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INTRODUCTION

This chapter offers a practical behavioral framework to assist those who provide health care to teenagers. Stages of adolescent development along with behavioral correlates are discussed, as are suggestions for effective patient–doctor communication, interviewing, and provision of health services. From a physiologic perspective, adolescence is the interval between the onset of puberty and the cessation of body growth. In psychosocial and behavioral terms, it is the time during which adult body image and sexual identity emerge; independent moral standards, intimate interpersonal relationships, vocational goals, and health behaviors develop; and the separation from parents takes place. Although some of these tasks may begin prior to puberty and evolve into adulthood, they provide the foundation for understanding adolescent behavior.

Health Status & Trends

Most teenagers are healthy. Compared with other age groups, mortality rates for teenagers are low. The majority of health problems in teenagers are behavior related and include unwanted pregnancy; sexually transmitted infections (STIs); weapon carrying; interpersonal violence; suicidal ideation; alcohol, cigarette, and illicit drug use including inappropriate use of prescription medications and various forms of opiates; and dietary and exercise patterns. Nationally, accidents are the leading cause of death for most populations of teenagers, although homicide (often gang related) leads in some geographic locations. Socioeconomic status and population density, rather than ethnic or racial grouping, define the neighborhoods most at risk for interpersonal violence-related death. The most common reasons for acute medical office visits for teenagers are routine or sports physicals, upper respiratory infections, and acne. One of the major challenges to a provider caring for teenagers is eliciting a history that reveals health-risk behaviors. Because most adolescent mortality and morbidity are preventable and because many behaviors such as sexual practices, diet, exercise, and substance use that result in adult disease begin in adolescence, ignoring this age group means missing a major public health opportunity.

In 1992, the American Medical Association published Guidelines for Adolescent Preventive Services (GAPS), the first set of developmentally and behaviorally appropriate comprehensive health care guidelines for adolescents. These guidelines remain the gold standard to this day. They emphasize anticipatory, preventive, and patient-centered services. Guidelines for Adolescent Preventive Services suggest that promotion of adolescent health and prevention of disease involve a partnership encompassing patients, parents, schools, communities, and health care providers. Although these guidelines have existed for several decades, and have been shown to be valuable as care standards and as quality measures, there is little evidence that they are being widely implemented.

Adolescent health outcomes—perhaps more than for any other population—are closely linked to cultural, educational, political, and economic policies at the local and national level. Guns and bullying are both relevant examples. For example, the availability of guns is not a problem that the health practitioner can resolve during an office visit, yet making them less available ...

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