Does Delivering Preventive Services in Primary Care Reduce Adolescent Risky Behavior?

Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California 94118, USA.
Journal of Adolescent Health (Impact Factor: 3.61). 11/2011; 49(5):476-82. DOI: 10.1016/j.jadohealth.2011.02.011
Source: PubMed


To determine whether the delivery of preventive services changes adolescent behavior. This exploratory study examined the trajectory of risk behavior among adolescents receiving care in three pediatric clinics, in which a preventive services intervention was delivered during well visits.
The intervention consisted of screening and brief counseling from a provider, followed by a health educator visit. At age 14 (year 1), 904 adolescents had a risk assessment and intervention, followed by a risk assessment 1 year later at age 15 (year 2). Outcomes were changes in adolescent behavior related to seat belt and helmet use; tobacco, alcohol, and drug use; and sexual behavior. Analysis involved age-related comparisons between the intervention and several cross-sectional comparison samples from the age of 14-15 years.
The change in helmet use in the intervention sample was 100% higher (p < .05), and the change in seat belt use among males was 50% higher (p = .14); the change in smoking among males was 54% lower (p < .10), in alcohol use was no different, and in drug use was 10% higher (not significant [NS]); and the change in rate of sexual intercourse was 18% and 22% lower than cohort comparison samples (NS).
The intervention had the strongest effect in the area of helmet use, shows promise for increasing seat belt use and reducing smoking among male adolescents, and indicates a nonsignificant trend toward delaying the onset of sexual activity. Participation in the intervention seemed to have no effect on the rates of experimentation with alcohol and drugs between the ages of 14 and 15 years.

Download full-text


Available from: Andrea K Garber
  • Source
    • "Current guidelines include screening for tobacco use as a part of routine health care; asking about tobacco use among patients' families and friends; educating about health risks; and providing cessation counseling for those patients who use cigarettes or other tobacco products [9e12]. Recent evidence suggests that brief, preventive counseling with a primary care provider shows promise for decreasing adolescent risk behaviors, including smoking [13]. Although e-cigarettes, as a relatively new product, are not explicitly mentioned in current guidelines, knowledge about these nicotine-containing devices is important for providers who wish to deliver comprehensive tobacco-related counseling to their patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery systems that may serve as a "gateway" to tobacco use by adolescents. Use of e-cigarettes by U.S. adolescents rose from 3% in 2011 to 7% in 2012. We sought to describe healthcare providers' awareness of e-cigarettes and to assess their comfort with and attitudes toward discussing e-cigarettes with adolescent patients and their parents. A statewide sample (n = 561) of Minnesota healthcare providers (46% family medicine physicians, 20% pediatricians, and 34% nurse practitioners) who treat adolescents completed an online survey in April 2013. Nearly all providers (92%) were aware of e-cigarettes, and 11% reported having treated an adolescent patient who had used them. The most frequently cited sources of information about e-cigarettes were patients, news stories, and advertisements, rather than professional sources. Providers expressed considerable concern that e-cigarettes could be a gateway to tobacco use but had moderately low levels of knowledge about and comfort discussing e-cigarettes with adolescent patients and their parents. Compared with pediatricians and nurse practitioners, family medicine physicians reported knowing more about e-cigarettes and being more comfortable discussing them with patients (both p < .05). Nearly all respondents (92%) wanted to learn more about e-cigarettes. Healthcare providers who treat adolescents may need to incorporate screening and counseling about e-cigarettes into routine preventive services, particularly if the prevalence of use continues to increase in this population. Education about e-cigarettes could help providers deliver comprehensive preventive services to adolescents at risk of tobacco use.
    Full-text · Article · Nov 2013 · Journal of Adolescent Health
  • Source
    • "Promising strategies for intervening with emotional and behavioural problems in young people have employed both cognitive-behavioural and motivational enhancement approaches [29,30,33]. Cognitive-behavioural strategies include education, advice, information about risk taking in peers, which is usually lower than young people think, and skills to refuse participation in risky behaviour [30,34]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. METHODS: PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff's self-perceived competency in young people's care and clinicians' detection and response to risk taking behaviours and emotional distress in 14-24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people were interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation. DISCUSSION: The PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months. Trial registration ISRCTN16059206 Key Words Young people, health risks, screening, motivational interviewing, emotional distress, primary care, health outcomes.
    Full-text · Article · Jun 2012 · BMC Public Health
  • Source
    • "This is especially relevant given the adverse health consequences of initiation of substance use in early adolescence, in combination with the fact that many adolescents start using substances in their early teens (Hibell et al. 2009; Monshouwer et al. 2008). Although recent preliminary evidence has shown that preventive intervention efforts may reduce adolescents’ risk behavior (Ozer et al. 2011), among which includes substance use, the present results indicate that significant gains can be achieved in clinical cost-effectiveness, by tailoring such prevention efforts–for example, in terms of intensity, duration, or specific methodology employed–to the exact needs of a subgroup based on their personality dimension. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Various studies found personality to be related to substance use, but little attention is paid to the role of personality risk dimensions with regard to an early onset of alcohol, tobacco, and marijuana use. Therefore, the current study used a variable-centered approach to examine whether anxiety sensitivity, hopelessness, sensation seeking, and impulsivity predict the onset of alcohol, tobacco, and marijuana use in early adolescence. Additionally, we adopted a person-centered approach to examine whether different personality subgroups could be identified, and whether these subgroups would be predictive of substance use. For that purpose, longitudinal data of a broader effectiveness study were used from 758 early adolescents (53 % female) aged 11-14 years. Structural equation models showed that hopelessness and sensation seeking were predictive of having ever used alcohol and tobacco. Also, sensation seeking was predictive of marijuana use. Latent profile analyses on the first wave data revealed a three-profile solution for boys (i.e., resilients, internalizers, and externalizers) and a two-profile solution for girls (i.e., resilients and internalizers). In contrast to our expectation, further analyses revealed no significant differences in substance use between the different subprofiles for both boys and girls. The separate personality dimensions thus seem more relevant in predicting the onset of substance use compared to the personality profiles. However, the personality profiles might be informative in explaining more excessive substance use behaviors.
    Full-text · Article · May 2012 · Journal of Youth and Adolescence
Show more