April 22, 2005
Teens Don’t Get Health Counseling They Need
Study finds little discussion of topics such as HIV, skin cancer
HealthDay News -- Teens aren't getting the preventive health counseling they need.A new study found that less than half of medical check-ups for adolescents included advice from the doctor on promoting healthy behaviors and reducing risky ones, despite evidence that this type of counseling works.
Only 5 percent of outpatient visits included discussion of HIV and other sexually transmitted diseases, yet teenaged girls visited doctors most frequently for pregnancy and prenatal care.
The information is particularly alarming, given that risky health behaviors in this age group remain high. More than a year ago, the American Medical Association tried to address this phenomenon by issuing recommendations that adolescents be counseled annually on issues such as smoking and unplanned pregnancies.
"Every year, we say that kids need counseling but we're still not able to increase the number of kids that do get counseling," said Dr. Sue Ellen Abdalian, head of adolescent medicine in the department of pediatrics at Tulane University School of Medicine in New Orleans. "There's no change in the trend, which is a little disheartening."
Abdalian was not involved in the study, which appears in the May issue of the Journal of Adolescent Health.
The teen years are critical ones, as the groundwork for future health problems (for example, obesity and its attendant risks) can be laid at this time. Other behaviors, such as violence and unsafe sex, cause more immediate problems.
"Most of the morbidity and mortality in the United States does originate at this time," Abdalian said. "We do know that kids listen to doctors. Even though they may not change their behavior immediately, it's still filed away. If they get reinforcement from the community, from public-service announcements, from schools, friends, we know that they listen better because the doctor already told them, or vice versa."
The authors of the new study used data on outpatient visits by 13- through 18-year-olds at doctors' offices and hospitals from two large national databases. They looked specifically at the patients' likelihood of being counseled in three health-promotion areas -- diet, exercise and growth/development -- and five risk-reduction topics -- smoking, skin cancer, injury prevention, contraception and transmission of sexually transmitted diseases, including HIV.
"This is the first study that we're aware of that tracks long-term trends over time," said study author Dr. Jun Ma, director for program prevention outcomes and practices at the Stanford University School of Medicine's Prevention Research Center.
In general, teens had the lowest rate of outpatient visits compared to other age groups, with rates particularly low for boys and ethnic minorities. In 2000, adolescents made 1.9 visits per capita, compared with 8.5 visits per capita for infants, 2.4 for children, and 6.1 for adults 65 and over.
Boys were most likely to see a doctor for sore throats, upper respiratory tract infections and acne, while girls most often went for pregnancy and prenatal care.
Between 1997 and 2000, 39 percent of all teen outpatient visits included counseling. The most frequent topics discussed were diet (included in 26 percent of visits) and exercise (included in 22 percent of visits). The average check-up lasted about 16 minutes.
Skin cancer was discussed the least often (3 percent of visits), followed by HIV/STD counseling (5 percent of check-ups) and family planning (8 percent).
The problem likely originates on a variety levels, the researchers said. "There are probably several breakdowns from the health-care system to the physicians to the patients," Ma said.
Health care for teens is also highly fragmented, Ma pointed out, with individuals in this age group getting care at school, from their own doctor, and at community-based clinics.
"It's not just physicians who are the source of primary care for this population and a lot of times the multiple systems do not have information exchange among themselves," she said. "Sometimes physicians assume that adolescents have already gotten preventive services from other systems."
Time constraints also contribute to the lack of counseling. "Everyone is pressed for time, including parents," Abdalian added. "They often feel the constraints of bringing kids back for another 16-minute visit."
Changes throughout the health-care system, such as updated information sharing technology, would likely be effective, Ma said.
Visit the American Medical Association for more on adolescent health.