Most adolescent morbidity and mortality are preventable, but the relative effectiveness of physician-based and community-based interventions is not clear.

More than 70% of adolescents are seen by a physician annually, on average making three visits per year.3 Adolescents generally view physicians as credible and valued sources of health-related information.4 Because most adolescent visits are to primary care providers, family physicians are in an excellent position to promote adolescent health. The National Ambulatory Medical Care Survey (NAMCS) found that a general medical or physical examination (including sports physical examinations) was the most frequent reason adolescents visited physician offices in 1990. Routine prenatal care examination was the most frequent reason for older adolescents visiting physicians. Although 15% of physician office visits by adolescents could be considered for health supervision, few visits include preventive services or anticipatory guidance.

From NAMCS, health promotion counseling, HIV counseling, instruction on breast self-examination, and advice on cholesterol reduction were each provided in fewer than 2% of adolescent visits.

The American Medical Association Department of Adolescent Health, with the assistance of a scientific advisory board, developed and published Guidelines for Adolescent Preventive Services (GAPS).5 The GAPS report is the first comprehensive set of recommendations for adolescent preventive strategies. It comprises 24 recommendations in four general areas: (1) health care delivery; (2) health guidance; (3) screening; and (4) immunizations. Physician-based interventions are strongly recommended in all categories including annual counseling visits with physicians for all adolescents.

Most of the data presented in GAPS are derived from community-based interventions (i.e., gun control, seat belt and helmet laws, and curfew regulations), or are based on expert opinion only.5 Whether an individual physician can effect the desired changes in personal health practices that lead to most morbidity and mortality in adolescents is not known. Before GAPS' comprehensive recommendations for preventive adolescent health care are adopted, more research is needed to develop and test prevention strategies in typical office settings. In the meantime, physicians can assist their communities by providing leadership on important topics affecting adolescent health, such as smoking or other substance abuse and injury prevention.

Source: http://www.articles2day.org/2012/08/health-care-of-adolescent.html

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