The preteen visit: An opportunity for prevention

The Journal of Family Practice. 2006 December;55(12):1054-1056

December 1, 2006|Family Medicine

Updated vaccine guidelines for different age groups; USPSTF recommendations for other interventions.

If preteens do visit a physician more frequently, it will provide an opportunity for other health care maintenance interventions, such as measuring height, weight, and blood pressure and providing health education on diet, physical activity, and substance abuse. Unfortunately, the evidence base for the effectiveness of preventive interventions at this age is very weak.

TABLE 2 lists the interventions for the age group 11 to 12 years that have been evaluated by the US Preventive Services Task Force (USPSTF). This is not a comprehensive list of all possible preventive interventions for young adolescents, only those that have been evaluated by the USPSTF. Those with either an A (strongly recommend) or B (recommend) recommendation are screening tests related to risks involved with sexual activity and will not apply to all young adolescents. Some of those with a D recommendation (recommend against) will surprise many physicians, as they have historically been included in various screening guidelines.

TABLE 2
US Preventive Services Task Force recommendations on interventions for adolescents

Recommend for Screening for chlamydia in sexually active females Screening for gonorrhea in those at high risk Screening for HIV for those at high risk
Recommend Against Routine screening for scoliosis Routine screening for testicular cancer Routine screening for herpes simplex virus
Insufficient Evidence to Recommend For or Against Screening and counseling for alcohol abuse Screening for high blood pressure Screening for depression Screening for family violence Screening for gonorrhea and HIV if low risk Screening for tobacco use Screening for obesity and overweight Counseling about physical activity
Reports in Progress Screening for abuse of illicit drugs Counseling on avoidance of recreational injuries Prevention of youth violence

For more information

For a listing of vaccine components and contraindications see: www.cdc.gov/nip/recs/contraindications.htm

Vaccine information statements are found at: www.cdc.gov/nip/publications/VIS/default.htm#hpv

For a useful chart with information on all vaccines go to: www.cdc.gov/nip/vaccine/vac-chart-hcp.htm

General information on immunizations is on the CDC web site: www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm

The United States Preventive Services Task Force lists current recommendations, rationales, and clinical considerations at: www.ahrq.gov/clinic/uspstfix.htm

The bulk of the potential interventions are in the I category (insufficient evidence to recommend for or against) or are the subject of an ongoing evaluation. Many of these receive this rating not because the targeted behavior is in question but because it is unclear how effective physician counseling in a clinical encounter is in changing these behaviors—for example, avoidance of tobacco products and maintenance of ideal weight. Many providers will probably choose to provide young adolescents advice on these topics in spite of the meager evidence available.

CORRESPONDENCE
Doug Campos-Outcalt, MD, MPA, 4001 North Third Street #415, Phoenix, AZ 85012. E-mail: dougco@u.arizona.edu

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