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Guidelines for adolescent preventive services

INTRODUCTION

The health status and health behaviors of adolescents have been monitored closely over the past decade [1,2]. Although improvement has been noted in certain indicators, compared with other age groups, adolescent health has failed to respond to the range of interventions developed for schools, communities, and the health system.

Unintentional injuries such as automobile crashes, intentional injuries such as homicide and suicide, and reproductive health issues such as unintended pregnancy and sexually transmitted infections remain the leading causes of adolescent morbidity and mortality. Alcohol and drug use contribute to many of these injuries and deaths. Over the past decade, obesity has become a major cause of adolescent morbidity and is a contributor to a dramatic increase in the number of youth with type 2 diabetes mellitus. The common denominator in this list is that most adolescent morbidity and mortality is related to personal behavior and, as such, is preventable.

The preventable nature of all of these conditions provides a clear mandate to pediatric health care providers. The challenge is to integrate preventive services into routine medical care. Practitioners can use clinic visits for routine examinations, such as preparticipation athletic evaluations and chronic disease management, to provide a range of preventive services. These clinical encounters offer an opportunity for early identification of risk behavior and disease, updating immunizations, and offering health guidance. Clinical preventive services are an adjunct to preventive interventions provided through schools and in the community.

PREVENTIVE SERVICE RECOMMENDATIONS FOR ADOLESCENTS

The purpose of preventive services is to reduce serious morbidity and premature mortality. Preventive services typically fall into four categories: screening, counseling to reduce risk, providing immunizations, and giving general health guidance. In addition, a recommendation for how frequently routine visits should occur usually is included. Various organizations have developed or revised guidelines that are designed to enable practitioners to identify and address specific health problems and behaviors that cause the greatest burden of suffering among adolescents:

  • The United States Preventive Services Task Force (USPSTF) — Guide to Clinical Preventive Services [3].
  • American Medical Association (AMA) — Guidelines for Adolescent Preventive Services (GAPS) 1994 [4].
  • American Academy of Family Physicians (AAFP) — Age Charts for Periodic Health Examinations (www.aafp.org) [5-7].
  • Maternal and Child Health Bureau (MCHB), US Public Health Services, and American Academy of Pediatrics (AAP) — Bright Futures: Guidelines for Health Care Supervision of Infants, Children, and Adolescents (www.brightfutures.org) [8,9].
  • American Academy of Pediatrics (AAP) — Recommendations for Pediatric Preventive Health Care 2007 [10].
  • Advisory Committee on Immunization Practices (ACIP) — Update of adolescent immunization 2006. These recommendations include vaccines for preventing human papillomavirus and meningococcal disease [11]. (See "Recommendations for the use of human papillomavirus vaccines" and "Meningococcal vaccines".)
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