HME

Adolescent Health

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Adolescent Health, Teen Health, Health Maintenance in Adolescents, Young Adult Health Maintenance, SAFE TIMES Mnemonic

  • See Also
  1. Health Maintenance in Children
  2. Adolescent Athlete
  3. Adolescent Chemical Dependency
  4. CRAFFT Questionnaire
  5. Adolescent Depression
  6. Adolescent Development
  7. Hypertension in Adolescents
  8. Bullying
  9. Eating Disorder
  10. Electronic Media Use in Adolescents (Screen Time)
  11. Social Media Use in Adolescents
  12. Adolescent History (HEEADSSS Mnemonic)
  • Epidemiology
  1. Top Causes of Death among adolescents (72%)
    1. Motor Vehicle Accidents (26%)
      1. Texted or emailed while driving in nearly 40% of high school students (2017)
      2. Rode in a car with a driver who was drinking Alcohol in >16% of high school students (2017, prior month)
    2. Unintentional Injuries (17%)
      1. Weapon carried in >16% of high school students (2017, prior month)
      2. Non-hunting or sport related gun carried (2017, prior year)
    3. Homicide (16%)
    4. Suicide (13%)
    5. Eaton (2012) MMWR Surveil Summ 61(4): 1-162 [PubMed]
  2. Top causes of morbidity
    1. Sex related
      1. Currently sexually active in >28% and no Condom use in nearly half (in 2017)
      2. Unintended Pregnancy (42 per 1000 for ages 15-19 in 2008)
      3. Sexually Transmitted Disease
    2. Mental illness (20%)
      1. Suicide seriously considered in >17% and attempted in 17% (in 2017)
    3. Substance Abuse
      1. Alcohol used in nearly 30% in prior month (in 2017)
      2. Marijuana used in prior 30 days in nearly 20% (in 2017)
      3. Prescribed Opiates misused in 14% (in 2017)
      4. Tobacco Abuse in nearly 9% and Electronic Cigarette use in >13% (in 2017)
      5. Hard drug use (e.g. Cocaine, Heroin, Methamphetamine, Hallucinogens, ecstacy) in 14% (in 2017)
    4. Obesity (15%)
    5. Bullying (19%)
  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)
  • Approach
  • 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. Bullying
  • 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
  • History
  • Topics for Discussion at Adolescent Visit
  1. See Adolescent History (HEEADSSS Mnemonic)
  2. 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
  3. Confidentiality
    1. Strive for confidentiality but it is not guaranteed (e.g. EHR, Billing, test results)
    2. Discussion is documented in the medical record
      1. The medical record is confidential but clinic staff has access to medical records
    3. Appointment billing may reflect discussion topic
      1. Parents will receive 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
  • Resources
  • Screening Tools
  1. See Adolescent History (HEEADSSS Mnemonic)
  2. See CRAFFT Adolescent Chemical Dependency Screening
  3. Depression screening (e.g. PHQ-2, PHQ-9)
  4. Rapid Assessment of Adolescent Preventive Services (RAAPS)
    1. http://www.possibilitiesforchange.com/raaps/
  • 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
  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
  • Prevention
  1. Contraception
    1. Long-Acting Reversible Contraception are preferred (e.g. IUD, dermal implants)
    2. Diedrich (2015) Am J Obstet Gynecol 213(5): 662 [PubMed]
    3. Schmidt (2015) J Adolesc Health 57(4): 381-6 [PubMed]
  2. Cancer Prevention
    1. Cervical Cytology (Pap Smear) every 3 years between ages 21 to 29
      1. Pap Smear not indicated at age <21 years
    2. Skin Cancer
      1. Minimize exposure to UV radiation (esp. fair skin) and use Sunscreen
  3. Prevention of Sexually Transmitted Infection
    1. One half of all new Sexually Transmitted Infections occur in age <25 years
    2. Gonorrhea and Chlamydia Screening in sexually active patients <25 years old at least yearly
    3. HIV Screening in >15 years old (younger if risk factors)
    4. Syphilis Screening if risk factors
  4. Immunizations (e.g. Meningococcal Conjugate Vaccine, Human PapillomavirusVaccine)
  5. Family meals improves Teen Health and well-being
    1. Regardless of family connectedness
    2. Eisenberg (2004) Arch Pediatr Adolesc Med 158:792-6 [PubMed]
  6. Screen for Major Depression each year
    1. Start with PHQ-2, and if positive complete PHQ-9
  7. Drug use
    1. See CRAFFT Adolescent Chemical Dependency Screening
    2. Second-hand Tobacco smoke
    3. Nicotine is a "Gateway drug"
      1. Leads to use of Alcohol
      2. Leads to use of Marijuana
      3. Leads to use of Cocaine
    4. Adolescents experiment at earlier ages
    5. New Drugs of Abuse
      1. Dextromethorphan Abuse
      2. Dimenhydrinate (Dramamine, Gravol)
        1. Antiemetic
        2. Pharmacies now store it behind the counter
      3. Ecstasy (MMDA)
      4. Energy Drinks
      5. Gamma Hydroxybutyrate (GHB)
      6. Inhalants
      7. Ketamine
  • References
  1. Ham (2012) Am Fam Physician 86(12): 1109-6 [PubMed]
  2. Klein (2020) Am Fam Physician 101(3): 147-58 [PubMed]