II. Epidemiology

  1. Top Causes of Death among adolescents (72%)
    1. Motor Vehicle Accidents (26%)
    2. Unintentional Injuries (17%)
    3. Homicide (16%)
    4. Suicide (13%)
    5. Eaton (2012) MMWR Surveil Summ 61(4): 1-162 [PubMed]
  2. Top causes of morbidity
    1. Unintended Pregnancy (42 per 1000 for ages 15-19 in 2008)
    2. Sexually Transmitted Disease
    3. Mental illness (20%)
    4. Obesity
  3. Health Care Delivery
    1. Acute Episodic Visit
      1. Most frequent reason for Adolescent Health care
    2. Chronic medical conditions in 10% of adolescents
      1. Diabetes Mellitus
      2. Asthma
      3. Allergies
      4. Seizure disorder
      5. Cystic Fibrosis
      6. Congenital Heart Disease
      7. Inflammatory Bowel Disease
      8. Juvenile Rheumatoid Arthritis
      9. Hemophilia
      10. Cancers (especially Leukemia)

III. History: Parental Involvement

  1. Prepare parents for autonomy
    1. Private appointments with adolescent alone
    2. Confidentiality (see below)
  2. Enlist parents to assist with questionnaire
    1. Family History of three generations
    2. Social history
    3. Home environment
    4. Family transitions
  3. Encourage adolescent to prepare concerns for visit
    1. Mental health
    2. Nutrition
    3. Conflict Management
    4. Autonomy and independence
    5. Achievements and challenges
    6. School reports
    7. School conferences
  4. Ask parents
    1. How are they doing in school?
    2. What do they do after school?
      1. Most common time for high risk behavior
    3. Have you clearly defined expected behavior?
  5. Other measures
    1. Parent intervention program reduces risky behaviors
      1. Stanton (2004) Arch Pediatr Adolesc Med 158:947-55 [PubMed]
  6. References
    1. Breuner (2003) AAFP Board Review, Seattle

IV. History: Topics for Discussion at Adolescent Visit

  1. Approach
    1. Assess the patient's specific ability to understand risky behavior consequences
      1. See Adolescent Development
    2. Assess parent's role
    3. Clarify confidentiality expectations (see below)
    4. Meet with adolescent alone if possible
      1. Bring up sensitive topics (e.g. Tobacco, Alcohol, drugs, sex)
    5. Personalize risk-reduction guidance and leverage the physician-patient relationship
  2. Confidentiality
    1. Strive for confidentiality but it is not guaranteed
    2. Discussion is documented in the medical record
      1. The medical record is confidential but
      2. Clinic staff has access to medical records
    3. Appointment billing may reflect discussion topic
      1. Parents will recieve invoice (e.g. Contraception)
      2. Consider alternative payment options
        1. Adolescent set-up with own private account
        2. Planned parenthood for Contraception
    4. Four topics mandate reporting
      1. Physical abuse
      2. Sexual abuse
      3. Homicidal Thoughts
      4. Suicidal thoughts
  3. Mnemonic: SAFE TIMES
    1. Sexuality issues
      1. Unintended Pregnancy
      2. Sexually Transmitted Disease
    2. Affect (depression) and abuse (drugs)
      1. See Adolescent Depression
      2. See CRAFFT Questionnaire
    3. Family (function and medical Family History)
    4. Exam (sensitve and appropriate)
    5. Timing of development (body image)
    6. Immunizations
      1. HPV Vaccine (GardasilVaccine)
      2. Meningococcal Vaccine (Menactra, Menveo)
      3. Tdap Vaccine (Adacel)
      4. Influenza Vaccine
    7. Minerals (nutritional issues)
    8. Education and employment (school and work issues)
    9. Safety
      1. Seat Belts
      2. Sport helmets (bike, skiing)
      3. Weapons
  4. Drug use
    1. Second-hand Tobacco smoke
    2. Nicotine is a "Gateway drug"
      1. Leads to use of Alcohol
      2. Leads to use of Marijuana
      3. Leads to use of Cocaine
    3. Adolescents experiment at earlier ages
    4. New Drugs of Abuse
      1. Dimenhydrinate (Dramamine, Gravol)
        1. Antiemetic
        2. Pharmacies now store it behind the counter
      2. Ecstasy (MMDA)
      3. Gamma Hydroxybutyrate (GHB)
      4. Ketamine

V. Risk Factors: Higher Risk Behaviors

  1. Drugs and Alcohol use
  2. Sexual behavior
  3. School performance
  4. Peer pressure
  5. Diet and Physical Activity
  6. Socioeconomic status
  7. Parental relationships

VI. Risk Factors: Teenage Pregnancy associated with Infant risks:

  1. Poor Prenatal Care (reluctance to seek care)
  2. Poor nutrition leads to Intrauterine Growth Retardation
  3. Smoking (one-third of pregnant teens)
  4. Use of Illicit Drugs
  5. Associated Sexually Transmitted Diseases
  6. Poor parenting skills

VII. Prevention

  1. Contraception
  2. Prevention of Sexually Transmitted Infection
  3. Immunizations (e.g. Meningococcal Conjugate Vaccine, Human PapillomavirusVaccine)
  4. Family meals improves Teen Health and well-being
    1. Regardless of family connectedness
    2. Eisenberg (2004) Arch Pediatr Adolesc Med 158:792-6 [PubMed]

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Ontology: Adolescent Health (C1456717)

Concepts Group Attribute (T102)
English Adolescent health, Adolescent Health