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Screening in preventive care for adolescents.

Preventive health care has received increasing attention in the medical literature, with rational screening strategies replacing the once-valued annual physical examination. In adolescence, visits to the doctor may occur only for a school physical or an acute illness, and integration of preventive health services with medical care is especially important. Although a time of rapid physical and psychological development, adolescence is usually free of the severe acute illnesses of childhood and debilitating chronic conditions of adulthood. Societal changes, however, including the prolongation of teen dependency, have intensified behavioral problems of the adolescent period. The major health risks for US adolescents are behavioral. Up to 76% ofadolescent deaths in the United States are caused by accidents, homicide and suicide; the rate of adolescent suicide has tripled in the last 20 years. Adolescent pregnancy, sexually transmitted diseases and substance abuse, especially alcohol and cigarettes, adversely affect the health of adolescents. A rational approach to health screening for adolescents would systematically address their most significant risks for morbidity and mortality, not only in youth but also in adulthood. Health maintenance protocols for children and for adults, organized as checklists in medical charts, are familiar to most primary care physicians. This format can be an effective way to incorporate screening into routine clinical practice with adolescents (see Figure 1). Screening protocols generally are designed to identify persons at risk for future morbidity or to detect disease at a treatable or reversible stage. A good screening test is safe, easy to do, acceptable to patients and sensitive. An ideal test would also be inexpensive and would have few false positive results. Techniques that enhance communication between patient and provider can increase the sensitivity and specificity of screening for behaviorally-related conditions as well as the utilization by the patient of available preventive services in general. The value of early identification of such organic conditions as high blood pressure and cervical dysplasia is well established. The literature is less developed regarding screening and intervention for behavioral problems. Studies